An 18-year-old male complains of painful urination and yellow-green discharge from the urethra, not associated with abdominal pain. What condition is most likely?

An 18-year-old male complains of painful urination and yellow-green discharge from the urethra, not associated with abdominal pain. What condition is most likely?

• A. Varicocele
• B. Testicular torsion
• C. Epididymitis
• D. Gynecomastia

Answer: (C)

In a sexually active young man, urinary symptoms plus urethral discharge point toward an infectious process involving the lower urinary tract and reproductive tract. Epididymitis fits best here because it is an inflammatory/infectious condition of the epididymis that often arises from ascending infection from the urethra and can be accompanied by dysuria and urethral discharge. While the classic presentation of epididymitis is scrotal pain and tenderness, the accompanying urethral discharge and painful urination reflect the infectious origin and the nearby involvement of the reproductive tract. The other options don’t align with this presentation as well. Varicocele mainly causes a dull scrotal heaviness and a “bag-of-worms” feel without urethral discharge. Testicular torsion presents with sudden, severe testicular pain and swelling, often with nausea or vomiting, and not with urethral discharge. Gynecomastia is a benign enlargement of breast tissue and has no relation to urinary symptoms or urethral discharge.

In a sexually active young man, urinary symptoms plus urethral discharge point toward an infectious process involving the lower urinary tract and reproductive tract. Epididymitis fits best here because it is an inflammatory/infectious condition of the epididymis that often arises from ascending infection from the urethra and can be accompanied by dysuria and urethral discharge. While the classic presentation of epididymitis is scrotal pain and tenderness, the accompanying urethral discharge and painful urination reflect the infectious origin and the nearby involvement of the reproductive tract.

The other options don’t align with this presentation as well. Varicocele mainly causes a dull scrotal heaviness and a “bag-of-worms” feel without urethral discharge. Testicular torsion presents with sudden, severe testicular pain and swelling, often with nausea or vomiting, and not with urethral discharge. Gynecomastia is a benign enlargement of breast tissue and has no relation to urinary symptoms or urethral discharge.