An adolescent male reports sudden onset of pain and swelling in the left scrotum. The provider notes a small area of cyanosis and that the testicle is firm and high in the scrotum.

An adolescent male reports sudden onset of pain and swelling in the left scrotum. The provider notes a small area of cyanosis and that the testicle is firm and high in the scrotum. The cremasteric reflex is absent. The TWIST test total is 5. What is an important NEXT step in managing this patient? • Consideration of underlying causes of this finding • Prescribing an anti-infective of cetriaxone or doxycycline • Reassurance that this is a benign finding and may resolve spontaneously • Referral to an emergency department for immediate surgical consultation