Testicular pain could be a rare sign of Covid, doctors have claimed after a 49-year-old tested positive with no other symptoms.
The anonymous man, from Turkey, sought medical advice because of swelling and pain in the left side of his groin and testicles in the summer.
He did not have any symptoms of the coronavirus, such as a persistent cough or high temperature.
However, doctors decided to swab him for the disease because he was in contact with someone who had later tested positive.
Results showed he had coronavirus, therefore the doctors suspected the testicular pain was his first symptom. They said he didn’t have any other health problems that could have caused it, such as an STI.
Doctors who reported the ‘unusual case’ in a medical journal said it shows how the coronavirus can take hold in people differently.
It is not clear how many men suffer testicular pain as a symptom of Covid-19. One small study in China suggested it was as common as one in five.
Scientists have raised concerns the virus could enter the testicles, where sperm is produced, and cause ‘long-term damage’. But so far there is little evidence of this happening, and none to suggest the virus can be spread through semen — the fluid which carries sperm.
A 49-year-old man’s testicular pain turned out to be a sign of Covid-19 (stock)
Ultrasound image used by the doctors to show increased inflammation along the spermatic cord (black arrows)
The story was reported in the medical journal Urology Case Reports by doctors at Acıbadem Mehmet Ali Aydinlar University in Istanbul, Turkey.
Dr Hakan Özveri and colleagues said the man’s testicular pain appeared to be the ‘first clinical sign of Covid-19’.
The man went to the hospital with a ‘swelling sensation’ and pain in the left side of his groin and testicles that had started earlier that day.
At first, his discomfort was intermittent. But after a few hours, it had become more severe and spread further up to his stomach.
Examination of his genitals revealed tenderness in the left spermatic cord, which runs through the abdominal region down into the testes.
The man reported that it hurt to touch his nether region — but there was no visible signs of inflammation on the skin.
Doctors were unable to give an explanation for his symptoms, with tests for STIs that can cause testicular pain, including chlamydia, coming back negative.
There was no indication he had an urinary tract infection or orchitis — inflammation of the testicles usually triggered by a virus or bacterial infection.
Dr Özveri and team wrote: ‘Covid-19 is a viral infection which predominantly attacks [the] respiratory organs.
‘However, as in our case, patients can exhibit various symptoms in organs other than the lungs, such as in genitals.
‘Patients with isolated genital symptoms such as testicular/spermatic cord pain and discomfort without other systemic symptoms should be closely followed for Covid-19.’
The man was hospitalised for treatment of Covid-19 even though he was not critically ill. He was given a five-day course of hydroxychloroquine — an anti-malarial drug which has been under trial for the potential of fighting the virus.
He was also given azithromycin and imipenem/cilastatin — two antibiotics used to treat a number of bacterial infections — despite the fact doctors insisted he did not have any other infection.
On the second day of his treatment, the man no longer complained about having any pain in his testicles.
But it took more than three weeks for him to clear coronavirus from his system. He returned home after 24 days in hospital.
It’s not the first time a link between the coronavirus and pain in the scrotum or groin area has been reported by doctors.
In July, American doctors reported a 43-year-old man from Massachusetts had only testicular pain needing hospital attention before a positive Covid-19 test.
In November, it was reported a man in Italy had ‘uncontrollable testicular pain’ before he died of Covid-19 several days later. He also suffered shortness of breath.
It’s not clear just how common the problem is because there have been no large-scale studies of both mild and seriously ill Covid-19 patients.
Scientists led by Huazhong University of Science and Technology, Wuhan, found that during Covid-19 illness, up to a fifth of infected men may have pain in the testes.
Six of the 34 men in China they studied complained of the symptom, the researchers reported in April.
The researchers said the significance remains unclear, noting that other viruses, such as mumps, HIV, and herpes, can cause inflammation in the testicles (orchitis).
Because the team did not look at semen during illness, they could not rule out that the coronavirus can spread during sex via semen.
Doctors from the San Antonio Uniformed Services Health Education Consortium in Texas have previously warned the damage caused by Covid-19 could have ‘a future impact on male fertility’.
They reported the virus had damaged the spermatocytes, which keep sperm healthy, of a 37-year-old man.
But no study has yet conclusively proven the virus can damage a man’s reproductive organs, reduce fertility or sexual potency.
Scientists say it is theoretically possible because of how the SARS-CoV-2 virus enters cells — through a receptor called ACE2.
ACE2, which acts as a the doorway for the virus to enter cells in various parts of the body, is found in abundance in the testicles.
But there is no proof the coronavirus travels through the body and replicates in the testes.
Another explanation for testicular pain in Covid-19 males is that the coronavirus travels in the bloodstream to reach the testes.
But this is ‘not generally’ what coronaviruses does, according to virology professor Ian Jones at the University of Reading.
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