Urgent Care Evaluation of Pain and Swelling in the Scrotum (Infectious Disease CME and Trauma CME)

A 14-year-old boy presents to your urgent care clinic with “lower abdominal pain”...

• You explain to the patient and his mother that the evaluation will include an examination of his abdomen, groin, and genital area. You ask whether he would prefer for his mother to remain in the room or step out. He says he would like for her to step out, so you arrange for a chaperone, in accordance with clinic policy.
• After his mother leaves the room, the patient tells you that his pain is in the left testicle specifically, began suddenly 6 hours prior, and is associated with nausea and headache.
• Chaperoned examination reveals a high-riding left testis with horizontal lie, scrotal edema, and tenderness to palpation.
• You consider the best next step in the management of this patient...

A 40-year-old man presents with testicular pain and dysuria…

• The patient awoke in bed with a person he did not know, after consuming alcohol at a bar the previous night. He does not recall whether sexual contact occurred. Since then, he has developed urethritis and a dull scrotal ache.
• After you explain the possible causes of his symptoms, he declines empiric use of ceftriaxone. He is amenable to doxycycline monotherapy while urine testing for gonorrhea and chlamydia is pending.
• He calls the clinic a week later, reporting continued testicular pain.
• You wonder if this is an ongoing symptom related to a partially treated sexually transmitted infection…

A 52-year-old man presents with a chief complaint of low back pain...

• He retired from work as a coal miner approximately 2 years prior. He denies any history of musculoskeletal pains.
• He endorses fatigue, swelling of the breast tissue, and a sense of heaviness in the scrotum, all of which he attributes to weight gain from being less active and reduced testosterone due to aging.
• Careful review of his surgical history reveals bilateral orchiopexy for cryptorchidism.
• You consider referring him for advanced imaging to confirm your suspected diagnosis…