Tenderness and induration occurring first in the epididymal tail and then spreading
Scrotum that is not usually swollen but may be indurated in long-standing cases
Fever, malaise, and myalgia (common)
Erythema and mild scrotal cellulitis
Parotiditis typically preceding the onset of orchitis by 3-5 days
In 20-40% of cases, association with acute epididymitis
Urethral discharge preceding the onset of acute epididymitis (in some cases)
Testicular enlargement, induration, and a reactive hydrocele (common)
Elevation of the affected hemiscrotum
In children, an underlying congenital anomaly of the urogenital tract
Long-standing (>6 weeks) history of pain, either waxing and waning or constant
Normal cremasteric reflex
Dysuria, frequency, or urgency
Subclinical infections (30-40% of patients)
Reactive hydrocele (in patients with advanced epididymo-orchitis)
Nontender epididymis
Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition)
Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion)
Bacterial prostatitis or seminal vesiculitis (in postpubertal individuals)
With tuberculosis, focal epididymitis, a draining sinus, or beading of the vas deferens
Usually, no nausea or vomiting (in contrast to testicular torsion)
