Dawaa Reference

chronic

Swelling of the Testis or Scrotum

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Acute Scrotum Pain - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470404/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS21.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Acute Scrotum Pain - disease-level clinical article (testicular-scrotal-swelling-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Ask about how the swelling started, how long it has lasted, and whether it is constant or comes and goes
  • A history of recent exertion, heavy lifting, or direct trauma to the area should be sought
  • Associated fever, painful or frequent urination, blood in the semen, abdominal or back pain, or weight loss should be asked about [abdominal pain · back pain · fever · urinary frequency · weight loss]
  • A sexual history covering partners, condom use, and any past STI treatment is important

Signs — what you find (4)

  • A testicle sitting higher than normal, lying abnormally, with an absent cremasteric reflex is the classic description of torsion
  • Prehn's sign: pain that eases when the testicle is lifted points to epididymitis, while unchanged pain points to torsion
  • The cremasteric reflex is unreliable - absent in up to 30% of healthy males and still present in 8% to 30% of confirmed torsion cases
  • Crepitus or subcutaneous gas felt on palpation of the scrotum, perineum, or thighs raises concern for a necrotizing infection [crepitus]

Tests (6)

  • Color Doppler ultrasound has a reported sensitivity of 96% to 100% and specificity of 84% to 95%
  • Ultrasound signs of torsion include an enlarged, uniformly dark testicle with no blood flow detected
  • Direct visualization of the twisted cord can produce a whirlpool or snail-shaped appearance on ultrasound
  • Infection causes increased blood flow to the testicle or epididymis on Doppler, the opposite of torsion
  • Radionuclide scrotal imaging has 89-98% sensitivity and 90-100% specificity for torsion but gives false positives with spermatocele, hydrocele, or hernia
  • CT imaging is reserved for suspected necrotizing skin and soft tissue infection or Fournier gangrene

If not this — what else fits (12)

  • Acute epididymitis/epididymo-orchitis
  • Testicular appendage torsion
  • Spermatic cord torsion
  • Henoch-Schonlein purpura
  • Strangulated/incarcerated inguinal hernia
  • Varicocele
  • Scrotal cellulitis
  • Fournier gangrene
  • Idiopathic scrotal edema
  • Scrotal or testicular abscess
  • Testicular neoplasm
  • Testicular rupture

SourceStatPearls "Acute Scrotum Pain" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Scrotal swelling can be infective (epididymo-orchitis, which a GP can start treating) or structural (hydrocele, hernia, tumour, torsion), so the GP treats likely infection while arranging urgent review for other causes. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Scrotal swelling can be infective (epididymo-orchitis, which a GP can start treating) or structural (hydrocele, hernia, tumour, torsion), so the GP treats likely infection while arranging urgent review for other causes.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Strongly suspected testicular torsion warrants immediate emergency surgical consultation without delay, with optimal salvage within 6 hours.
  • RED FLAG - Sudden onset with severe pain, which may be testicular torsion, swelling that is hard and irregular or does not transilluminate, which may be a tumour, or fever with systemic illness.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.