A 69-Year-Old Man With Scrotal Swelling: USMLE Question

Answer: B. Escherichia coli

Epididymitis is a common cause of testicular swelling in males. It can be characterized as acute or chronic. In acute epididymitis, the onset of testicular pain is often associated with redness, warmth, and inflammation in the scrotum. Chronic epididymitis may have pain as the only symptom. Classically, individuals will have symptoms like testicular pain, swelling, and associated dysuria.

Examination findings suggestive of epididymitis include a positive Prehn sign (relief of pain with testicular elevation), localized tenderness to the posterior aspect of the testicle, a normal testicular lie, and cremasteric reflex. Urinalysis may show pyuria. In individuals older than 35 years, E coli is the most common bacterial pathogen.

Major Takeaway: The most common cause of epididymitis in individuals older than 35 years is E coli. Symptoms include testicular pain, swelling, and associated dysuria, frequency, and/or urgency. Examination findings include a positive Prehn sign (relief of pain with testicular elevation), normal testicular lie, and normal cremasteric reflex.