Mumps is otherwise known as epidemic parotitis and is a result of an infection with a virus belonging to the Rubulavirus genus. It initially presents with the non-specific symptoms of a headache, fever, fatigue and parotid edema that usually affects both of the glands. The term "mumps" is derived from the characteristic expression of the face assumed by patients who exhibit parotid gland edema [1].

The virus has an incubation period of 2 to 3 weeks and usually subsides on its own after supportive treatment has been administered. After the initial symptoms develop, the virus continues to circulate in the blood for approximately seven to ten days, during which period other organs are subjected to the viral load [2]. Thus, complications that involve other organs, such as pancreatitis, meningitis, orchitis and deafness tend to develop in up to half of the patients affected by mumps, with orchitis being the one most frequently diagnosed in male patients in the age before or after puberty [3].

Mumps orchitis presents approximately 10 days after the onset of the initial symptoms, but they can also be delayed for six weeks. The classical presentation involves one of the testicles, but both can be affected in up to 1/3 of the patients. Symptomatology also exhibits an exacerbation, with the onset of high-grade fever, vomiting, and headache, whereas the testicles appear edematous and tender during the physical examination. The orchitis tends to resolve within 14 days after the initial presentation and may be further complicated by atrophy, even though sterility does not often develop due to the condition [4]. Epididymitis may co-exist with mumps but is usually diagnosed before the onset of orchitis [5].

• Pain

  RESULTS: Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. [ncbi.nlm.nih.gov]

  Over-the-counter medicines like ibuprofen, naproxen and acetaminophen help to reduce the pain. If the pain is severe, then a more powerful medicine like narcotic pain killer is suggested. [findatopdoc.com]

  The severity of pain varies, a difference of larger, it is difficult to judge according to the severity of pain, the extent of testicular damage. [tcmwell.com]

• Swelling

  However, in case of scrotal swelling mumps orchitis should still be considered. Despite vaccination mumps has not been erradicated. [ncbi.nlm.nih.gov]

  It manifests a few days after the appearance of the parotid swelling, but occasionally may precede it, and rarely may present even without the parotid swelling. [jpbsonline.org]

  However, sometimes children suffering from mumps in the first 7 days after the swelling occurs around the scrotum, testicles also swelling, pain or a sense of falling, and sometimes accompanied by fever and chills. [tcmwell.com]

  Diagnosis is usually suspected due to parotid swelling and can be confirmed by isolating the virus on a swab of the parotid duct. [dbpedia.org]

• Fever

  Symptoms associated with mumps orchitis include testicular edema and pain, tenderness, high-grade fever, and vomiting. [symptoma.com]

  After 7 days of hospitalization, the patient recovered from fever and testicular pain. [ncbi.nlm.nih.gov]

  Most patients with mumps orchitis are hospitalized because of high fever and severe testicular pain. Fevers are frequent in mumps orchitis, although leukocytosis or pyuria are not evident in most patients. [synapse.koreamed.org]

  Abstract In the first book of the Epidemics Hippocrates gave this excellent description of mumps complicated by orchitis: Swellings appeared about the ears, in many on either side, and in the greatest number on both sides, being unaccompanied by fever [pediatrics.aappublications.org]

• Weakness

  · Mumps orchitis, with reduced testicular size, has been suggested as a risk factor for testicular cancer, but this association appears to be weak, with an incidence of 0.5%. [news-medical.net]

  Mumps orchitis, with reduced testicular size, has been suggested as a risk factor for testicular cancer, but this association appears to be weak, with an incidence of 0.5%. [sciencedaily.com]

  These include: Rest when you feel weak or tired. Take over-the-counter pain relievers, such as acetaminophen and ibuprofen, to bring down your fever. Soothe swollen glands by applying ice packs. [healthline.com]

• Asymptomatic

  In about one-third of cases the infection is asymptomatic and is called subclinical infection. However, these people can still transmit the virus and are therefore called virus carriers. [news-medical.net]

  Before the introduction of the mumps vaccine in the United States in 1967, 15% to 27% of infections were asymptomatic. [cdc.gov]

  There were around 6,758 cases in total in 2013 in England but this remains well below figures seen in the mumps epidemic in 2005 when the figure for England and Wales was 43,378. [ 3 ] Presentation [ 2 ] Mumps can be asymptomatic. [patient.info]

  Estimates show that between 30 percent to 40 percent of mumps cases might go undiagnosed because they’re “subclinical” and asymptomatic (don’t cause symptoms strong enough to make someone visit a doctor). [draxe.com]

• Cough

  Many had dry coughs without expectoration, and accompanied with hoarseness of voice. [pediatrics.aappublications.org]

  It is transmitted by the virus present in cough or sneeze droplets, or rarely through urine. Transmission starts before the swelling is seen and lasts about 5 days after the start of the swelling. [news-medical.net]

  Encourage the sick person to cough or sneeze into a tissue. Mumps: high-risk groups Mumps is uncommon in Australia because of our immunisation programs, but cases still occur. [betterhealth.vic.gov.au]

  Specifically, if somebody with mumps coughs or sneezes next to a person who is not immunized, the uninfected person is at risk of catching the illness. [menshealth.about.com]

  Examples of how mumps can be spread include: Sneezing or coughing. Using the same cutlery and plates as an infected person. Sharing food and drink with someone who is infected. Kissing. [medicalnewstoday.com]

• Nausea

  Seven days following the initial symptomatic treatment for fever and parotid swelling, the patient was hospitalized for fever with a temperature of 100.7°F, nausea, vomiting, and painful left scrotal swelling [Figure 2]. [jpbsonline.org]

  Symptoms usually develop within 15 to 24 days of initial infection and include: Swelling and pain in the glands in the neck and around the ears Difficulty and pain when swallowing Headaches, pains in the joints, nausea and vomiting, a high temperature [sharedjourney.com]

  In addition to pain and swelling of the testes, systemic symptoms may develop, such as malaise, fever, nausea, headache, and myalgias. [merckmanuals.com]

  Symptoms Orchitis signs and symptoms usually develop suddenly and can include: Swelling in one or both testicles Pain ranging from mild to severe Fever Nausea and vomiting General feeling of unwellness (malaise) The terms "testicle pain" and "groin pain [mayoclinic.org]

• Vomiting

  Symptoms associated with mumps orchitis include testicular edema and pain, tenderness, high-grade fever, and vomiting. [symptoma.com]

  Seven days following the initial symptomatic treatment for fever and parotid swelling, the patient was hospitalized for fever with a temperature of 100.7°F, nausea, vomiting, and painful left scrotal swelling [Figure 2]. [jpbsonline.org]

  Symptoms usually develop within 15 to 24 days of initial infection and include: Swelling and pain in the glands in the neck and around the ears Difficulty and pain when swallowing Headaches, pains in the joints, nausea and vomiting, a high temperature [sharedjourney.com]

  These are cases with pain that's hard to control with vomiting, high fever and if you are not getting better with antibiotics given by mouth. Occasionally, for bad cases, narcotics are needed for a few days. [urologyhealth.org]

• Lower Abdominal Pain

  Symptoms of mumps orchitis may include mild to severe testicular pain, swelling, tenderness, lower abdominal pain, fever, and chills. [healthcommunities.com]

  Swollen ovaries One in 20 females who get mumps after puberty experience swelling of the ovaries (oophoritis), which can cause: lower abdominal pain high temperature being sick The symptoms of oophoritis usually pass once the body has fought off the underlying [nhs.uk]

• Testicular Pain

  Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. [ncbi.nlm.nih.gov]

  Overview of Testicular Pain Testicular pain, or any pain in one or both sides of the scrotum (sac that holds the testicles), should be taken seriously. Pain in the scrotum can occur in males of any age, including newborns. [wgurology.com]

  Symptoms of mumps orchitis may include mild to severe testicular pain, swelling, tenderness, lower abdominal pain, fever, and chills. [healthcommunities.com]

  Symptoms of orchitis may include the following: Testicular swelling Testicular redness Testicular pain and tenderness Fever and chills Nausea Malaise and fatigue Headache Body aches Pain with urination In epididymo-orchitis, the symptoms may come on and [emedicinehealth.com]

• Scrotal Pain

  These glands are very sensitive and even a minor injury can cause pain or discomfort. Many types of testicular or scrotal pain need medical attention. [wgurology.com]

  Centers for Disease Control and Prevention (CDC), epididymitis is especially common in young sexually-active men and is the most common cause of acute (severe) scrotal pain in adolescent males. [healthcommunities.com]

  Men with epididymitis and orchitis typically present with a gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever. [aafp.org]

• Testicular Mass

  normal cremasteric reflex Testicular masses or swollen testicles with hypoechoic and hypervascular areas Testicular torsion Acute onset of pain, usually severe High-riding transversely oriented testis; abnormal cremasteric reflex; pain with testicular [aafp.org]

• Swelling of the Scrotum

  When to see a doctor If you have pain or swelling in your scrotum, especially if the pain occurs suddenly, see your doctor right away. A number of conditions can cause testicle pain, and some require immediate treatment. [mayoclinic.org]

Mumps orchitis is mostly diagnosed clinically since it develops following a typical presentation of mumps. Symptoms associated with mumps orchitis include testicular edema and pain, tenderness, high-grade fever, and vomiting.

A complete blood cell count (CBC) carried out on a patient affected by mumps orchitis is expected to display leucocytosis or leucopenia, alongside elevated rates of C-reactive protein. A urinalysis and culture should be carried out to exclude other bacterial infections as the cause of orchitis; patients affected with mumps orchitis usually display no abnormal findings on urinalysis or on a urethral culture. Ultrasonography can also be employed, as it can detect testicular and epididymal edema and hypervascularization in hypo-echogenic surroundings; its diagnostic value is increased when the imaging modality preferred is a color Doppler ultrasound [6].

As far as serology is concerned, immunoglobulin M (IgM) antibodies that are specific to a mumps infection can be detected in the serum after averagely 8 days following the development of the symptoms. The test's specificity, however, is low. A real-time polymerase chain reaction test (real-time PCR) is a valuable diagnostic tool for the detection of mumps with a high specificity and sensitivity. Lastly, the virus can be found in the urine and saliva within the first 13 days after symptoms have arisen [7] [8] [9].

• Chlamydia

  In young sexually active men the most common organism is chlamydia and this infection is sexually transmitted. [netdoctor.co.uk]

  Other testing may include a urinalysis and urine culture, screening for chlamydia and gonorrhea, ultrasound imaging, or blood tests. [encyclopedia.com]

In 3 of 4 patients pre-treatment examination revealed subfertility (oligoasthenospermia), while 2 to 4 months after interferon treatment, as well as during the entire followup period normospermia was found. [ncbi.nlm.nih.gov]

[…] find comprehensive information on Orchitis and Epididymo-Orchitis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful information HERE. [dovemed.com]

Prognosis of Mumps Orchitis In bilateral disease, the development of testicular atrophy with the risk of infertility is possible. Hypergonadotropic hypogonadism is possible in severe bilateral mumps orchitis. [urology-textbook.com]

References http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/mumps http://www.cdc.gov/mumps/ https://www.nlm.nih.gov/medlineplus/mumps.html#summary Further Reading Mumps Prognosis Mumps in Pregnancy [news-medical.net]

The present study has proven that the presence of antisperm antibodies does not play a role in the etiology of mumps orchitis. [ncbi.nlm.nih.gov]

Epidemiology Mumps orchitis develops in 30% of patients with mumps after puberty Etiology of Mumps Orchitis Mumps virus is a paramyxovirus with a single-stranded RNA. [urology-textbook.com]

(Etiology) Causes of acute orchitis: Viral infection: Mumps orchitis was once the most common cause. [dovemed.com]

In patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome, fungal and viral etiologies, including cytomegalovirus, have been reported. 7, 8 Noninfectious etiologies of epididymitis have been identified in numerous groups [aafp.org]

Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility. © 2010 THE [ncbi.nlm.nih.gov]

Following a review of the literature (epidemiology and statistics of mumps, frequency of orchitis, survey of the morphology and endocrine functions of the testicle, sterility, and hormonal imbalances following mumps orchitis), attention is directed to [popline.org]

Here we review the epidemiology, clinical presentation, diagnostic methods, treatment options and complications of mumps orchitis, as a complication of mumps virus, with particular emphasis on testicular atrophy, subfertility and infertility. [unboundmedicine.com]

Epidemiology Mumps orchitis develops in 30% of patients with mumps after puberty Etiology of Mumps Orchitis Mumps virus is a paramyxovirus with a single-stranded RNA. [urology-textbook.com]

Author information Affiliations Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Boulevard, Suite 550, Rockville, MD 20852-7234, USA B Trabert & K A McGlynn [nature.com]

The etiology and pathophysiology of testicular dysfunction in man. Fertil Steril 1978; 29 : 481-91 [ PubMed ] [ Google Scholar ] 12. Erpenbach K. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology Epididymitis is the most common cause of intrascrotal inflammation, 5 and retrograde ascent of pathogens is the usual route of infection. [aafp.org]

CONCLUSIONS: Systematic treatment with interferon-alpha-2B does not seem completely effective in preventing testicular atrophy after mumps orchitis. Further investigations involving larger populations are needed. [ncbi.nlm.nih.gov]

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