Family Nurse Practitioner Exam

A sexually active male presents with scrotal pain and dysuria. What is the most likely diagnosis?

1. Acute urinary tract infection

2. Acute pyelonephritis

3. Acute orchitis

4. Acute epididymitis

The correct answer is: Acute epididymitis

The presentation of scrotal pain combined with dysuria strongly suggests acute epididymitis as the most likely diagnosis. In acute epididymitis, inflammation of the epididymis typically causes significant discomfort in the scrotal area. This condition is often seen in sexually active males, especially those under 35, and is frequently associated with sexually transmitted infections such as Chlamydia trachomatis or Neisseria gonorrhoeae, leading to both scrotal pain and urinary symptoms like dysuria. Acute urinary tract infections primarily present with dysuria, frequency, and urgency but usually do not cause significant scrotal pain. Acute pyelonephritis involves kidney infection and would typically present with systemic symptoms such as fever, flank pain, and possibly nausea or vomiting, differentiating it from the localized pain of epididymitis. Acute orchitis, which is inflammation of the testis, could also present with scrotal pain but is less common and typically associated with viral infections like mumps or post-infectious etiologies, rather than the dysuria typically seen alongside epididymitis. Thus, considering the combination of symptoms and the common etiology, acute epididymitis stands out as the most