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This is pretty rare before puberty. It is an acute inflammation or infection of the epididymis, a structure that lies along the spermatic cord in the scrotum. It presents as sudden painful scrotal swelling. There usually is pus in the urine. The germ that causes it is usually bacterial; we are not always successful in figuring out exactly which germ it is. The major problem with epididymitis lies in the fact that differentiation from torsion of the testicle can be very difficult. Surgical exploration is often the only way to be sure, and must be undertaken very quickly to save the testicle if torsion is present. If the problem is just infection, bed rest and antibiotics are curative.