Swollen and painful crown jewels

Dear Dr. G,

I am a fit and healthy man in my early thirties.

I recently encountered some issues with my testicles, and really hope you can help.

I started noticing slight discomfort in my left scrotum a fortnight ago, when urinating.

Over the last few days, it has swollen to double its size and the pain has caused much concern.

It is also painful every time I urinate and have a mild fever.

I think I may have caught some infection somewhere, but am just really puzzled how I got it.

I am too embarrassed to tell anyone about the “lopsided” painful crown jewel.

Can you tell me what can possibly be wrong with my testicles?

Is it normal to have the swelling of the testicles progressing so fast?

Can the testicles really get infected?

What are the possible causes of swellings in the crown jewels?

The swelling of the testicle tends to get bigger and uncomfortable. Is it a bad sign?

I am worried and embarrassed about someone “fondling” my balls, if I go to the doctors.

Can you please help me to clarify the risk of my swollen crown jewels?

Regards,

Painful swollen Pete

The gradual swelling of the testicles tends to be benign in nature. Benign swellings of the testicles including varicoceles, hydrocele, epididymal cysts and hernia, develop slowly and most of these swellings are painless. Rapid and painful testicular swelling is likely to be caused by the infection known as epididymal-orchitis.

This is a medical condition characterised by the inflammation of the testis and the associated curved structure at the back of the testicle, known as epididymis.

Epididymal orchitis in younger men typically develops over the course of several days, resulting in painful swelling of one testicle.

This is often associated with painful frequent urination and urethral discharge.

Typical causes of epididymal orchitis in sexually young men are sexual in nature. Common sexually transmitted infections such as gonorrhea and chlamydia backtrack from the urethral into the testicles, following unprotected sexual intercourse.

Infections of the testicles in older men are usually caused by enteric bacteria such as E. Coli. Such infection arises from dehydration or bladder outflow obstruction due to prostate enlargement.

Benign Prostatic Hyperplasia is common in older men due to incomplete bladder emptying after urination. The residual urine tends to get infected in the bladder, and the backwards infection of the testicle occurs when the cystitis is not treated early enough.

Non-bacterial or non-infective epididymal orchitis can also occur. Mumps is a viral illness caused by paramyxovirus that is well-known to be associated with painful infections of the testicle.

Non-infectious causes of testicle inflammation can also occur when sterile urine refluxed through the ejaculatory ducts causing epididymal orchitis, without the pathogens.

Symptoms of epididymal orchitis are usually sufficient in determining the diagnosis.

These include rapid painful swellings of the testicle associated with redness of the scrotum. Palpation of the testicle reveals a significant disparity in sizes and the scrotal pain is also relieved by the elevation of the affected testis.

For men who are squeamish about scrotal examinations, there is painless ultrasound imaging to determine the diagnosis. Complications such as chronic epididymal orchitis and abscess can also be detected by ultrasound scans.

Both acute and chronic forms of epididymal orchitis can be fully treated by antibiotics.

The treatment of choice for sexually transmitted bacteria are ceftriaxone and azithromycin.

Enteric bacterial infections in older men are usually sensitive to antibiotics such as Ciprofloxcillin and Augmentin.

The complete resolution of the infection is achievable with an adequate duration of antibiotics. Late treatment of the infection can be associated with infertility or scrotal abscess, which may result in surgical removal of the testicle.