Mumps: Symptoms, Causes & Complete Treatment Guide

What Is Mumps and What Causes It?

Mumps is an acute viral infection caused by the mumps virus (a paramyxovirus). It primarily affects the parotid glands, which are the largest salivary glands located just in front of and below each ear. The virus spreads through respiratory droplets when an infected person coughs, sneezes, or talks, and can also spread through contact with contaminated surfaces.

Mumps, also known medically as epidemic parotitis or infectious parotitis, has been recognized as a disease for centuries. Before the introduction of widespread vaccination programs, mumps was one of the most common childhood infections worldwide, affecting millions of children each year. The development and implementation of the MMR (measles, mumps, rubella) vaccine has dramatically reduced the incidence of mumps in most developed countries.

The mumps virus belongs to the genus Rubulavirus within the family Paramyxoviridae. It is an enveloped, single-stranded RNA virus that can survive for short periods outside the human body on surfaces and objects. Once the virus enters the body through the respiratory tract, it travels to the lymph nodes where it replicates before spreading through the bloodstream to various organs, with a particular affinity for the salivary glands, especially the parotid glands.

Understanding the nature of mumps is important because, despite the effectiveness of vaccination, outbreaks continue to occur globally. These outbreaks often happen in close-contact settings such as universities, sports teams, and communities with lower vaccination rates. The disease remains endemic in many parts of the world where vaccination coverage is insufficient, highlighting the ongoing importance of public health vaccination programs.

Why Has Mumps Become Less Common?

The dramatic decline in mumps cases since the 1960s is directly attributable to the introduction and widespread use of the MMR vaccine. In countries with robust childhood vaccination programs, mumps has transformed from a near-universal childhood experience to a relatively rare disease. Most countries that include the MMR vaccine in their national immunization schedules report fewer than a few dozen cases per year, a stark contrast to the hundreds of thousands of annual cases seen before vaccination.

However, mumps has not been eliminated. Periodic outbreaks continue to occur, often affecting young adults in their twenties and thirties who may have incomplete immunity. This can happen because some individuals received only one dose of the vaccine instead of the recommended two, their vaccine-induced immunity has waned over time, or they never received the vaccine at all. Additionally, no vaccine provides 100% protection, so even fully vaccinated individuals can occasionally contract mumps, though their symptoms tend to be milder.

Who Is Most at Risk for Mumps?

While anyone can get mumps, certain groups face higher risk. Unvaccinated individuals have the highest risk of infection. People in close-contact environments such as college dormitories, military barracks, and athletic teams are more likely to be exposed during outbreaks. International travelers visiting countries with endemic mumps or lower vaccination rates also face increased risk. Additionally, healthcare workers who may come into contact with infected patients need to ensure their immunity is up to date.

What Are the Symptoms of Mumps?

The classic symptoms of mumps include painful swelling of one or both parotid (salivary) glands, causing characteristic puffiness in the cheeks and jaw area. Other symptoms include fever, fatigue, headache, loss of appetite, and muscle aches. Symptoms typically appear 16-18 days after exposure, though some infected people remain asymptomatic.

The clinical presentation of mumps can vary significantly from person to person. Some individuals experience classic symptoms that make diagnosis straightforward, while others have atypical presentations or no symptoms at all. Studies suggest that approximately 20-30% of mumps infections are asymptomatic, meaning the infected person shows no signs of illness despite being able to spread the virus to others.

In those who do develop symptoms, the illness typically follows a predictable progression. The initial phase, known as the prodrome, begins with nonspecific symptoms that can easily be mistaken for other viral illnesses. Over one to two days, patients may experience low-grade fever, general malaise, headache, muscle aches, and loss of appetite. These early symptoms are followed by the distinctive salivary gland involvement that characterizes mumps.

The hallmark of mumps is parotitis, or inflammation of the parotid glands. These glands are the largest of the salivary glands and are located just in front of and below each ear, extending toward the angle of the jaw. When inflamed, they cause visible swelling that can give the face a characteristic "chipmunk-like" appearance. The swelling typically begins on one side and progresses to involve the other side within a few days in approximately 70% of cases with parotitis.

Classic Symptoms of Mumps

• Parotid gland swelling: Painful swelling of one or both cheeks, typically starting on one side and spreading to the other within 1-3 days
• Fever: Temperature elevation ranging from mild (38°C/100.4°F) to moderate (39.5°C/103°F), usually lasting 3-4 days
• Pain when chewing or swallowing: Discomfort that worsens when eating, especially acidic or sour foods
• Earache: Pain radiating to the ear on the affected side due to proximity of parotid gland
• Difficulty opening mouth: Trismus or jaw stiffness from gland swelling
• Fatigue and malaise: General feeling of tiredness and unwellness
• Headache: Ranging from mild to moderate intensity
• Loss of appetite: Often due to pain when eating

The pain associated with parotid swelling is often most severe at the beginning and gradually improves over several days. The pain typically worsens when eating, particularly when consuming acidic or sour foods like citrus fruits or pickles, because these foods stimulate saliva production and increase pressure within the inflamed gland. Patients often describe a sharp, shooting pain when they first bite into food.

Symptoms in Children vs. Adults

While the core symptoms of mumps are similar across age groups, there are notable differences in how children and adults experience the disease. Children typically have milder symptoms and are less likely to develop complications. Their fever tends to be lower, the parotid swelling may be less pronounced, and they generally recover more quickly with fewer lingering effects.

Adults tend to experience more severe symptoms and have a significantly higher risk of complications. Adult patients often report more intense pain, higher fevers, and longer duration of illness. More importantly, complications such as orchitis, oophoritis, and meningitis occur much more frequently in adults than in children. This is why adult mumps infections require closer monitoring and why vaccination in childhood is so important.

Submandibular and Sublingual Gland Involvement

While the parotid glands are most commonly affected, mumps can also involve the other salivary glands. The submandibular glands, located beneath the jaw, are affected in approximately 10% of cases. When these glands swell, patients may experience swelling and tenderness under the chin and jaw. The sublingual glands, located under the tongue, can also be involved, though this is less common. Swelling of these glands can cause difficulty speaking and swallowing.

How Does Mumps Spread and How Contagious Is It?

Mumps is highly contagious and spreads primarily through respiratory droplets when an infected person coughs, sneezes, or talks. The virus can also spread through direct contact with saliva or contaminated surfaces. A person with mumps is contagious from about 2 days before to 5 days after the onset of parotid swelling.

The mumps virus is remarkably efficient at spreading from person to person. When someone with mumps coughs, sneezes, talks, or even laughs, they release tiny droplets containing the virus into the air. These droplets can be inhaled by people nearby or can land on surfaces where the virus can survive for a short time. If someone touches a contaminated surface and then touches their nose, mouth, or eyes, they can become infected.

The contagious period for mumps begins approximately two days before symptoms appear, which is particularly problematic for disease control because people can unknowingly spread the virus before they realize they are sick. The contagious period continues until about five days after the onset of parotid gland swelling. During this time, infected individuals should avoid contact with others, especially those who are unvaccinated or immunocompromised.

The incubation period for mumps, meaning the time between exposure to the virus and the onset of symptoms, ranges from 12 to 25 days, with an average of 16 to 18 days. This relatively long incubation period means that outbreaks can spread significantly before the first cases are identified, as infected individuals may expose many others during the weeks before they develop symptoms.

How Long Does Mumps Last?

For most people, mumps is a self-limiting illness that resolves within one to two weeks. The acute phase, with fever and the worst of the parotid swelling and pain, typically lasts about a week. The swelling gradually decreases over the following days, though some residual swelling may persist for up to two weeks. Complete recovery, including return of normal energy levels, usually occurs within two to three weeks of symptom onset.

When Should You See a Doctor for Mumps?

You should see a healthcare provider if you suspect you have mumps, especially to confirm the diagnosis and receive guidance on isolation. Seek immediate medical care if you develop severe headache, stiff neck, high fever, testicular pain or swelling, severe abdominal pain, confusion, or difficulty swallowing or breathing.

While most cases of mumps resolve on their own without requiring specific medical treatment, there are several important reasons to seek medical evaluation. First, a healthcare provider can confirm the diagnosis through clinical examination and laboratory testing. Second, mumps is a notifiable disease in most countries, meaning cases must be reported to public health authorities to help track and control outbreaks. Third, a doctor can monitor for potential complications and provide guidance on symptom management.

In many countries, healthcare providers are required by law to report confirmed or suspected cases of mumps to public health authorities. This reporting system helps track disease patterns, identify outbreaks, and implement control measures to protect the broader community. When you seek medical care for suspected mumps, you're not only helping yourself but also contributing to public health surveillance efforts.

What to Expect at the Doctor's Visit

When you visit a healthcare provider with suspected mumps, they will typically begin with a thorough medical history and physical examination. They will ask about your symptoms, when they started, and whether you have been in contact with anyone known to have mumps. They will also inquire about your vaccination history, as this information is important for assessing your risk and guiding testing decisions.

During the physical examination, the doctor will carefully examine your neck and jaw to assess the salivary glands, check for fever, and look for signs of complications. They may also examine your abdomen and, in male patients, check for testicular involvement.

How Is Mumps Diagnosed?

Mumps is diagnosed through a combination of clinical presentation (characteristic parotid swelling), medical history (vaccination status, exposure history), and laboratory testing. Laboratory confirmation includes viral RNA detection by PCR from saliva, urine, or blood samples, as well as serological testing for mumps-specific IgM and IgG antibodies.

The diagnosis of mumps often begins with recognition of the characteristic clinical picture: bilateral or unilateral parotid swelling in someone with a history of potential exposure to the virus. However, because other conditions can cause salivary gland swelling, laboratory confirmation is important, especially in vaccinated populations where mumps is less common and other causes should be ruled out.

The most reliable method for confirming mumps is the detection of the mumps virus itself through polymerase chain reaction (PCR) testing. This test can identify the genetic material of the mumps virus in samples collected from the patient. The best samples for PCR testing are obtained from the buccal (cheek) area or from saliva, collected as early as possible after symptom onset, ideally within the first three days of parotitis. Urine samples can also be used and may be positive for a longer period after symptom onset.

Serological testing, which looks for antibodies against the mumps virus in the blood, can also help confirm the diagnosis. The presence of mumps-specific IgM antibodies suggests a recent or current infection, while IgG antibodies indicate past infection or vaccination. However, interpreting serological results can be complex in vaccinated individuals, who may already have detectable IgG antibodies from their vaccinations.

Testing in Vaccinated Individuals

Diagnosing mumps in vaccinated individuals presents unique challenges. Vaccinated people who contract mumps may have a modified immune response that can affect test results. They may have lower viral loads, making PCR detection more difficult, and their serological responses may be atypical. For this reason, healthcare providers often use a combination of testing methods and clinical judgment when evaluating suspected mumps in vaccinated patients.

How Is Mumps Treated?

There is no specific antiviral treatment for mumps. Since it is a viral infection, antibiotics are not effective. Treatment is supportive and focuses on relieving symptoms through rest, adequate hydration, pain relievers like paracetamol or ibuprofen for fever and pain, and soft foods that are easy to chew and swallow.

The management of uncomplicated mumps focuses on supportive care to help patients feel more comfortable while their immune system fights off the virus. Most people with mumps can be treated at home with simple measures that address their symptoms. The good news is that the vast majority of mumps infections resolve completely without any lasting effects.

Rest is essential during the acute phase of illness. The body needs energy to fight the infection, and adequate rest helps support the immune response. Patients should limit physical activity, especially if they have fever, and allow themselves to sleep as much as needed. As symptoms improve, activity can gradually be increased.

Hydration is equally important. Fever increases fluid loss, and the difficulty eating that comes with parotid swelling can lead to reduced fluid intake. Patients should drink plenty of water, clear broths, and other fluids. Acidic beverages like orange juice should be avoided as they can increase pain by stimulating saliva production in the inflamed glands.

Pain and Fever Management

Over-the-counter pain relievers can help manage the discomfort associated with mumps. Paracetamol (acetaminophen) is often the first choice for both fever and pain relief. It can be given to children over three months of age, following package directions for appropriate dosing based on age and weight. Ibuprofen is another option that provides both pain relief and anti-inflammatory effects; it can be used in children over six months of age.

For children under 18 years old, aspirin (acetylsalicylic acid) should be avoided unless specifically recommended by a healthcare provider. Aspirin use in children with viral infections has been associated with Reye's syndrome, a rare but serious condition affecting the liver and brain.

When Hospitalization May Be Needed

Most people with mumps can recover at home with supportive care. However, hospitalization may be necessary if complications develop. Patients with meningitis, encephalitis, severe orchitis, or pancreatitis may require hospital admission for closer monitoring, intravenous fluids, pain management, and treatment of complications. Patients who are unable to maintain adequate hydration due to severe pain or vomiting may also need hospitalization for intravenous fluid support.

What Are the Possible Complications of Mumps?

While most mumps infections resolve without complications, serious complications can occur, especially in adults. These include meningitis (inflammation of brain membranes), encephalitis (brain inflammation), orchitis (testicular inflammation affecting 15-30% of post-pubertal males), oophoritis (ovarian inflammation), pancreatitis, and rarely, permanent hearing loss.

The risk of complications from mumps increases significantly with age, which is one reason why adult infections tend to be more concerning than childhood cases. While children typically recover from mumps without any lasting effects, adults, particularly those who contract the disease after puberty, face a substantially higher risk of developing one or more complications.

It's important to understand that even with complications, most people ultimately recover completely. However, some complications can be serious and require medical attention. Being aware of the signs of complications allows for prompt medical care when needed.

Orchitis (Testicular Inflammation)

Orchitis is one of the most common complications of mumps in males who have passed puberty, affecting approximately 15-30% of post-pubertal male patients. It typically develops within the first week after the onset of parotid swelling, though it can occasionally occur before the parotid symptoms or in the absence of parotid involvement altogether.

Symptoms of orchitis include sudden onset of testicular pain and swelling, usually affecting just one testicle but occasionally involving both. The affected testicle becomes enlarged, tender, and warm to the touch. Patients often experience accompanying symptoms such as high fever, nausea, and significant discomfort.

While orchitis can cause some degree of testicular atrophy (shrinkage) in up to half of affected men, complete sterility is rare. Most men who experience mumps orchitis retain their fertility, especially when only one testicle is affected. Even bilateral orchitis rarely results in complete infertility, though it may reduce sperm count.

Meningitis and Encephalitis

Mumps meningitis, inflammation of the membranes surrounding the brain and spinal cord, occurs in approximately 1-10% of people with mumps. Symptoms include severe headache, stiff neck, sensitivity to light, and sometimes nausea and vomiting. Most cases of mumps meningitis are relatively mild and resolve without treatment, though hospitalization may be needed for monitoring and supportive care.

Encephalitis, or inflammation of the brain itself, is a rarer and more serious complication. It can cause symptoms ranging from drowsiness and confusion to seizures and altered consciousness. While mumps encephalitis can be serious, most patients recover completely with appropriate supportive care.

Other Complications

• Oophoritis: Inflammation of the ovaries occurs in approximately 5% of post-pubertal females with mumps, causing lower abdominal pain. It rarely affects fertility.
• Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain, nausea, and vomiting. It occurs in approximately 4% of cases.
• Hearing loss: Mumps is one of the leading causes of acquired sensorineural hearing loss. It is usually unilateral and may be temporary or permanent.
• Mastitis: Breast tissue inflammation can occur in both females and males.

How Can You Prevent Mumps?

The most effective way to prevent mumps is through vaccination with the MMR (measles, mumps, rubella) vaccine. Two doses of the vaccine provide approximately 88% protection against mumps. The vaccine is part of routine childhood immunization programs in most countries and can also be given to adults who lack immunity.

Vaccination remains the cornerstone of mumps prevention. The MMR vaccine is a live attenuated vaccine that provides protection against three viral diseases: measles, mumps, and rubella. The vaccine stimulates the immune system to produce antibodies against these viruses without causing the actual diseases.

In most countries, children receive their first dose of MMR vaccine at around 12-15 months of age and a second dose at 4-6 years of age. This two-dose schedule provides optimal protection. After two doses, approximately 88% of recipients are protected against mumps, 97% against measles, and 97% against rubella.

Adults who are unsure of their vaccination status or who received only one dose of MMR vaccine should consult with a healthcare provider about receiving a catch-up dose. This is particularly important for people at higher risk of exposure, such as healthcare workers, college students, and international travelers.

Why Vaccination Matters

Before the introduction of the mumps vaccine, mumps was a near-universal childhood experience. Millions of children were infected each year, and while most recovered without problems, thousands experienced complications. The introduction of the MMR vaccine has reduced mumps cases by more than 99% in countries with high vaccination coverage.

Vaccination not only protects the vaccinated individual but also contributes to herd immunity, which helps protect people who cannot be vaccinated, such as infants too young for the vaccine or people with certain immune system disorders. When a high percentage of a population is vaccinated, the spread of the disease is significantly reduced, protecting everyone in the community.

Isolation and Infection Control

If you have mumps or suspect you might, isolation is essential to prevent spreading the virus to others. The following measures can help reduce transmission:

• Stay home from work, school, or childcare for at least 5 days after the onset of parotid swelling
• Avoid close contact with household members as much as possible, especially those who are unvaccinated
• Cover your mouth and nose when coughing or sneezing
• Wash your hands frequently with soap and water
• Do not share eating utensils, drinking glasses, or personal items
• Clean and disinfect frequently touched surfaces

Is Mumps Dangerous During Pregnancy?

Unlike rubella, mumps infection during pregnancy is not associated with congenital malformations or birth defects. However, mumps in the first trimester may slightly increase the risk of miscarriage. Pregnant women should avoid exposure to mumps and ensure their immunity status is known before conception.

One of the important distinctions between mumps and its vaccine-preventable companions, measles and rubella, is its effect on pregnancy. While rubella infection during pregnancy can cause serious birth defects (congenital rubella syndrome), mumps has not been linked to similar congenital abnormalities. Research has not shown that mumps virus causes malformations in the developing fetus.

However, mumps infection during pregnancy is not without concern. Some studies have suggested a slightly increased risk of miscarriage when mumps occurs during the first trimester. For this reason, pregnant women should take precautions to avoid exposure to mumps, and women planning pregnancy should ensure they are immune through previous vaccination or infection.

The MMR vaccine should not be given during pregnancy because it is a live attenuated vaccine. Women who are not immune to mumps and wish to become pregnant should receive the MMR vaccine and wait at least one month before attempting conception. If a pregnant woman is exposed to mumps, she should contact her healthcare provider for guidance.

Frequently Asked Questions About Mumps