Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. The complexity lies in the use of history, clinical examination and investigations in a restricted time frame, to identify the appropriate management path.To evaluate the literature regarding important and common differentials of acute scrotal pain with the intent to enable primary care doctors to appropriately assess and manage the acutely painful scrotum.Since there is no single feature in the history, examination or investigation that is pathognomonic in diagnosing acute scrotal pain, the triad together is pivotal in its clinical evaluation. If there is any suspicion of testicular torsion, a prompt referral to a surgeon with relevant experience or to the emergency department may salvage the testis. Epididymitis and torsion of the appendix testis may be managed conservatively once testicular torsion has been ruled out.