Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of unilateral scrotal pain, swelling, and erythema. Associated symptoms include dysuria, frequency, urgency, and occasional fever or chills. No history of trauma or recent urological instrumentation. Pain is progressive, radiating to the inguinal canal.
Clinical Examination Findings
Scrotal examination reveals a tender, indurated, and enlarged epididymis. Testicular tenderness may be present (orchitis). Prehnโs sign is positive (relief of pain with scrotal elevation). Cremasteric reflex is intact. No evidence of testicular torsion or inguinal hernia. Scrotal ultrasound demonstrates increased blood flow (hyperemia) and epididymal enlargement.
Treatment Protocol
Initiate empiric antibiotic therapy based on age and risk factors (e.g., Ceftriaxone 500mg IM once + Doxycycline 100mg BID for 10 days, or Levofloxacin 500mg daily). Recommend scrotal support, bed rest, and NSAIDs for pain management. Advise abstinence from sexual activity until completion of treatment and partner evaluation if STI is suspected.