Can Jejunitis Cause Testicular Pain or Dysuria?
Yes, jejunitis (inflammation of the jejunum) can cause testicular pain, as demonstrated by documented cases of enteric infections presenting with testicular symptoms, though this is an uncommon extraintestinal manifestation.
Mechanism of Referred Testicular Pain from Intestinal Inflammation
Campylobacter jejuni enterocolitis, which causes ileocecal inflammation similar to jejunitis, has been documented to present with bilateral testicular pain as the primary symptom, suggesting that intestinal inflammation in proximity to the genitourinary tract can cause referred pain 1.
The proposed mechanism involves referred pain from ileocecal inflammation to the testicles, similar to how appendicitis is known to cause testicular pain through shared visceral innervation pathways 1.
In the documented case, the patient had no objective scrotal findings on physical examination but exhibited mild right lower abdominal tenderness with CT imaging showing ileocecal wall thickening 1.
Sexually Transmitted Enteric Organisms and Epididymitis
Sexually transmitted enteric organisms (such as E. coli) can cause epididymitis among men who are the insertive partner during anal intercourse, which represents a direct link between enteric pathogens and testicular pain 2.
Epididymitis caused by enteric organisms is typically accompanied by urethritis, which is often asymptomatic but can manifest as dysuria (pain with urination) 2.
Men with epididymitis typically present with unilateral testicular pain and tenderness, with hydrocele and palpable swelling of the epididymis usually present 2.
Dysuria and Enteric Inflammation
While jejunitis itself does not directly cause dysuria, associated urethritis from enteric organisms can produce pain after urinating 2.
The evaluation should include a Gram-stained smear of urethral exudate for diagnosis of urethritis (>5 polymorphonuclear leukocytes per oil immersion field) and examination of first-void uncentrifuged urine for leukocytes 2.
Critical Diagnostic Considerations
Testicular torsion must be ruled out emergently when evaluating testicular pain, as it is a surgical emergency that occurs more frequently among adolescents and in men without evidence of inflammation or infection 2, 3.
Emergency testing for torsion is indicated when pain onset is sudden, pain is severe, or test results do not support urethritis or urinary tract infection 2, 3.
Ultrasound with Doppler is the first-line imaging for acute scrotal pain to differentiate between epididymitis, torsion, and other causes 4.
Clinical Pitfall to Avoid
In patients presenting with testicular pain and no objective scrotal findings, consider intra-abdominal pathology including enteric infections like Campylobacter colitis or jejunitis, particularly if there is associated abdominal tenderness or gastrointestinal symptoms 1.
Failure to improve within 3 days of initiating treatment for presumed epididymitis requires reevaluation of both diagnosis and therapy, with consideration of alternative diagnoses including intra-abdominal pathology 2, 4.
Management Approach When Jejunitis is Suspected
If enteric infection is confirmed as the cause, treatment should focus on the underlying intestinal infection with appropriate antimicrobials based on culture results 1.
Adjunctive therapy includes bed rest, scrotal elevation, and analgesics until fever and local inflammation subside 2, 4.
For epididymitis caused by enteric organisms in men, ofloxacin 300 mg orally twice daily for 10 days or levofloxacin 500 mg orally once daily for 10 days is recommended 2.