Acute testicular pain and epididymo-orchitis

At a glance

• Testicular torsion is a surgical emergency. Suspect it in any sudden severe testicular pain, especially under 25, and send to theatre without waiting for imaging.
• Epididymo-orchitis is the most common cause in adults. In sexually active men it is usually chlamydia or gonorrhoea; after instrumentation, anal sex or a UTI, think E. coli and other enteric organisms.
• Empirical treatment (ASHM): ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily for 14 days. Change to cover enteric organisms when urine culture or history points that way.