Testicular Pain

Lots of things can cause painful testicles. There are 2 main causes but it can be hard to tell which it is — always do medical consult for testicular problems

• Testicular torsion — twisted testis/testicle is a medical emergency — can cause necrosis (testicle tissue can die)
• If you can’t exclude twisted testicle — send to hospital urgently
• Epididymo-orchitis — infected testes  
• In children — usually due to UTI or viruses but may be STI in sexually active boys — consider sexual abuse
• In younger men — usually due to STI
• In older men or men with recent urinary tract procedure or catheter — may be due to UTI bacteria
• Can be due to mumps virus
• Decision to manage as infected testes is based on clinical assessment regardless of POC Test or laboratory results

Check

• U/A 
• Head-to-toe exam — with attention to 
• Abdominal assessment —consider hernia
• Scrotum and testes — Table 7.34
• Full STI check
• If under 15 years — medical consult

Do — if twisted testicle

• Do not let him eat or drink anything — may need operation — consider IV fluids
• Give pain relief — usually moderate–severe pain
• Urgent medical consult to send to hospital 

Do — if infected testes

• Give pain relief
• Advise wearing firm underpants — may help pain
• Medical consult

All men with discharge from penis AND men under 45 years with no discharge

• Treat as STI related
• Give ceftriaxone IM — adult 500mg, single dose mixed with lidocaine (lignocaine) 1%
• AND azithromycin oral — adult 1g, single dose
• THEN doxycycline oral — adult 100mg, twice a day (bd) for 14 days OR azithromycin oral — adult 1g, single dose — second dose 1 week later
• If allergy to penicillin — medical consult

Men 45 years or over with no discharge

• Treat as UTI related

Follow-up

• Tell man to come back straight away if getting worse
• If likely to be STI related — offer STI check and treatment to sexual partner/s

At 3 days

• Check results of STI check and urine MC&S if available
• If results show different infection — medical consult about changing antibiotic
• If positive STI result — contact trace and treat partners for gonorrhoea and chlamydia
• STI and safer sex education
• If UTI — see UTI follow-up
• If not getting better — medical consult to  send to hospital
• If getting better — continue antibiotics and review at 1 week

At 1 week

• Check results if not available earlier — follow-up as above
• Check antibiotics taken properly
• If using azithromycin OR if all doxycycline not taken — give azithromycin oral — adult 1g, single dose