My 14 yr old Dutch Harness gelding has always had a very meaty looking sheath but recently it’s gotten bigger with ‘nipples’ on each side - not actual nipples, just looks like nipples. Plus his scrotum (on right side) now has a ball shaped swelling that looks like a descended testicle.
This weirdness all started after he recovered (very quickly with oxytet) from a mild bout of tick fever. No symptoms other than fever. Might not mean a thing = coincidence, but I thoght I’d mention it.
For some reason, and honestly I really can’t pinpoint why, that sort of edema makes me think Lyme. Maybe because a lot of “huh that’s weird” stuff seems to come with Lyme around here and resolve with Lyme treatment?
But given that he did have a recent tick fever, maybe it’s worth exploring?
I think so too – read the edema thing ‘somewhere’ ??? might have been about Potomac Fever or Lyme but I can’t remember! I’m having the vet out this week.
And the vet said … ? 
OP your photo is a question that I would drop a few bucks for a vet to check out, just to avoid bigger bills if it becomes that kind of problem. I invest in avoidance, if that makes sense.
Zero experience to offer. But following out of pure curiousity, because one never knows what will come up next with some adjacent horse. Basic extra information via COTH is always welcome. 
Yes! My late gelding had a swollen sheath and no cause was ever really found. It was chalked up to older age and inactivity.
Probably good to run a CBC at least. If I still have pictures I will post.
My Old Man did the same thing. Vet said ‘make him move more’ and it was gone in 24 hours.
These days many vets would be willing to just take a look at the photos you posted, without an in-person examination. And offer a brief comment, or else tell you they need to examine it. Worth a try to just email or text those photos and find out if your vet thinks that this is anything that matters.
My guys was pretty constant. Some days it was more swollen than others. Sort of weird I still have pictures of this 
ETA- horse was metabolic and I suspected Cushings but he passed away before I had gotten a positive test.
I’ve got a bunch of swollen sheath pics of my gelding over the years. I think the OP is wondering about experiences related to tick borne treatment. My geldings sheath issues were always superficial insect related exposure. Like ground wasps.
You have to remember the midline of a horse, especially the sheath is always prone to pooling edema from a myriad of causes
Treatment has ranged from movement to cold hosing to Dex to the last time I applied an arnica poultice to the exterior sheath. That worked a treat when the aforementioned did not.
I had two that looked like this as they got older…both ended up with a Cushings diagnosis not long after. My current gelding hasn’t had another episode of the swelling since we started prascend.
Just something else to consider.
What @Critter said. Its a sign of cushings. When my pony gets to much grass or after shots, his sheath swells juts like the picture above.
Google images of “horse hernia”. Many look like a descended testicle when they’re near the sheath area.
Yes! This happened to my guy this spring. I panicked a bit but it was lack of movement.
In the case at my stable yard a pony developed this type of sheath before a diagnosis of Equine Metabolic Syndrome.
Yes, vet is coming out – I just wanted to get some COH ideas over the weekend before she gets here.
Interestingly one of my other guys, 15 yr old OTTB, also has a bit of swelling – droopy looking sheath like a reaction to bug bites. But it’s been freezing here (I’m in NY) for weeks so no bugs.
He’s pasture buddy to the one in question (+ one other gelding who’s normal) and they are all out together in huge hilly pastures 24/7 = lots of movement.
Will report back after vet visit.
I was going to say that in my years of caring for boarder horses, those that had swollen sheaths eventually got diagnosed with Cushings. YMMV.
I am fascinated by this being an indicator of cushings. I’ve been half assedly asking for that test for years and keep getting brushed off. I am going to insist on it this spring.
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