What physical exam finding is expected in a 39-year-old male with acute epididymitis?

In a patient with acute epididymitis, the Prehn sign is often positive, which indicates that the pain decreases when the affected testicle is elevated. This phenomenon occurs because the elevation of the testis can relieve tension on the inflamed epididymis, providing temporary pain relief. The presence of a positive Prehn sign can help clinicians differentiate epididymitis from testicular torsion, where pain typically remains constant regardless of testicular position.

The other findings are not characteristic of acute epididymitis. Hematuria, for example, is more commonly associated with urinary tract infections or kidney stones rather than epididymitis. Abdominal rebound tenderness suggests peritoneal irritation, which is typically linked to conditions such as appendicitis or peritonitis rather than isolated epididymitis. A tender, boggy prostate indicates prostatitis rather than epididymitis, where the focus is primarily on the epididymis and not the prostate. Thus, the positive Prehn sign is a relevant and expected physical exam finding in this clinical scenario.