What are the causes of testicular swelling (orchialgia)?

From the Guidelines

Testicular swelling is most commonly caused by epididymitis, orchitis, or testicular torsion, and prompt medical attention is essential to prevent complications and improve treatment outcomes. The causes of testicular swelling can be categorized into infectious and non-infectious etiologies. Infectious causes include epididymitis, orchitis, and scrotal abscess, while non-infectious causes include testicular torsion, hydrocele, varicocele, hernia, trauma, and testicular cancer 1.

Key Considerations

• Epididymitis is the most common cause of acute scrotum in adolescent boys and adults, accounting for approximately 50-60% of cases 1.
• Testicular torsion is a surgical emergency that requires prompt recognition and treatment within 6-8 hours to prevent testicular loss 1.
• The diagnosis of testicular swelling can be challenging due to the large differential diagnoses and overlapping clinical presentations 1.

Diagnostic Approach

• A clinical risk scoring system, such as the Testicular Workup for Ischemia and Suspected Torsion Score, can help diagnose testicular torsion 1.
• Scrotal ultrasound examination can be useful in diagnosing epididymitis and testicular torsion 1.
• Midstream urine for culture and urethral swab/smear can help identify the underlying cause of epididymitis 1.

Treatment Approach

• For infectious causes like epididymitis, antibiotics such as ciprofloxacin 500mg twice daily for 10 days or doxycycline 100mg twice daily for 10 days may be prescribed 1.
• Anti-inflammatory medications like ibuprofen 400-600mg every 6-8 hours can help reduce pain and swelling 1.
• Applying ice packs for 15-20 minutes several times daily and wearing supportive underwear can provide relief while healing occurs 1.

Importance of Prompt Medical Attention

• Prompt medical attention is essential to prevent complications and improve treatment outcomes, especially for testicular torsion, which requires emergency treatment within hours to prevent tissue death 1.
• Early diagnosis and treatment can significantly improve treatment outcomes and reduce the risk of long-term complications 1.

From the Research

Causes of Testicular Swelling

• Infection is a common cause of testicular swelling, with epididymitis and orchitis being two of the most common conditions associated with this symptom 2, 3
• The most common pathogens responsible for epididymitis and orchitis vary by age group:
  • In men between 14 and 35 years of age, Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens 2, 3
  • In men older than 35 years, enteric bacteria such as coliform bacteria are the primary pathogens 2, 3
• Other possible causes of testicular swelling include:
  • Reflux of urine into the ejaculatory ducts, which is considered the most common cause of epididymitis in children younger than 14 years 3
  • Bladder outlet obstruction, which can lead to epididymitis in men older than 35 years 3
• Symptoms of epididymitis and orchitis typically include:
  • Gradual onset of scrotal pain
  • Symptoms of lower urinary tract infection, such as fever and dysuria
  • A swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex 2