What is the cause of a 35-year-old male's persistent testicular burning sensation, given his girlfriend's diagnosis of syphilis and Mycoplasma, and unclear ultrasound results?

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DS

Dainyal Siddiqui, MD

Internal Medicine

MJ

Manuel Jimenez, MD

Cardiology

FP

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 27, 2025 • View editorial policy

Differential Diagnosis for the 35-year-old Male Patient

  • Single most likely diagnosis + Epididymitis: This condition is characterized by inflammation of the epididymis, which can cause a burning sensation in the testicle. Given the patient's symptoms and recent exposure to a partner with an STD, epididymitis is a plausible diagnosis, especially if caused by Mycoplasma or other sexually transmitted pathogens.
  • Other Likely diagnoses + Orchitis: Inflammation of one or both testicles, which can be caused by bacterial or viral infections, including those transmitted sexually. The burning sensation and the context of recent STD exposure make this a likely consideration. + Testicular torsion (chronic or intermittent): Although testicular torsion typically presents acutely, intermittent torsion could potentially cause chronic or recurring pain. However, the two-year duration of symptoms makes this less likely. + Varicocele: A varicocele is an enlargement of the veins within the scrotum and can cause aching or burning sensations. It's a common condition but less directly related to the recent STD exposure.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Testicular cancer: Although the patient's symptoms have been chronic, testicular cancer can present with a variety of symptoms, including aching or burning sensations. Given the potential for serious outcomes if missed, it's crucial to consider and rule out testicular cancer. + Syphilis (in its various stages): Given the partner's diagnosis of syphilis, it's essential to consider syphilis in the patient, especially since syphilis can cause a wide range of symptoms, including pain and inflammation in the genital area.
  • Rare diagnoses + Sarcoidosis: A condition that can cause inflammation in various parts of the body, including the testicles, leading to pain and discomfort. It's less common and not directly related to STDs but could be considered in a differential diagnosis for chronic testicular pain. + Henoch-Schönlein purpura (HSP): A form of vasculitis that can affect various parts of the body, including the testicles, causing pain. It's rare and more commonly seen in children, but it should be considered in cases of unexplained testicular pain.

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