⚠️ Testicular pain is a common emergency presentation. Always first consider testicular torsion — a surgical emergency requiring urgent referral when suspected. Prompt assessment is critical, as the window for testicular salvage is narrow. :contentReference[oaicite:1]{index=1}

🦠 Causes

👉 Epididymitis:
- Bacterial (UTI organisms: E. coli, Klebsiella, Proteus)
- STIs in sexually active men (Chlamydia, Gonorrhea)
- Urinary reflux (e.g., posterior urethral valves in children)
- Trauma to the scrotum
👉 Orchitis:
- Viral (e.g., mumps orchitis in unvaccinated individuals)
- Bacterial – often part of epididymo‑orchitis
👉 Testicular torsion (emergency): sudden, severe pain with absent cremasteric reflex.
👉 Torsion of testicular appendage: may present similarly but is less urgent
👉 Other: trauma, tumour, hernia — consider if appropriate

🤒 Clinical Features

👉 Epididymitis:
- Gradual onset scrotal pain and swelling
- Red, warm, tender epididymis (pain may radiate to groin/abdomen)
- ± Fever, dysuria if UTI/STI‑related
👉 Orchitis:
- Testicular pain and swelling; may follow systemic viral symptoms
- Tender erythematous testis
- Mumps orchitis often occurs days after parotitis
👉 Testicular torsion:
- Sudden severe unilateral pain; nausea/vomiting may occur
- High‑riding, tender testis, absent cremasteric reflex
- Negative Prehn’s sign does NOT reliably exclude torsion

Per NICE CKS, a diagnosis of testicular torsion should be suspected in any person presenting with acute scrotal pain and/or swelling before considering other causes.

🔬 Investigations

📉 Spirometry: (Not applicable here — focus on scrotal assessment)
📊 Clinical exam: must include palpation of testis position, tenderness, cremasteric reflex
🧲 Urinalysis & STI screen: in cases suspected of epididymitis/orchitis
🖥️ Scrotal Doppler ultrasound: only if not delaying urgent surgical referral when torsion is suspected, and useful to confirm blood flow where torsion is unclear

💊 Management

👉 Suspected Testicular Torsion:
- Urgent referral to on‑call urology/surgical team — do not delay for imaging in high‑suspicion cases
- Analgesia provided while arranging urgent transfer
👉 Epididymitis / Epididymo‑orchitis:
- Rest, scrotal support, analgesia (NSAIDs ± paracetamol)
- Empirical antibiotics guided by STI risk (e.g., ceftriaxone + doxycycline) or UTI features
- Partner notification and STI testing where appropriate
👉 Orchitis (viral): supportive care; mumps orchitis does not require antivirals but may need ENT or public health advice

📌 Key exam tip: Testicular torsion = **sudden onset**, surgical emergency with absent cremasteric reflex. Epididymitis = **gradual onset**, often with urinary/STI features. Orchitis = testicular inflammation, may follow viral symptoms. Always **rule out torsion first** and refer urgently if suspected. 🚨

📚 NICE References

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Epididymitis and Orchitis (Children) (NICE Compliant)

🦠 Causes

🤒 Clinical Features

🔬 Investigations

💊 Management

📚 NICE References

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