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assess inflammation/infection is the two-glass pre- and post-massage cases of suspected sexually transmitted pathogens, a therapeutic
test (PPMT). The PPMT has good concordance with the four-glass test regimen that covers both of these pathogens is mandatory.
for the initial evaluation.
27
The PPMT is therefore a reasonable
alternative when EPS cannot be obtained or when microbiological Antibiotic resistance in N. gonorrhoeae has increased dramatically over
assistance is not available, because EPS – due to its usually small the last few years. The World Health Organization (WHO) surveillance of
volume – has to be processed and plated immediately. antibiotic resistance in N. gonorrhoeae in the Western Pacific Region,
carried out in 2005, revealed up to 100% resistance to penicillins and
Antibiotic treatment is warranted only if CBP has been detected quinolones and up to 80% resistance to tetracyclines in some countries.
28
in a suitable localisation study; the treatment period is approximately four Penicillin- and fluoroquinolone-resistant strains have already reached
weeks. The agents of choice are the fluoroquinolones because western countries. The Centers for Disease Control and Prevention (CDC)
of their excellent pharmacokinetic properties within the prostate. has adapted to this resistance trend and now recommends ceftriaxone at
Prostatitis due to P. aeruginosa or enterococci often fails to respond to a rather low single intramuscular dose of 125mg for treatment of acute
treatment. Increasing fluoroquinolone resistance among enterobacteria urethritis and 250mg for the treatment of epididymitis as the first-line
also leads to increasing treatment failure. In the case of CBP due to agent for the treatment of acute urethritis and epididymitis caused by N.
fluoroquinolone-resistant strains, prolonged treatment with cotrimoxazole gonorrhoeae.
29
Additional treatment of non-gonococcal agents is also
for two to three months is recommended for susceptible pathogens. recommended; here, a tetracycline agent can be used.
29
Urethritis and Epididymitis Conclusion
The microbiological diagnosis of acute infectious urethritis and Antibiotic resistance is an increasing problem in all urological
acute epididymitis must be made as specifically as possible. A infections. Both uncomplicated and complicated, and especially
urethral Gram stain, urine culture and other studies, such as nosocomial, uropathogens may exhibit resistance to multiple antibiotics
amplification techniques, for the identification of N. gonorrhoeae and and pose problems for empirical therapy. In particular, N. gonorrhoeae
C. trachomatis should be obtained for all patients. with high resistance rates against various antibiotics has been seen
much more frequently in the last few years in sexually transmitted
In both infections antimicrobial agents should be chosen for initial diseases such as urethritis and epididymitis. In order to choose the right
empirical treatment based on the probability of the aetiological agent. antibiotic for empirical therapy it is necessary to consider the bacterial
Acute infectious urethritis is almost always a sexually transmitted disease spectrum and the local antibiotic susceptibility of the uropathogens. To
caused by N. gonorrhoeae and/or C. trachomatis. In acute epididymitis, combat the development of antibiotic resistance, a basic understanding
sexually transmitted pathogens and pathogens causing complicated UTIs of antibiotic action and resistance mechanisms is helpful. The rate of
are aetiological agents. Young sexually active men with acute antibiotic resistance will possibly continue to increase. Strategies to
epididymitis are at risk of C. trachomatis or N. gonorrhoeae, while older combat this trend, such as antibiotic policies, will need to be developed
men more frequently harbour pathogens seen in complicated UTIs. In and incorporated into urological praxis. ■
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