What is the diagnosis for a swollen left testicle with occasional whitish discharge?

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If you have a swollen left testicle with discharge, you most likely have epididymitis or epididymo-orchitis, which requires antibiotic treatment, but you must first rule out testicular torsion, a surgical emergency.

Clinical Assessment

The key distinction is between epididymitis and testicular torsion, as the latter requires immediate surgery within 6 hours to prevent permanent damage. Testicular torsion typically presents with sudden onset of severe pain, while epididymitis develops gradually over days with milder symptoms. The presence of discharge strongly suggests infection rather than torsion.

Diagnostic Approach

You need an immediate physical examination and ultrasound evaluation. The examination should assess:

  • Pain onset pattern: Sudden (torsion) vs gradual over days (infection)
  • Testicular position: Normal position suggests infection; abnormal suggests torsion
  • Discharge characteristics: Purulent discharge indicates infection, not torsion

Ultrasound with Doppler is essential to differentiate between conditions:

  • In epididymitis: increased blood flow, enlarged epididymis, and swollen testis
  • In torsion: decreased or absent blood flow, with possible "whirled" appearance of the spermatic cord

Most Likely Diagnosis

Epididymitis or epididymo-orchitis is most probable, given the presence of discharge, which strongly suggests infection rather than torsion. The discharge indicates either:

  • Sexually transmitted infection (if under 35 years old): Chlamydia or gonorrhea
  • Urinary tract infection (if over 35 years old): E. coli or other bacteria

Treatment Approach

If you are under 35 years old, treatment should cover sexually transmitted infections:

  • Ceftazidime 1g IV once, then oral doxycycline 100mg twice daily for 10 days
  • This covers both gonorrhea and chlamydia

If you are over 35 years old, treatment should cover urinary tract bacteria:

  • Levofloxacin 500mg daily for 10 days, or ciprofloxacin if local resistance patterns allow

Supportive care is essential: bed rest, scrotal elevation, and pain medication until symptoms improve.

Warning Signs

Seek immediate emergency care if:

  • Sudden onset of severe pain (suggests torsion)
  • No improvement within 3 days of antibiotics (requires reevaluation)
  • Worsening symptoms despite treatment

Your sexual partner(s) need treatment too if the infection is sexually transmitted, specifically anyone you had contact with in the 60 days before symptoms started.

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Uh oh, I think I need to start over with a proper response. Let me provide the correct medical guidance:


If you have a swollen left testicle with discharge, you most likely have epididymitis or epididymo-orchitis, but you must first rule out testable torsion, a surgical emergency.

Immediate Assessment Needed

The critical first step is determining if this is testicular torsion, which requires surgery within 6 hours to prevent permanent damage. However, the presence of discharge strongly suggests infection (epididymitis) rather than torsion, as torsion does not cause discharge.

Key Distinguishing Features

Epididymitis characteristics:

  • Gradual onset of pain over days
  • Discharge from the penis (white or purulent)
  • Possible fever and urinary symptoms
  • Pain may improve when lifting the testicle

Testicular torsion characteristics:

  • Sudden onset of severe pain
  • No discharge
  • Rapid swelling
  • Pain worsens when lifting the testicle

Diagnostic Approach

You need immediate evaluation with:

  • Physical examination to assess testicular position, swelling pattern, and discharge characteristics
  • Ultrasound with Doppler to evaluate blood flow and rule out torsion

If you are under 35 years old, the most likely causes are:

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae

If you are over 35 years old, the most likely cause is:

  • E. coli or other urinary tract bacteria

Treatment Approach

If under 35 years old, treatment should cover sexually transmitted infections:

  • Ceftriaxone 250mg IM once, plus doxycycline 100mg twice daily for 10 days

If over 35 years old, treatment should cover urinary bacteria:

  • Levoflone 500mg daily for 10 days, or ciprofloxacin if appropriate

Supportive care includes:

  • Bed rest
  • Elevating the scrotum
  • Pain medication
  • Avoiding sexual activity until treatment is complete

Critical Actions

Seek immediate emergency care if:

  • Sudden onset of severe pain
  • No improvement within 3 days of antibiotics
  • Worsening symptoms despite treatment

Sexual partners need treatment too if infection is sexually transmitted, specifically anyone you had contact with in the 60 days before symptoms started.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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