In the latest issue of the journal BJU International, urologists in Ireland report an alarming increase in the number of teenage boys and young men developing mumps orchitis. The condition causes one or both testicles to swell and can lead to serious fertility problems.
"Boys who did not receive the measles-mumps-rubella (MMR) vaccine during the mid 1990s are now collecting in large numbers in secondary schools and colleges and this provides a perfect breeding ground for the virus," said Niall Davis at the Mater Misericordiae University Hospital in Dublin.
During the pre-vaccine era, mumps was most likely to affect children aged between five and seven, with epidemics happening every four to five years. Since the introduction of the MMR in 1968, there has been a dramatic reduction in cases, with the USA reporting a 99 percent fall. But 15 years ago there was a global shortage of the MMR vaccine and media scares about links to autism led to a reduced uptake. In some parts of the UK, uptake fell from 91 percent to 58 percent and public concern linking MMR to autism still remains high.
"It is those unvaccinated boys that we are now seeing in our urology department," says Mr Davis. "It's estimated that as many of 42 percent of patients with mumps experience at least one complication. As well as swollen testicles, these can include aseptic meningitis, acute inflammation of the brain, deafness and pancreatitis."
Key findings by Davis and his colleagues included:
- Around 50 percent of males with mumps orchitis will experience testicular atrophy, where one or both testicles reduce in size.
- Subfertility can occur in about 13 percent of patients, even if their testicles have not reduced in size.
- There is a direct link between high levels of testicular swelling and increased sperm abnormalities.
Davis stressed that doctors should be aware of this epidemiological shift and the resurgence of mumps orchitis. "They need to ensure that male patients in this high-risk group are vaccinated and educated about the risks and complications of the virus," he concluded.
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Source: BJU International