Mumps may present as testicular pain
Epididymo-orchitis may be secondary to mumps infection and can occur without evidence of other systemic features, including parotitis.
A prospective study found cases of mumps in men presenting with testicular pain to a GUM clinic during a mumps outbreak in the community.
Of the 23 men who met the inclusion criteria, all described symptoms of testicular pain (18), swelling (8) and/or dysuria (3). Their ages ranged from 16 to 50, with a mean age of 30.8. Seventeen patients denied having a history of mumps; one had been vaccinated. Five described preceding fever.
All patients had a full sexual health screen. In addition a mid-stream specimen of urine was taken and IgG and IgM serology for mumps antibodies was carried out.
When examined, 12 men had tenderness, seven had testicular swelling (two had both tenderness and swelling) and six had no signs. None of the men in the study had parotid swelling.
The study found that three men were positive for mumps IgM serology and two were positive for IgG.
This paper suggests that mumps should be considered as a differential diagnosis in men presenting with testicular pain suggestive of epididymo-orchitis and that GPs should be aware of outbreaks in the community.
During one winter season, we picked up two cases of mumps in our practice. Both patients were young men presenting with testicular pain and sore throat, but with no discernible parotitis. Both had immunological evidence of mumps infection.
This is a very relevant paper, especially as outbreaks of mumps and measles are now more common because of low levels of MMR uptake, affecting a cohort of young men who would not have had MMR as part of their childhood immunisation schedule.
Emerson C, Dinsmore WW, Quah SP. Are we missing mumps epididymo-orchitis? Int J STD AIDS 2007;18:341-2Reviewer
Dr Richard Ma
GP principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London