A 35-year-old man from India is evaluated for a 4-month history of left scrotal discomfort. On physical examination, there is tenderness throughout the left scrotum and left epididymis but with minimal swelling. He denies fever, chills, or other genitourinary or systemic symptoms. The initial workup, including urine culture and testing for chlamydia, gonorrhea, and syphilis, was negative. During the past 10 years, his only sexual activity has involved vaginal intercourse with his wife. He has no other medical problems and takes no medications aside from a daily multivitamin. He was raised in India and came to the United States at the age of 29 years. He visits his family in India every few years but otherwise denies recent travel.