3) Acute epididymal-orchitis – exclude gonococcal infections (See under genital discharge)
4) Testicular Torsion – thunderclap scrotal pain, early pubertal, diffuse scrotal tenderness, teste located high in the scrotum, swollen diffusely tender testes, transverse rotation of the testes, anterior epididymis, thickened spermatic cord, past recurrent mild similar episodes, cremasteric reflex negative (retraction of scrotum and testicle with ipsilateral stroking of the inner proximal thigh), Tx – Surgical exploration
5) Appendiceal Torsion – moderate pain developing over a few days, prepubertal, point tenderness at the upper pole of the testis, cremasteric reflex positive, Mx – bed rest an scrotal elevation
6) Epididymitis - moderate pain developing over a few days, adolescence, point tenderness over the epididymis., cremasteric reflex positive, Prehn’s sign positive (scrotal elevation relieves the testicular pain), Mx - Antibiotics