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Testicular Torsion Mimic — SCE Infectious Diseases MCQ

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EasySTIsTesticular Torsion MimicSCE Infectious Diseases

A 28-year-old man presents with acute scrotal pain. On examination, the left testis is tender, swollen, and high-riding with an absent cremasteric reflex. Doppler ultrasound shows absent blood flow to the left testis. NAAT for STIs is pending. What is the most important immediate action?

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Correct answer: A — Urgent surgical exploration for suspected testicular torsion — this is a urological emergency, NOT an infection

A high-riding, horizontally oriented testis with absent cremasteric reflex and absent blood flow on Doppler is testicular torsion until proven otherwise. This is a urological emergency — viability drops to <10% after 12 hours of ischaemia. The presentation can mimic epididymo-orchitis but the absent blood flow is the key distinguishing feature. In a young man presenting to sexual health services with acute scrotum, torsion must be excluded before diagnosing infection. ID/GUM clinicians must recognise this surgical emergency.

Reference: NICE CKS 2024 – Testicular torsion; BASHH 2020 – Acute scrotal pathology