title: Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?
abstract: OBJECTIVE
  To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK.
  
  
  METHODS
  In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database.
  
  
  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. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. 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.
  
  
  CONCLUSIONS
  As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.
authors.affiliation: Department of Urology, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK. indianajoe72@yahoo.com
authors.forename: Joe
authors.initials: J
authors.lastname: Philip
authors.forename: David
authors.initials: D
authors.lastname: Selvan
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Desmond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007248:Infertility, Male / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009107:Mumps / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D009108:Mumps Vaccine / Q000627:therapeutic use; D009920:Orchitis / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D009108:Mumps Vaccine