Differential Diagnosis for Testicular Pain in an 18-Year-Old
Single Most Likely Diagnosis
- Epididymitis: Although the patient is not sexually active, epididymitis can also be caused by non-sexually transmitted bacteria, especially in younger men. The intermittent nature of the pain and the fact that the testicles are non-tender could align with a less severe or early case of epididymitis.
Other Likely Diagnoses
- Varicocele: This condition, characterized by an enlargement of the veins within the scrotum, can cause intermittent pain and is common in young men. The pain can be exacerbated by standing or physical activity.
- Hydrocele: A hydrocele is an accumulation of fluid in the scrotum that can cause discomfort or pain, which might be intermittent and not necessarily associated with tenderness of the testicles.
- Spermatocele: A spermatocele is a cystic structure filled with sperm that arises from the head of the epididymis. It can cause intermittent pain or discomfort.
Do Not Miss Diagnoses
- Testicular Torsion: Although the testicles are described as non-tender, testicular torsion is a medical emergency that requires prompt attention. Early stages or intermittent torsion might not always present with the classic signs of severe pain and tenderness.
- Testicular Cancer: While less common, testicular cancer can present with pain or discomfort, although it's often painless. Given the potential severity of missing this diagnosis, it's crucial to consider it, especially with any testicular symptoms.
Rare Diagnoses
- Henoch-Schönlein Purpura (HSP): A systemic vasculitis that can cause testicular pain among other symptoms like rash, joint pain, and gastrointestinal issues. It's rare but should be considered in the differential diagnosis of testicular pain in young men.
- Polyarteritis Nodosa (PAN): A vasculitis of medium and small arteries that can affect various organs, including the testicles, causing pain. It's a rare condition but one that could have significant implications if missed.