From the Guidelines
The most common cause of testicular pain in adolescent males is epididymoorchitis or epididymitis. This condition is characterized by inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm, and is often accompanied by orchitis, which is inflammation of the testicle itself [ 1 ]. According to the American College of Radiology, epididymoorchitis or epididymitis is the most common cause of acute scrotum in adolescent boys and adults [ 1 ].
Key Characteristics and Treatment
- Epididymoorchitis or epididymitis typically presents with gradual onset of pain, swelling, and tenderness in one testicle, often accompanied by redness and warmth of the scrotum.
- Treatment usually involves antibiotics such as doxycycline 100mg twice daily for 10-14 days or ceftriaxone 250mg as a single intramuscular dose plus doxycycline, especially if sexually transmitted infections are suspected [ 1 ].
- Pain management with NSAIDs like ibuprofen 400-600mg every 6-8 hours, scrotal support, and rest are also important.
- It is essential for adolescents to seek immediate medical attention for testicular pain to rule out testicular torsion, a surgical emergency that can cause testicular loss if not treated within 6 hours [ 1 ].
Other Causes of Testicular Pain
- Other common causes of testicular pain in this age group include trauma, varicocele (enlarged veins), hydrocele (fluid collection), and referred pain from other conditions.
- Torsion of the testicular appendage is more common in prepubertal boys, while testicular torsion is a surgical emergency with a bimodal distribution presenting more frequently in neonates and postpubertal boys than in adults [ 1 ].
From the Research
Causes of Testicular Pain in Adolescent Males
- The most common cause of testicular pain in adolescent males is not explicitly stated in the provided studies, but epididymitis is a common condition that presents with testicular pain and is often seen in the outpatient setting 2.
- In children younger than 14 years, the most common cause of epididymitis is considered to be reflux of urine into the ejaculatory ducts 2.
- In sexually active males 14 to 35 years of age, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens causing epididymitis 2, 3.
- The treatment of epididymitis depends on the age of the patient and the likely causative organisms, with a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline being the treatment of choice for sexually active males 14 to 35 years of age 2, 3.
Treatment Adherence
- Adherence to treatment guidelines for chlamydia and gonorrhea remains a concern, with nonadherence to Centers for Disease Control and Prevention treatment guidelines being a significant issue 4.
- A study found that chlamydia was infrequently treated with the recommended antibiotic, doxycycline, and gonorrhea was infrequently treated with the recommended antibiotic, ceftriaxone 4.
- Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections 4.