Acute Scrotal Swelling or Pain

Clinical Description

CAUSES

• Chlamydia trachomatis
• Neisseria gonorrhea

Signs and Symptoms

• Scrotal swelling
• Scrotal pain
• Urethral discharge
• Dysuria
• Frequency of micturition
• Fever

Distinguish from scrotal swelling/pain due to:

• Other long-standing causes, e.g. Scrotal hydrocele, varicocele, inguinal hernia
• Recent/acute illness, e.g. Testicular torsion or trauma, inguinal hernia

Investigations

• Urethral swab for culture
• Urine culture and sensitivity
• Ultrasound scan of the scrotum

Note: Thorough history and physical examination are necessary to exclude potentially life- threatening conditions and to determine whether immediate surgical attention is required

Non-pharmacological

• Bed rest
• Cold compress If there is no evidence of painful and/or swollen scrotum, look for signs of another STI and if present treat appropriately
• Scrotal support until inflammation and fever subsides

Pharmacological

• Even if the presumptive diagnosis is an STI, treat all patients and partners for gonorrhea and chlamydia infection:
• Give Ceftriaxone 250mg IM STAT and
• Give Azithromycin 1g orally as single dose.
• Additional therapy for the patient