There are some common risk factors for both bacteria and viral infections that cause testicular pain. These risk factors include:  Sexual activity Strenuous physical activity, such as frequent bicycle or motorcycle riding Prolonged sitting, such as frequent travel or truck driving History of prostate or urinary tract infection Benign enlarged prostate or prostate surgery, typical in older men Anatomic defects such as a posterior urethral meatus, which occur in prepubescent boys Testicular pain from trauma, called testicular torsion, includes pain of the testicles and of the epididymis, which is the tube that runs on the underside of the testicles. To evaluate this, it requires a meticulous physical exam. If you have experienced any testicular trauma at all, especially testicular torsion caused by a twisting of the testicles, have it checked because it is a testicle-threatening problem.  Your doctor may check your Cremasteric reflex, which is absent in cases of trauma. This is done by running a reflex hammer along the inner thigh, which will cause the testicle to rise up protectively into the scrotal sac in healthy testicles.  Testicular torsion usually represents itself as an abrupt pain. Age plays a major factor in the determination of infection. Infectious causes of testicular pain include bacterial infection of the testicles and epididymis. This is due to bacteria that make their way up from the rectum, usually in men older than 35 and younger than 14. For young men between 15 and 35, the most common reason for infections of the testicles are sexually transmitted bacteria, such as Chlamydia and Gonorrhea. You will have pain when the area is touched during examination. Your doctor may check to see if elevating the testicles will ease your pain, which is referred to as Prehn’s sign.  Treatment of the infection will help with pain relief and combat any worsening of the infection and potential sepsis. The Cremasteric reflex will still occur with pain due to infections. Orchitis is due to viral infection, which causes pain and swelling in the testicle to come on abruptly. There is acute pain and swelling of the testicle. Orchitis occurs due to mumps orchitis, a viral infection seen with more prevalence as we see a lack of the MMR vaccine being given in early childhood, around 11 months. Approximately 20 to 30 % of kids with mumps will get mumps orchitis. It usually begins one week after the onset of parotitis, which is the swelling of the parotid glands beneath the jaw. There is no treatment for viral mumps orchitis and it may cause infertility. The only way to help is with supportive care, such as pain medications and ice packs. For STIs, the symptoms will likely be pain in the testicles, which may be accompanied by burning during urination. The onset of the symptoms is gradual and can take weeks for them to show up. The testicular pain may also be associated with nausea and vomiting as well as abdominal pain. You will have a normal Cremasteric reflex.  An ultrasound will show increased vascularity, pockets of infection, or abscess formations. You may also suffer from other symptoms, such as discharge or blood in the urine. The pain caused by this bacterial infection develop quickly, over a day or so. Your epididymis and testicles will swell rapidly and become enlarged, red, and tender. It will also cause great pain. You may also have a different infection, such as a urinary tract infection or urethral infection. Lab tests are helpful in detecting infection. Your doctor may test your urine for bacteria, such as E coli. If you are a sexually active young man, your doctor may run a urine multiplex polymerase chain reaction (M-PCR), which will show if you have chlamydia or gonorrhea. An ultrasound is routinely performed for all scrotal pain and swelling, in order to check for more complicated problems.
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