How mumps affect male fertility

Mohammad Raheem who is in his mid-20s started having difficulty in his throat while having breakfast. He became very worried about how it would affect his preparation for his semester examination, especially after he began to experience tiredness, headache and feverish conditions. Strange as the diagnosis was to him, he was told by a medical […]

Mohammad Raheem who is in his mid-20s started having difficulty in his throat while having breakfast. He became very worried about how it would affect his preparation for his semester examination, especially after he began to experience tiredness, headache and feverish conditions.

Strange as the diagnosis was to him, he was told by a medical doctor that he was battling mumps. “What is mumps?” He asked.

According to Dr Abdulhameed Abioye Abdulazeez, mumps is an acute, self-limited, systemic viral illness characterised by the swelling of one or more of the salivary glands, typically the parotid glands, adding that it is caused by the Rubulavirus (RNA) which is within the genus paramyxovirus and a member of the family paramyxoviridae.

Speaking on its transmission and symptoms, Dr Abdulazeez said humans were the sole reservoir for the mumps virus, with person to person transmission via respiratory droplets, saliva, direct contact or fomites.

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He said the presence of maternal antibodies typically protected infants younger than 12 months old from the disease, while infections could be symptomatic in 20 to 30 per cent of persons.

He said of those with symptomatic infection, adults tended to be more severely affected when compared to children, adding that lifelong immunity usually followed clinical or subclinical mumps infection, although that the second infections had been documented.

The medical expert said mumps had an incubation period of 16 to 18 days, but that cases could arise 12 to 25 days after exposure.

He said, “After this period, prodromal symptoms (such as low-grade fever, malaise, myalgias, headache and anorexia) occur and can last three to five days. After this prodromal period (about 48 hours), the clinical path of the virus depends on which organ is affected.

“The most common presentation is parotitis (an inflammation of one or both parotid glands. Parotid glands are salivary glands located between your jaw and ear on either side of the face, in humans) which occurs in 30 to 40 per cent of all patients and in 95 per cent of those who are symptomatic.

“Parotitis is caused by direct viral infection of the ductal epithelium and presents with localised gland inflammation. Other reported sites of infection are the central nervous system (CNS), eyes, pancreas, kidneys, testes, ovaries and joints.”

According to him, mumps is the only known cause of epidemic parotitis used as a clinical parametre of maximum communicability of the mump virus.

He noted that a patient was considered infectious from about three days before the onset of and up to four days after the start of active parotitis (although it has been suggested that the communicable period is actually longer, lasting from six days before, to nine days after, facial swelling is apparent).

Despite the classic correlation of mumps and parotitis, Dr Abdulazeez said mumps was no longer the most common cause of parotid swelling, adding that other viral causes included cytomegalovirus, parainfluenza virus 1 and 3, influenza A and HIV.

He said bacterial infections, drug reactions and metabolic disorders could also cause parotitis.

How mumps affect fertility in men

On how mumps affect fertility in men, Dr Abdulazeez, who is also a registrar at the Department of Anaesthesia, Federal Medical Centre (FMC), Bida, Niger State, said, “About one third of post-pubertal male patients develop unilateral orchitis.

“Orchitis (an inflammation of one or both testicles) is the most common complication of mumps infection in adult males. This inflammation usually follows parotitis but may precede or occur in the absence of parotid gland swelling. Orchitis usually appears during the first week of parotitis, but it can occur in the second or third week. Bilateral orchitis occurs less frequently (about 10 per cent of cases). Gonadal atrophy (wasting of the testicle – the male gonad – manifested by a decrease in size and potentially by a loss of fertility) may follow orchitis and poses a greater risk with bilateral involvement.

However, he said sterility was rare as, “Prepubertal boys may develop orchitis, but it is uncommon in boys younger than 10 years old. Orchitis presents with high fevers (39 to 41°C), severe testicular pain accompanied by swelling and erythema of the scrotum. Nausea, vomiting and abdominal pain are often present. Fever and gonadal swelling usually resolve in one week, but tenderness may persist.

“Retrospective case studies have investigated a possible link between mumps, orchitis and the subsequent development of testicular cancer; no increased risk has been shown to date,” adding that oophoritis  (inflammation of the oviduct, cervix and vagina) occurs in about  seven per cent of post-pubertal female patients.

On prevention, the medical expert said there was a need to ensure immunisation against it and for children to complete their immunisation.

He said, “We should also limit our international travel to mumps-free zones at a particular time, balance our diets to boost immunity and for parents and educators to exclude infected children from large-population facilities until nine days after parotid swelling begins or swelling subsides, while children and adults should imbibe good hand washing practices.

Treatment

He stressed that mumps without associated major complications could be managed on an outpatient basis with supportive health guidance and continuity of care.

Patients diagnosed with mumps, Abdulazeez noted, should be isolated for five days from the onset of symptoms to minimise the risk of infecting others.

He said that conservative, supportive medical care was indicated for patients, adding that, “No antiviral agent is indicated for treatment of the viral illness which is a self-limited disease (diseases that go away on their own).”

While stating that a light diet with generous/oral fluid intake was essential, he said maintenance of adequate hydration and alimentation of patients was important.

He advised against acidic foods and liquids which might cause swallowing difficulty, as well as gastric irritation. Bed rest, he noted, was recommended to foster a speedy recovery and indicated for patients with complicated cases.

While prescribing analgesics (acetaminophen, ibuprofen) for headaches or discomfort due to parotitis, Dr Abdulazeez said, “Topical application of warm or cold packs to the swollen parotid area may soothe the region.”

He noted that stronger analgesics might be required for patients with orchitis and recommended bed rest, scrotal support and ice packs in some cases.

He said patients with specific complications might require inpatient care for intravenous fluid stabilisation, pain management and continuous close observation.

But in the case of patients with meningitis, encephalitis, myocarditis, nephritis, or severe pancreatitis, Dr Abdulazeez said such required a higher level of inpatient supportive care.

Consultation and transfer

The medical expert said consultation might be considered in complicated cases involving multiple organs, adding that medical and treatment guidance from specialists in critical care, infectious disease, neurology, cardiology, gastroenterology and urology might be indicated.

He said transfer to a medical facility with a higher level of care was rarely indicated: “This action is warranted, if major complications are present and the current medical facility cannot properly support the patient’s treatment needs.”