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Sexually Transmitted InfectionsQuestion 16/20

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A 43-year-old man with HIV is evaluated in urgent care for left-sided testicular pain and fever. He denies trauma to the genital region. He reports condomless anal intercourse with 2 partners in the past month. On physical examination, the left epididymis is exquisitely tender, with some testicular swelling. A first-void urine sample reveals 17 white blood cells and positive leukocyte esterase. Results from urine culture and nucleic acid amplification testing (NAAT) for sexually transmitted infections are pending. A presumptive diagnosis of epididymitis is made based on clinical findings.

Which one of the following groups of organisms includes the pathogens most often identified as causing acute epididymitis in men who have sex with men?

This illustration shows typical findings with epididymitis—unilateral swelling and tenderness of the epididymis, often with concomitant swelling and tenderness of the testicle. With epididymitis, pain is often relieved upon lifting the testicles and scrotum (Prehn's sign). Patients with epididymitis usually have a normal cremasteric reflex (unilateral testis elevation when stroking skin on upper medial thigh).
Figure 1. Epididymitis
This illustration shows typical findings with epididymitis—unilateral swelling and tenderness of the epididymis, often with concomitant swelling and tenderness of the testicle. With epididymitis, pain is often relieved upon lifting the testicles and scrotum (Prehn's sign). Patients with epididymitis usually have a normal cremasteric reflex (unilateral testis elevation when stroking skin on upper medial thigh).
Illustration by Jared Travnicek, Cognition Studio
This illustration shows twisting of spermatic cord and reduced blood flow to the left testicle. With testicular torsion, the affected testis is usually elevated ('high riding'). In contrast to patients with epididymitis, patients with torsion have increased pain with elevation of the scrotum and testes, and they have an abnormal cremasteric reflex.
Figure 2. Testicular Torsion
This illustration shows twisting of spermatic cord and reduced blood flow to the left testicle. With testicular torsion, the affected testis is usually elevated ('high riding'). In contrast to patients with epididymitis, patients with torsion have increased pain with elevation of the scrotum and testes, and they have an abnormal cremasteric reflex.
Illustration by Jared Travnicek, Cognition Studio
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Question Last Updated
February 1st, 2025

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