A 30-year-old transgender woman presents with a 1-week history of progressive tenderness and diffuse pain in her right scrotal area, as well as moderate dysuria. Physical examination reveals extreme tenderness along the posterolateral aspect of the right testicle. No urethral discharge is noted. She is not taking any medication and denies recent trauma or prior genitourinary procedures or operations. She reports both receptive and insertive condomless anal intercourse with cisgender men and gender nonbinary partners. She denies fever, chills, hematuria, or other systemic symptoms. She tested negative for HIV approximately 6 months prior.