Gbenga had been lifting car engines for a week and assumed he had strained something. Five days of escalating testicular pain with swelling changed his mind. Mascot Healthcare identified chlamydial epididymitis and treated it before it could cause fertility-threatening complications.
Auto mechanic, Mushin. Presented with 5-day history of right testicular and epididymal pain, scrotal swelling, and mild fever. Initially dismissed as "strained" from heavy lifting. Chlamydia NAAT positive.
Epididymitis (Chlamydia trachomatis)Gbenga works in a mechanic workshop. Lifting, straining, and bending are normal. When his right testicle began aching on a Monday, he logged it under "occupational strain" and kept working. By Wednesday it was worse. By Friday — the fifth day — his scrotum was visibly swollen and he had a fever.
His girlfriend told him to go to a clinic. He went to a pharmacy first; they gave him ibuprofen and said it would settle. On Saturday morning, with the swelling unchanged and pain worse when he coughed, he came to Mascot Healthcare.
The doctor examined him on the couch. The testis itself was non-tender. The epididymis — the coiled tube attached to the back of the testis — was extremely tender. "This is not strain," the doctor said. "This is epididymitis — infection of the tube behind the testis."
Epididymitis — inflammation of the epididymis — can cause permanent damage to the sperm-transporting tube if untreated. Early diagnosis and antibiotic treatment preserve fertility.
Gradually worsening dull ache in the right scrotum, radiating to the groin.
The epididymis (posterior to the testis) was exquisitely tender on palpation — the key clinical finding.
The right scrotum was visibly swollen and warm — consistent with inflammation.
Low-grade fever indicating the body's inflammatory response.
A small amount of clear discharge noticed in the underwear — pointing to urethral infection origin.
Ibuprofen 400 mg TDS — partial pain relief; no anti-infective effect.
Scrotal support (tight underwear) — appropriate comfort measure; not treatment.
Rest from heavy lifting — appropriate but insufficient.
Assumed occupational cause — delayed presentation by 5 days.
Scrotal ultrasound confirmed epididymal enlargement and increased blood flow on Doppler — consistent with acute epididymitis. The testis itself was normal. Testicular torsion (a surgical emergency) was excluded clinically and on Doppler.
Urethral swab for chlamydia and gonorrhoea NAAT was taken — chlamydia positive, gonorrhoea negative. Treatment: an extended course of medication (longer than for simple urethritis). A painkiller for pain relief, and scrotal support.
His partner was informed and treated concurrently. Gbenga was advised to abstain from sexual activity for the duration of treatment.
Acute Epididymitis — Chlamydia trachomatis (NAAT positive); testicular torsion excluded on Doppler ultrasound
Extended course of medication; a painkiller for pain relief; scrotal support; partner treatment; abstinence during treatment; follow-up
Significant improvement by day 7. Complete resolution of swelling and tenderness by day 14. Test of cure at day 21: chlamydia NAAT negative.
Full clinical resolution within 2 weeks. Gbenga's partner was treated simultaneously — confirmed cleared at 3 weeks. No recurrence at 2-month review.
Testicular pain with epididymal tenderness in a sexually active young man is epididymitis until proven otherwise. It is an STI complication with fertility consequences if undertreated.
Distinguishing epididymitis from testicular torsion is critical — torsion is a surgical emergency. Doppler ultrasound differentiates the two quickly.
Testicular pain with a fever in a sexually active man isn't a strain — it may be epididymitis. Get it assessed within 24 hours.
Walk in to Mascot Healthcare, Akoka — same-day consultation, transparent pricing, 4.9★ rated.