# Swelling of the Testis or Scrotum

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- 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 date: 2026-08

## Verified against

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

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
SWELLING OF THE TESTIS OR SCROTUM
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
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Acute
               Scrotum Pain - disease-level clinical article (testicular-scrotal-
               swelling-clinical.txt)  (2026-08)

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
  Source  StatPearls "Acute Scrotum Pain" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    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
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   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.
   Caution  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.
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