Differential Diagnosis for Testicular Pain

Single Most Likely Diagnosis

• Epididymitis: This is often the most common cause of testicular pain, especially in sexually active young men. It is usually caused by a bacterial infection, such as Chlamydia or Gonorrhea, and presents with pain, swelling, and tenderness of the epididymis.

Other Likely Diagnoses

• Orchitis: Inflammation of one or both testicles, usually caused by viral or bacterial infections. It can present with testicular pain, swelling, and fever.
• Testicular Torsion: A condition where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It is a medical emergency and presents with sudden, severe testicular pain, often accompanied by nausea and vomiting.
• Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins. It can cause a dull, aching pain and is more common on the left side.

Do Not Miss Diagnoses

• Testicular Torsion: Although listed under other likely diagnoses due to its severity and the need for immediate intervention, it is crucial not to miss this diagnosis as it can lead to loss of the testicle if not treated promptly.
• Testicular Cancer: While less common, testicular cancer can present with a painless testicular mass, but sometimes it can cause pain. Early detection is key for effective treatment.
• Appendicitis (with a retrocecal appendix): Although rare, an inflamed appendix located behind the cecum can irritate the testicle and cause pain, mimicking testicular pathology.

Rare Diagnoses

• Henoch-Schönlein Purpura (HSP): A form of vasculitis that can affect various parts of the body, including the testicles, causing pain and swelling.
• Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis. It usually does not cause pain but can be uncomfortable if large.
• Testicular Infarction: A rare condition where the blood supply to the testicle is compromised, not due to torsion, but potentially due to other vascular issues.

Each of these diagnoses has distinct characteristics and requires careful consideration based on the patient's presentation, history, and physical examination findings.