Can hand, foot, and mouth disease (HFMD) cause testicular pain in an adult male?

Hand, Foot, and Mouth Disease Can Cause Testicular Pain in Adult Males

Yes, hand, foot, and mouth disease (HFMD) can cause testicular pain in adult males, presenting as viral epididymo-orchitis or testicular mass-like lesions. 1

Mechanism and Presentation

• HFMD is primarily a childhood viral infection but can occur in adults, with increasing incidence of adult cases being reported 2, 3
• When HFMD affects the testicles, it can manifest as:
  • Viral epididymo-orchitis with intense testicular pain 1
  • Hypoechoic mass-like areas in the testis visible on ultrasound 1
  • Testicular masses that may mimic tumors but can resolve with conservative management 4

Diagnostic Approach

• Ultrasound with Doppler is the first-line imaging for acute scrotal pain and can help differentiate between various causes 5
• Key diagnostic considerations for testicular pain include:
  • Recent history of HFMD (oral lesions, papulovesicular lesions on hands and feet) 1, 6
  • Timing of testicular pain (typically occurring days after initial HFMD symptoms) 1
  • Ultrasound findings showing hypoechoic areas or mass-like lesions 1

Differential Diagnosis

• Epididymitis/epididymo-orchitis (most common cause of testicular pain in adults) 7, 5
• Testicular torsion (surgical emergency requiring intervention within 6-8 hours) 8
• Torsion of testicular appendage 5
• Testicular tumor (should be considered in cases of testicular mass) 4

Management Considerations

• For suspected viral epididymo-orchitis due to HFMD:
  • Conservative management with serial ultrasounds may be appropriate 4, 1
  • Bed rest, scrotal elevation, and analgesics until inflammation subsides 7
  • Follow-up imaging to document resolution of lesions 1

Important Clinical Pearls

• HFMD-associated testicular pain typically occurs days after the initial viral symptoms 1
• Unlike bacterial epididymitis, which requires antibiotic treatment, viral epididymo-orchitis from HFMD is typically self-limiting 1
• In cases of testicular mass with recent HFMD history and negative tumor markers, observation may be preferable to immediate surgical intervention 4
• Failure to improve within 3 days requires reevaluation of both the diagnosis and therapy 7

Pitfalls to Avoid

• Misdiagnosing a viral testicular lesion as a tumor, potentially leading to unnecessary orchiectomy 4
• Failing to consider viral etiology in patients with testicular pain and recent history of viral illness 1
• Not recognizing HFMD in adults due to its reputation as primarily a childhood disease 6, 2, 3