Nokea
A 22 year old male presents in your clinic, c/o pain in his testicle and penis. The pain began last night and has steadily become worse. He hurts when he urinates. He has not attempted intercourse since the pain began. He has tried Tylenol and Ibuprofen without improvement. Denies fever or night sweats. He has had 4 previous sexual partners and has had a new partner for the last month. She is using oral contraceptives and they do not use a condom. On exam, you see a young man lying on his side, mildly ill. His temp is 100.2. There are no visible lesions on the penis, or discharge from the meatus. The scrotum appears normal. Palpation of the testes reveals severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges noted with bearing down. Urine analysis shows WBCs and bacteria. What diagnosis of the male genitalia is most likely?
Correct Answer: B
Rationale: The correct answer is B: Acute epididymitis. The patient's symptoms of pain in the testicle and penis, worsened pain with urination, and presence of WBCs and bacteria in the urine analysis are indicative of an infection. The severe tenderness at the superior pole of the left testicle and tenderness on palpation of structures superior to the testicle through the scrotal wall suggest involvement of the epididymis. The risk factors of multiple sexual partners and recent unprotected intercourse also support the diagnosis of epididymitis, which is commonly caused by sexually transmitted infections. Acute orchitis (choice A) typically presents with swelling and tenderness of the entire testicle, not just the epididymis. Torsion of the spermatic cord (choice C) presents with sudden onset severe testicular pain and may have a high-riding testicle. Prostatitis (choice D) presents with symptoms related to the prostate gland, such as pelvic