Management of epididymo-orchitis in primary care: results from a large UK primary care database

Background Epididymo-orchitis is a common urological presentation in men but recent incidence data are lacking. Guidelines for management recommend detailed investigation and treatment for sexually transmitted pathogens, such as Chlamydia trachomatis. Data from secondary care indicate that these guidelines are poorly followed. It is not known how epididymo-orchitis is managed in UK general practice. Aim To estimate the incidence of cases of epididymo-orchitis seen in UK general practice, and to describe their management. Design of study Cohort study. Setting UK general practices contributing to the General Practice Research Database (GPRD). Method Men, aged 15-60 years, consulting with a first episode of epididymo-orchitis between 30 June 2003 and 30 June 2008 were identified. All records within 28 days either side of the diagnosis date were analysed to describe the management of these cases (including location) and to compare this management with guidelines. Results A total of 12 615 patients with a first episode of epididymo-orchitis were identified. The incidence was highest in 2004-2005 (25/10 000) and declined in the later years of the study. Fifty-seven per cent (6943) of patients were managed entirely within general practice. Of these, over 92% received an antibiotic, with ciprofloxacin being the most common one prescribed. Only 18% received a prescription for doxycycline. Most men, including those under 35 years, had no investigation recorded and fewer than 3% had a test for chlamydia. Conclusion These results indicate low rates of specific testing and treatment for sexually transmitted infections in males who attend general practice with symptoms of epididymo-orchitis. There is a need for further research to understand the pattern of care delivered in general practice

Management of first-episode pelvic inflammatory disease in primary care: results from a large UK primary care database

Background Prompt and effective treatment of pelvic inflammatory disease (PID) may help prevent long-term complications. Many PID cases are seen in primary care but it is not known how well management follows recommended guidelines. Aim To estimate the incidence of first-episode PID cases seen in UK general practice, describe their management, and assess its adequacy in relation to existing guidelines. Design of study Cohort study. Setting UK general practices contributing to the General Practice Research Database (GPRD). Method Women aged 15 to 40 years, consulting with a first episode of PID occurring between 30 June 2003 and 30 June 2008 were identified, based on the presence of a diagnostic code. The records within 28 days either side of the diagnosis date were analysed to describe management. Results A total of 3797 women with a first-ever coded diagnosis of PID were identified. Incidence fell during the study period from 19.3 to 8.9/10 000 person-years. Thirty-four per cent of cases had evidence of care elsewhere, while 2064 (56%) appeared to have been managed wholly within the practice. Of these 2064 women, 34% received recommended treatment including metronidazole, and 54% had had a Chlamydia trachomatis test, but only 16% received both. Management was more likely to follow guidelines in women in their 20s, and later in the study period. Conclusion These analyses suggest that the management of PID in UK primary care, although improving, does not follow recommended guidelines for the majority of women. Further research is needed to understand the delivery of care in general practice and the coding of such complex syndromic conditions

Initial list of indicator markers for early inflammatory arthritis across different clinical domains, based on round-table clinical discussions.

*<p>these markers were selected for initial searches.</p

Indicator marker groups.

<p>Indicator marker groups.</p

Prevalence of indicator markers during study period.

<p>Prevalence of indicator markers during study period.</p

Data types contributing to characterisation of a clinical entity.

<p>Data types contributing to characterisation of a clinical entity.</p

Schematic model of the GPRD database.

<p>Schematic model of the GPRD database.</p

<i>A priori</i> and <i>a posteriori</i> strategies for developing code lists.

<p><i>A priori</i> and <i>a posteriori</i> strategies for developing code lists.</p

Frequency of combinations of indicator markers.

<p>Frequency of combinations of indicator markers.</p

Survival curves for selected indicator markers in the 3

<p> <b>years preceding RA diagnosis, by gender.</b></p