Urological emergencies in general practiceBMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7049.112a (Published 13 July 1996) Cite this as: BMJ 1996;313:112
Simple test diagnoses or excludes epididymo-orchitis
- Dermot Murray
- Consultant in genitourinary medicine William Donald Clinic, Department of Genitourinary Medicine, Derbyshire Royal Infirmary NHS Trust, Derby DE1 2QY
EDITOR,—Chris Dawson and Hugh Whitfield state that the differential diagnosis of torsion of the testis includes epididymo-orchitis.1 A simple clinical test will diagnose or exclude epididymo-orchitis; most cases occurring between the ages of 20 and 40 are secondary to sexually acquired urethritis.
The patient should be instructed to perform a two glass test. The first 40-50 ml of urine to be voided should be caught in the first container, and the residue should be caught in the second container. If the patient has urethritis the first voided urine will be turbid and cloudy, whereas the residual urine will be clear. If this is the case the patient should be referred to the local department of genitourinary medicine for testing for Neisseria gonorrhoea and Chlamydia trachomatis. Gonorrhoea may be detected shortly after a two glass test,2 but non-specific urethritis may be missed unless time is allowed to elapse between urination and urethral evaluation (DM, international conjoint sexually transmitted diseases meeting, Montreal, 17-21 Jun 1984).3 This simple test, and advice to the patient, can prevent unnecessary surgery.