History
Pain History
A thorough pain history can establish if the pain is true acute onset testicular pain fitting with testicular torsion or is referred from other pathology. Acute onset of pain is typically associated with testicular torsion with one study recently finding sudden onset of pain was seen in 90% of patients with testicular torsion, in 69% of patients with appendix torsion, in 58% of patients with epididymitis, and in 78% of patients with normal scrotums.10
Gradual onset pain is classically more likely to be torsion of the appendage, but may also correlate with a history of intermittent torsion. Previous torsion and orchidopexy (which is typically done bilaterally) makes further torsion highly unlikely.
Sexual History
Sexually transmitted infections are a common cause of epididymo-orchitis. Eliciting a sexual history can help guide treatment by revealing risk factors such as: previous sexually transmitted infection, urethral discharge, number of sexual partners in the past 12 months, men who have sex with men. Men who perform penetrative anal intercourse are also at risk of infection with enteric organisms due to exposure to gastrointestinal flora.7
Other aspects of the history
Testicular torsion typically presents in a post-pubertal male with sudden onset severe, unilateral, testicular pain. There may be a history of similar episodes of self –limiting pain indicating spontaneous torsion and detorsion (intermittent torsion). Precipitants may be related to forceful contraction of the cremasteric muscle secondary to trauma, physical exertion, an erection or sudden coldness. Associated features include: anorexia, gastrointestinal upset and fevers.11
Other causes of epididymo-orchitis to be aware of include mumps (fevers and parotid gland swelling) and vasculitides such as Buergers syndrome and Henoch-Schönlein purpura (rash and arthralgia).
The patients’ past medical history may reveal other differentials such as: hernias, renal stones, aortic abdominal aneurysm.