Suppurative epididymo-orchitis in young "high risk" patients--a new problem?

During a 4-year period we have treated 3 young patients with severe epididymo-orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of "high risk" activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV-positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure. Investigations for atypical pathogens should be performed when young patients present with refractory epididymo-orchitis. These patients should also be counselled with regard to HIV testing.