A 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has not had urethral discharge. He is sexually active with one female partner. Vital signs are within normal limits. Physical examination shows a tender right testicle; lifting it provides relief. The penis appears normal, with no discharge at the meatus. Urinalysis shows numerous leukocytes but no bacteria. Which of the following factors most likely contributed to this patient's current condition?

Question

A 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has not had urethral discharge. He is sexually active with one female partner. Vital signs are within normal limits. Physical examination shows a tender right testicle; lifting it provides relief. The penis appears normal, with no discharge at the meatus. Urinalysis shows numerous leukocytes but no bacteria.  Which of the following factors most likely contributed to this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Epididymitis presents with acute testicular pain, tenderness, and pyuria.  It is caused by retrograde passage of organisms from the urethra into the ejaculatory duct and vas deferens.  The microbiology is largely influenced by patient age: epididymitis in young men is usually due to sexually acquired infections (eg, Chlamydia trachomatis, Neisseria gonorrhoeae), whereas in older men (age >35) it is usually due to gram-negative colonic flora.

A 19-Year-Old Man Comes to the Physician with Right-Sided, Dull