An adolescent presents with scrotal pain and fever; which condition is most likely?

An adolescent presents with scrotal pain and fever; which condition is most likely?

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

Answer: (C)

Painful scrotum with fever in an adolescent most strongly points to an infection of the epididymis (epididymo-orchitis). Fever indicates an infectious/inflammatory process, and in sexually active teens this is often due to pathogens such as gonorrhea or chlamydia spreading to the epididymis, producing tenderness and swelling. This scenario contrasts with testicular torsion, which usually arrives as a sudden, severe pain with a high-riding testis and often a decreased cremasteric reflex; fever is not a hallmark feature there and torsion is a surgical emergency. Varicocele tends to cause a dull, aching fullness that worsens with standing and improves with lying down, typically without fever. Testicular cancer usually presents as a painless or minimally painful mass rather than acute febrile pain. If torsion cannot be confidently excluded, urgent Doppler ultrasound to assess blood flow is warranted.

Painful scrotum with fever in an adolescent most strongly points to an infection of the epididymis (epididymo-orchitis). Fever indicates an infectious/inflammatory process, and in sexually active teens this is often due to pathogens such as gonorrhea or chlamydia spreading to the epididymis, producing tenderness and swelling. This scenario contrasts with testicular torsion, which usually arrives as a sudden, severe pain with a high-riding testis and often a decreased cremasteric reflex; fever is not a hallmark feature there and torsion is a surgical emergency. Varicocele tends to cause a dull, aching fullness that worsens with standing and improves with lying down, typically without fever. Testicular cancer usually presents as a painless or minimally painful mass rather than acute febrile pain. If torsion cannot be confidently excluded, urgent Doppler ultrasound to assess blood flow is warranted.