What condition is suggested by sudden onset testicular pain with a negative cremasteric reflex?

Sudden onset testicular pain combined with a negative cremasteric reflex strongly suggests testicular torsion. Testicular torsion occurs when the spermatic cord becomes twisted, cutting off the blood supply to the testicle. This condition typically presents with severe, acute pain and often occurs without any preceding trauma.

The cremasteric reflex is a protective reflex that causes the scrotum to contract and elevate the testicle on the side of light touch or stimulation on the inner thigh. In cases of testicular torsion, this reflex is usually absent because the underlying condition affects the nerve supply to the area.

In contrast, conditions like epididymitis generally present with gradual onset of pain, and the cremasteric reflex is typically intact. Testicular cancer may present with a painless mass rather than acute pain, and appendicitis primarily involves abdominal pain rather than isolated testicular pain. Thus, the presentation of sudden severe testicular pain and an absent cremasteric reflex aligns most closely with testicular torsion.