Does coronavirus cause testicular pain? Man with 'stabbing' sensation tests positive after going to hospital
There is still a lot that scientists and doctors do not know about the new coronavirus. Many details are emerging, and one of them raises the question of whether COVID-19 can cause testicular pain.
In a case report, doctors from the US describe a man who was referred to the emergency department (ED) for abdominal and testicular pain, and who was subsequently found to test positive for COVID-19.
The 42 year-old-male was referred by his primary care physician for further evaluation of eight days of abdominal, testicular, and back pain. The doctors in the report did not refer to the testicular pain as a symptom, but called it an “atypical presentation of COVID-19.” The case study has been published in The American Journal of Emergency Medicine.
The patient described his symptoms as a constant stabbing pain that originated from his groin and migrated to his abdomen flank, back, and chest. He saw his personal physician one week earlier, where he was diagnosed with constipation and sent home on a bowel regimen. The pain intermittently continued with “waxing and waning severity” for eight days, which prompted his physician to refer him to the emergency department. He did not show any symptoms of COVID-19 such as cough or shortness of breath when he came to the hospital.
“Additionally, he reported subjective fevers two days before presentation. On review of systems, he denied any rhinorrhea, sore throat, cough, shortness of breath, nausea or vomiting,” say doctors from Harvard Medical School, Boston, Massachusetts General Hospital, Boston, and Mt Auburn Hospital, Cambridge.
In the physical examination, doctors did not find anything abnormal in the testicular area, although they did find some tenderness in the stomach area. The remainder of the patient's physical exam was normal.
Standard blood work, a chest radiograph, and an abdominal CT scan were done. His chest radiograph revealed no abnormal findings. While the X-ray did not show any damage to the lungs, it was captured by the CT scan. The patient was subsequently diagnosed with pneumonia. “The patient was subsequently started on cefpodoxime and azithromycin for treatment of both his colitis and pneumonia and discharged home with instruction to follow up with his physician,” says the study.
Two days after he came to the hospital’s emergency department, the patient's physician informed the hospital that the patient had tested positive for COVID-19. “The team was notified that one day prior to his ED visit, the patient had received COVID-19 testing due to his attendance at a biotechnology conference two weeks prior that was known to be the nidus of the Massachusetts outbreak,” says the report.
According to the authors, the day he came to the ED, the patient sat in the waiting room for two hours before he was sent to an examination room. The team who examined him did not wear full personal protective equipment (PPE) before he was examined. As a result, many patients and healthcare workers were exposed to the man.
In this case, timely communication regarding his COVID-19 test could have protected dozens of patients and healthcare workers, say experts. “Unfortunately, given the date of presentation, atypical features and lack of communication, we were not able to piece the findings to the patient's symptoms at that time,” say doctors.
The experts recommend that since the frequency of asymptomatic and atypical presentations of COVID-19 is not known yet in healthcare settings, medical workers must be vigilant, and consider wearing full PPE for all patients as community spread increases. “Asymptomatic and atypical presentations of COVID-19 will continue to present to the ED as the number of COVID-19 cases rises. The patient described in this case report was not demonstrating any respiratory symptoms nor was the team aware that the patient was recently tested before his ED visit. Therefore, proper PPE was not worn by the treating healthcare workers. As a result, over 25 patients and healthcare workers were notified of their potential exposure,” says the report.
Currently, personal protection equipment recommendations are in flux and it is unclear if patients outside of “flu-like symptoms” require PPE, say the doctors. Accordingly, the medical experts presented this case as a “lesson learned from the front lines and to bring awareness of atypical COVID-19 cases as they continue to present.” “As studies continue to demonstrate more patients who present asymptomatically or atypically, our need for increased guidance on PPE grows,” says the team of doctors.