Are we missing mumps epididymo-orchitis?

Abstract

Mumps epididymo-orchitis has not been recorded as a cause of testicular symptoms without systemic features (including parotitis). The aim of the present study was to assess if we were missing cases in the genitourinary clinic during a previous outbreak of mumps in the community. During a prospective pilot study from November 2005 to February 2006, all patients presenting with symptoms or signs of epididymo-orchitis were studied. These patients were assessed for previous exposure to mumps virus or vaccine, and any current evidence of systemic illness. All patients included had a full sexual health screen (loop test, chlamydia polymerase chain reaction [PCR], gonorrhoea culture, HIV and Venereal Disease Research Laboratory [test]/Treponema pallidum particle agglutination assay), urinary tract infection excluded by urinalysis and mid-stream specimen of urine (MSSU) and mumps serology (Immunoglobulin M [IgM] and Immunoglobulin G [IgG]) performed. Twenty-three patients met inclusion criteria. Their ages ranged from 16 to 50 years, average 30.8 years. All had symptoms of these, 18 had testicular pain, eight swelling, (four had both pain and swelling) and three also had dysuria. On examination, 12 had tenderness, seven swelling, (two both tenderness and swelling) and six had no signs. Seventeen denied history of mumps, one patient had a record of vaccination and five described fever. None had parotid swelling. Three patients were chlamydia PCR positive, two had candida cultured, three had non-specific urethritis (>10 polymorphonuclear leucocyte/high powered field) and 13 had negative sexually transmitted infection screen (one known HIV-positive). Three had positive IgM mumps serology and two were IgG-positive. It is important to include mumps in the differential of epididymo-orchitis and to be aware of outbreaks in the community that may present with genital symptoms, as the management and partner notification will be different.

Transcriptional networks in the human epididymis

“…Though epididymitis (inflammation of the epididymis) is more commonly caused by bacteria, viruses such as rubulavirus, coxsackie‐B virus, herpesvirus (HSV), and human papilloma virus (HPV) are likely viral pathogens in the epididymis (Dejucq & Jegou, ; Kapranos et al ., ; Emerson et al ., ; Vuorinen et al ., ). While investigating the antiviral defense response mechanisms of HEE cells (Browne et al ., ), we found that the toll‐like receptor (TLR) 3 and retinoic acid‐inducible gene I (RIG‐I)‐like receptors (RLRs) are enriched in cells from the corpus and cauda regions.…”

Chronic orchitis: a neglected cause of male infertility?

“…Clinicians should be aware that orchitis may be secondary to mumps infection even in the absence of a history or clinical evidence of parotitis, as indicated by mumps‐specific serology (Philip et al. , 2006; Emerson et al. , 2007).…”

Aktuelle Aspekte der Epididymo-Orchitis

“…5 % der Patienten über einen respiratorischen Infekt innerhalb der letzten 10 Tage vor Beginn der Epididymitis [13,22]. Allerdings haben nur wenige Studien eine mögliche virale Genese untersucht [6,11,19,34,35]. In einer aktuellen Studie wurden alle Patienten ohne Nachweis bakterieller Erreger systematisch auf 23 verschiedene Viren mittels PCR-Diagnostik getestet.…”

“…In nur 2 Fällen wurden Enteroviren nachgewiesen, während Mumps trotz Diagnostik im nationalen Referenzzent-rum niemals detektiert wurde [13]. Obwohl das Mumpsvirus immer wieder in der Literatur als möglicher Erreger diskutiert wird [34], passen die Ergebnisse gut zu umfassenden epidemiologischen Daten von mehreren Tausend Fällen aus der Zeit vor Verfügbarkeit einer Vakzinierung, bei denen nach einer Parotitis primär der Hoden betroffen war und der Nebenhoden lediglich synchron oder metachron sekundär involviert war [36]. Der Nachweis von Viren im Ejakulat bzw.…”