Testicular Pain
Differential Diagnosis
Common Diagnoses
Occasional Diagnoses
- Idiopathic Chronic Testicular Pain (Accounts For 25% of Chronic Cases)
- Varicocoele
- Haematocoele
- Hydrocoele
- Trauma (Fractured Testis)
- Undescended or Misplaced Testis
- Torsion of the Appendix Testis
- Post-Vasectomy Pain
Rare Diagnoses
- Testicular Carcinoma (Teratoma and Seminoma)
- Incarcerated or Strangulated Inguinoscrotal Hernia
- Syphilis
- Referred from Spinal Tumours
- Neuralgia Testis
- Tuberculosis of the Testis
Ready Reckoner
Key distinguishing features of the most common diagnoses
| Orchitis | EO | Torsion | Epididymal Cyst | Stone | |
|---|---|---|---|---|---|
| Testicle Tender | Yes | Yes | Yes | No | No |
| Urethral Discharge | No | Possible | No | No | No |
| Fever | Yes | Possible | No | No | No |
| Testis High in Scrotum | No | No | Yes | No | No |
| Transilluminating Lump | No | No | No | Possible | No |
Possible Investigations
Likely:Urinalysis, MSU.
Possible:Urethral swab, ultrasound.
Small Print:Lumbosacral spine and abdominal X-rays, syphilis serology.
- Urinalysis: Protein, blood and pus cells in EO. Blood alone with stone.
- MSU: Will identify UTI.
- Urethral swab for gonococcus and Chlamydia necessary if STD suspected.
- Plain lumbosacral spine and abdominal X-rays are valuable to investigate referred testicular pain (stones and spinal pathology).
- Ultrasound is good at ‘seeing’ if a testicular mass arises from the body of the testis or its coverings, and whether solid or not.
- Syphilis serology: If syphilis suspected.
Top Tips
- In an adult, relief of pain by elevating the testicle suggests epididymitis.
- A negative urinalysis does not exclude epididymitis.
- In mild, chronic testicular ache, examine the patient standing up, otherwise you may miss a varicocoele.
Red Flags
- A sudden onset of excruciating pain associated with nausea suggests torsion of testis – especially in children and adolescents. Admit immediately.
- Repeated episodes of spontaneously resolving pain may represent recurrent, self-correcting torsion. Refer for possible orchidopexy and warn the patient to report urgently if there is severe and persisting pain.
- If non-gonococcal/chlamydial epididymitis is clinically suspected, treat immediately with a broad-spectrum antibiotic.
- If epididymitis does not settle with antibiotics, consider abscess formation – admit for IV antibiotics or surgical drainage.