A 22-yeаr-оld cоmplаins оf pаin in his penis and left testicle that began last night and has steadily become worse. It hurts when he urinates and he has not attempted intercourse since the pain began. He took Tylenol and ibuprofen without improvement. He does find elevating the scrotum on a folded hand-towel helps some if he's lying down. He denies any fever or night sweats. He appears mildly ill. On examination, the penis is circumcised, with no lesions or discharge from the meatus. The scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness on palpation of the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria.Which diagnosis is most likely in this case?
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