Enteric Infections and Testicular Pain

Diagnosis and Evaluation

The Centers for Disease Control and Prevention recommends that men with epididymitis typically present with unilateral testicular pain and tenderness, with hydrocele and palpable swelling of the epididymis usually present 1
The evaluation should include a Gram-stained smear of urethral exudate for diagnosis of urethritis (>5 polymorphonuclear leukocytes per oil immersion field) and examination of first-void uncentrifuged urine for leukocytes 1
Testicular torsion must be ruled out emergently when evaluating testicular pain, as it is a surgical emergency that occurs more frequently among adolescents and in men without evidence of inflammation or infection 1, 2

Ultrasound with Doppler is the first-line imaging for acute scrotal pain to differentiate between epididymitis, torsion, and other causes 3
For epididymitis caused by enteric organisms in men, ofloxacin 300 mg orally twice daily for 10 days or levofloxacin 500 mg orally once daily for 10 days is recommended 1
Adjunctive therapy includes bed rest, scrotal elevation, and analgesics until fever and local inflammation subside 1, 3

Failure to improve within 3 days of initiating treatment for presumed epididymitis requires reevaluation of both diagnosis and therapy, with consideration of alternative diagnoses including intra-abdominal pathology 1, 3
Emergency testing for torsion is indicated when pain onset is sudden, pain is severe, or test results do not support urethritis or urinary tract infection 1, 2