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Mumps Orchitis

Review literature: (Manson, 1990).

Definition of Mumps Orchitis

Mumps orchitis is an acute viral orchitis as a complication of epidemic parotitis.

Epidemiology

Mumps orchitis develops in 30% of patients with mumps after puberty, 10–30% have bilateral manifestation.

Etiology and Pathogenesis of Mumps Orchitis

The mumps virus is a neurotropic paramyxovirus with single-stranded RNA. Orchitis leads to infiltration of lymphocytes, damage to the blood-testis barrier, edema with rise of intratesticular pressure with pressure atrophy (caused the inelastic tunica albuginea). Infertility, subfertility and hypogonadism may develop, depending on the extent of the (bilateral) disease.

Signs and Symptoms

• Incubation period: 14–25 days
• Fever, headache
• parotid inflammation (more common bilateral), cloudy saliva
• Orchitis: the scrotal symptoms occur after 4–6 days with a painful testicular swelling, in 10–30% bilateral.
• Spontaneous improvement of symptoms after 1–2 weeks

Diagnostic Workup of Mumps Orchitis

• Ultrasound and Doppler-Sonography of the testis
• In cases of clinical doubt about the diagnosis, serological diagnosis of mumps is possible.
• Surgical exploration is necessary, if testicular torsion or tumor cannot be excluded.

Differential Diagnosis of Orchitis

• Septic spread of bacterial diseases (typhoid fever, brucellosis, urogenital tuberculosis
• Continuous bacterial spread of bacterial epididymitis
• Viral infections (mumps)
• Malaria

Treatment of Mumps Orchitis

General measures:

• Bed rest
• Testicular elevation and cooling
• Non-steroidal anti-inflammatory drugs (e.g., diclofenac)

Experimental Approaches:

Leuprorelin (Vicari and Mongioì, 1995) and interferon-α (Ku et al., 1999) was successfully used to treat mumps orchitis and to prevent testicular atrophy.

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.

References

  Deutsche Version: Mumps Orchitis