# Pain in the testis (scrotal pain) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: BASHH UK national guideline for the management of epididymo-orchitis 2020 (Int J STD AIDS 2021;32(10):884-895), Treatment recommendations · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Doxycycline monograph (chapter PDF p297) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ofloxacin monograph (chapter PDF p394) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - BASHH UK national guideline for the management of epididymo-orchitis 2020 (Int J STD AIDS 2021;32(10):884-895), Treatment recommendations ## Treatment metadata - Doxycycline — 100 mg — oral.solid - Ceftriaxone — 1000 mg — injection - Ofloxacin — 200 mg — oral.solid ## Complete treatment card ```text PAIN IN THE TESTIS (SCROTAL PAIN) Sources: BASHH UK national guideline for the management of epididymo-orchitis 2020 (Int J STD AIDS 2021;32(10):884-895), Treatment recommendations · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Doxycycline monograph (chapter PDF p297) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ofloxacin monograph (chapter PDF p394) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Ask when the pain started, how long it has run, and whether it comes and goes - Ask about exertion, heavy lifting or a direct blow, and about swelling, discharge, redness or rash [rash · redness] - Ask about fever, dysuria, frequency, urgency, blood in the semen, abdominal or back pain, and weight loss [abdominal pain · back pain · burning on passing urine · fever · weight loss] - Ask about diabetes, heart failure, or anything that weakens immunity - Take a sexual history: how many partners and of which gender, condom use, past infections SIGNS - what you find (11) - Inspect the abdomen, groin, penis and scrotum fully uncovered - Note rashes, ulcers, odd asymmetry, or a testis lying across; the left normally sits lower - Feel scrotum, perineum and thighs for crepitus or gas beneath the skin [crepitus] - Palpate the contents, comparing the size of each testis and hunting a mass or a hernia [hernia] - Inspect the urethra for discharge, and test the cremasteric reflex on both sides - The classic torsion picture is a high, uneven testis lying wrongly with the reflex gone on that side - Prehn sign: lifting the testis eases the pain of epididymitis, but not the pain of torsion - That classic picture is not seen in every case, and trusting it causes missed or late diagnosis - An absent cremasteric reflex proves little, as up to 30% of normal males lack one - A reflex that is present does not exclude torsion: 8% to 30% of surgically confirmed cases kept theirs - Epididymo-orchitis can abolish the reflex as well TESTS (12) - Where cord torsion is strongly suspected, go to emergency surgical consultation with no further delay - Salvage classically means exploration and detorsion inside six hours of pain onset - Pain already lasting longer than six hours is not a reason to slow evaluation or exploration - Where they cause no delay: blood count, urine microscopy and culture, urethral swabs for gonorrhoea and chlamydia - If systemically unwell or septic, add blood cultures, inflammatory markers and imaging from pelvis to mid-thigh - Doppler ultrasound is the imaging of choice, so long as it delays no surgical referral - Torsion on scan: an enlarged, uniform, hypoechoic testis with colour flow absent - The twisted cord itself can sometimes be seen directly on the scan - Infection does the reverse, raising flow to testis or epididymis on Doppler - Scanning may also show an abscess, or gas sitting in the wall of the scrotum - Radionuclide scanning throws false positives with spermatocele, hydrocele and inguinal hernia - Use CT where necrotising skin and soft-tissue infection or Fournier gangrene is the worry IF NOT THIS - what else fits (12) - Acute epididymitis or epididymo-orchitis - Torsion of a testicular appendage - Torsion of the spermatic cord - Henoch-Schonlein purpura - A strangulated or incarcerated inguinal hernia - Varicocele - Cellulitis of the scrotal skin - Fournier gangrene - Idiopathic scrotal oedema - Haematoma within the testis - Abscess of the scrotum or of the testis - Testicular infarction, tumour, or rupture Source StatPearls "Acute Scrotum Pain" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Doxycycline + Ceftriaxone 1. DOXYCYCLINE [1 of 2 - GIVE ALL TOGETHER] Adult 100 mg by mouth twice daily x 10-14 days Peds BASHH wrote this guideline for people aged 16 and over. Acute scrotal pain in a boy is torsion until a surgeon says otherwise - refer, do not treat. Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph): "100 to 200 mg/day in 1 to 2 divided doses", 100 mg capsules; the epididymo-orchitis indication and the 10-to-14-day course are from the BASHH UK national guideline for the management of epididymo-orchitis 2020, which is not held in this corpus. Why Half of BASHH's first-line regimen for sexually acquired epididymo-orchitis, given with ceftriaxone. Given alone it is the regimen for disease probably due to chlamydia or other non-gonococcal organisms, where gonorrhoea has been excluded. Caution TESTICULAR TORSION FIRST. Sudden severe pain, a high-riding or transversely lying testis, or onset in a boy or young man is torsion until proved otherwise, and the testis is lost in hours. Refer the same hour; do not start antibiotics and review. The formulary's 7-day course is for chlamydial urethritis. Epididymo-orchitis needs 10 to 14 days - a short course here is a treatment failure with a testis at stake. Test for chlamydia and gonorrhoea, and treat sexual partners. Not in pregnancy, not in children, and not with retinoid therapy. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) 2. CEFTRIAXONE [2 of 2 - GIVE ALL TOGETHER] Adult 1 g intramuscularly as a single dose - Single dose, given with the doxycycline course Peds Not applicable - this guideline covers people aged 16 and over. A boy with acute scrotal pain is a surgical referral. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph), General Adult Dosage: "IV or IM 1-2 g once or devided twice daily", 1 gm vial; the epididymo- orchitis indication and single-dose regimen are from the BASHH UK national guideline for the management of epididymo-orchitis 2020, which is not held in this corpus. Why BASHH raised this to 1 g in line with its gonorrhoea guideline, to cover strains with reduced susceptibility. It is given with doxycycline, not instead of it. Caution Given WITH doxycycline as one regimen. Ceftriaxone alone does not treat the chlamydia that causes most of these. Ask about penicillin and cephalosporin allergy before giving it. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP 3. OFLOXACIN [2nd line] Adult 200 mg by mouth twice daily x 14 days Peds Fluoroquinolones are avoided in children other than in specific circumstances. Refer. Source BASHH UK national guideline for the management of epididymo-orchitis 2020 (Int J STD AIDS 2021;32(10):884-895), Treatment recommendations Why The alternative where gonorrhoea has been excluded, and the choice where an enteric organism is likely - an older man, recent instrumentation, or a urine dipstick positive for leucocytes and nitrites. BASHH also offers levofloxacin 500 mg once daily there. Caution Fourteen days, not seven. Fluoroquinolones carry tendon rupture and aortic aneurysm warnings, and the risk rises with age and with concurrent corticosteroids. A confirmed uropathogen is an indication for urology referral to exclude a structural abnormality or obstruction. Egypt JEDCOFLACIN 200 MG 20 F.C.TAB. JEDCO INT. CO... 43.25 EGP (2.16/unit) OFLOXIN 200MG 10 F.C.TAB. KAHIRA 21.60 EGP (2.16/unit) OFLICIN 200MG 10 F.C.TAB. MEMPHIS 24.00 EGP (2.40/unit) EPICOFLOCIN 200 MG 10 F.C.TABS. EIPICO 28.00 EGP (2.80/unit) OFLOXACIN 200MG 10 TAB SEDICO 30.00 EGP (3.00/unit) KIROLL 200MG 10 F.C. TAB. GLAXO SMITHKLINE 34.50 EGP (3.45/unit) TARIVAN 200MG 10 TAB. ALEXANDRIA 44.00 EGP (4.40/unit) TARIVID 200MG 10 F.C. TAB. SANOFI 82.00 EGP (8.20/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)