Scrotum Abscess

Abscess or collection of pus inside the scrotal sac is termed as scrotal abscess.

There can be many causes of getting a scrotal abscess. They include various kinds of infections in and around the scrotum.

Common Causes

  • Folliculitis on the scrotal surface
  • Testicular infection
  • Epididymitis
  • Drainage from ruptured appendix into the scrotal sac

Folliculitis

Pulled hair over the scrotal skin may infect the hair follicle. Such infections may spread to surrounding area, if left untreated. Small abscess may also be formed.

Epididymitis

The coiled tube-like canal behind the testes, that carry and store the sperms is called epididymis.

Symptoms

  • Pain in the area. This is only on the affected side. It is aggravated while you pass stool.
  • Urgency and increased frequency of urination. Act of urinating is also painful.
  • Swelling and redness over the affected scrotum
  • Enlarged lymph nodes in the inguinal area
  • Fever, mild to moderate
  • Discharge from the penis, may be with urine. Sometimes, blood may be seen in semen.

Causes

Epididymitis is most commonly cause due to some bacterial infection or STDs, like chlamydia or gonorrhea.

The infection may be confined to the epididymis or may even extend up to the testes, leading to orchitis.

Severe infections may lead to scrotal abscess.

Certain medications, like amiodarone, may inflame the epididymis to cause epididymitis.

This organ may secondarily get affected in infections like tuberculosis.

It is essential to treat the condition urgently.

If not treated, the following complications may occur-

  • Infection from the epididymis may spread to involve the testes, leading to orchitis.
  • Scrotal abscess
  • Infertility
  • The infection may become chronic, leading to chronic epididymitis.

Diagnosis

Diagnosis is made on the basis of symptoms. An ultra sound may be done to rule out other conditions which present with similar symptoms. These include testicular torsion, tumors of testes etc.

STD screening may be done.

Treatment

Appropriate antibiotics need to be given at the earliest. If pus is formed, it needs to be drained out surgically.

In cases where surgical drainage is not possible, the whole or part of the epididymis is surgically removed. This is called epididymectomy.

While being treated, bed rest is advised. The scrotum may be elevated by keeping a towel under it. Cold packs may be put to reduce inflammation over the affected scrotum.

Avoid sex till the treatment is complete.

Orchitis

Infection and subsequent inflammation of the testes is called orchitis.

Causes

Commonest cause of orchitis is viral infection due to mumps virus, especially if it occurs during teenage.

Bacterial orchitis usually occurs as a sequel of epididymitis, and may be due to STD or some other bacteria.

Symptoms

These are similar to those of orchitis. They include-

  • Pain and swelling over the affected scrotum.
  • Fever, nausea
  • Discharge from the penis
  • Ache in the groin region, especially while urination or voiding.

Treatment

Rest is advised. Inflammation is reduced by giving anti inflammatory drugs. Cold ice packs may be applied over the affected side.

Bacterial infections require appropriate antibiotics.

Scrotal abscess may occur as a complication of perforated appendix.

Medical Advice (Q&As) on “Scrotal Abscess

  1. Betty deHoop

    our son 26 y.o. had an infected hair on his scrotum, of course he tried to pop it and got a little pus out. The next day he woke with a hot node on the right side, an enlarged, very painful, reddened testicle. The skin lesion was red, hard and painful. He had a low grade fever (99). I took him to urgent care fearing a torsion. They diagnosed a skin infection behind the scrotum and gave him an antibiotic (Cephalexin). A few hours later, the pain became unbearable and I took him to the local Emergency department. They immediately got an ultrasound, negative for torsion but showing epididymus infection. He was given treatment for STI (assumed) causative agents (GC and chlamydia) an IV antibiotic (Rocephin) and an oral antibiotic (doxy) and pain medication. The next day the ER MD called to inform us that the cultures for STI were negative and gave him a different antibiotic (levoflaxacin), discontinuing the STI treatment (DOXY) but continuing the tx for the skin infection (cephalexin) The next day the scrotal hair infection burst open and had COPIOUS amounts of thick yellow pus draining from the area. The scrotum is unchanged and remained very painful. The scrotol skin lesion was evacuated, he soaked in a warm tub and washed the area thoroughly, covered with PSO and covered with a sterile dry gauze. The following morning he vomited, felt ill, and the area near the access was hard and the testicle was still warm, hard and painful. I’m worried that the ER MD did not dx the abcess and should know about it because I’m afraid the causation of the infection of the epididymus is unknown and I don’t want my son’s testicle damaged (necrotic)
    or there is another abcess or there is something else going on. Our son has a continued low grade fever (masked by pain med now) the scrotal skin abcess appears to getting better but the scrotum remains swollen, painful and the node in the inguinal right groin remains swollen. I’m going to take him back to the ED if he is not markedly improved tomorrow. (NOTE: Our son is staying with us temporarily, preparing to enter the US Navy. He did a strenuous physical test (PST) the day before all of this began and so he does not have a primary physician here thus the use of Urgent care and ED unit. I am a nurse and I just feel like something is not right-not a good feeling for a critical care nurse!
    Thanks for any help

    Reply
    1. Buddy M.D. Post author

      He still seems to have a infected focus inside the scrotal sac which needs treatment. Appropriate antibiotics, pus evacuation, and pain control will all continue till there is any evidence of pain or swelling there. Normally, it takes around 6 weeks for the condition to get alright.

      You may also consider giving him some scrotal support, like athlete cup etc. This would aid healing.

      Avoid delaying treatment. This may give the infection a chance to spread further.

      Any cough, cold or any node in the neck region?

      Reply

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