What differentiates epididymitis from testicular torsion?

• A. Presence of fever and pyuria
• B. Absence of cremasteric reflex
• C. Severe pain with nausea
• D. Location of tenderness in the abdomen

Answer: (A)

Epididymitis is an inflammation of the epididymis, commonly associated with symptoms such as fever, dysuria, and pyuria, which indicates an infection. The presence of fever and pyuria helps to differentiate it from testicular torsion, which is more characterized by sudden onset severe scrotal pain without accompanying fever and does not typically involve urinary symptoms.

In testicular torsion, patients usually present with acutely severe pain and may have associated nausea, but fever and pyuria are not present because it is not an infectious process. The cremasteric reflex may still be present in cases of epididymitis, whereas it is often absent in testicular torsion. The location of tenderness also typically differs, with pain more localized to the testicle in torsion, while epididymitis may have tenderness that is more diffuse and perhaps involves the surrounding area due to inflammation.

Therefore, the presence of fever and pyuria is a key indicator of epididymitis, making it the correct choice in distinguishing it from testicular torsion.