GPAtlas🧭 When to suspect
Mumps is an acute illness caused by a paramyxovirus, classically producing tender swelling of the parotid (and sometimes other salivary) glands – parotitis – which may be unilateral or bilateral and obliterates the angle of the jaw. There is often a prodrome of fever, malaise, headache, myalgia and anorexia for a few days before the swelling, and pain is typically worse on chewing, swallowing or drinking acidic fluids. The incubation period is 14–25 days (around 17), and patients are most infectious from a couple of days before the swelling appears to about 5 days after its onset – the basis of the standard 5-day exclusion. Roughly 1 in 6 infections are asymptomatic.
Although now uncommon since the introduction of the MMR (measles, mumps and rubella) vaccine, mumps still circulates – particularly as outbreaks in older teenagers and young adults (commonly in universities and colleges) who received only one dose or whose immunity has waned. In primary care the task is twofold: confirm and control spread (mumps is a notifiable disease requiring notification to the UK Health Security Agency (UKHSA), oral fluid testing and a 5-day exclusion), and recognise the complications. Most cases are self-limiting within 1–2 weeks, and there is no antiviral treatment.
| Differential to consider | Distinguishing features |
|---|---|
| Bacterial (suppurative) parotitis | Systemically unwell, usually unilateral; pus expressible from the parotid duct on massage; typically elderly, dehydrated or post-operative. |
| Salivary duct stone (sialolithiasis) | Recurrent swelling that worsens around meals; afebrile; often submandibular rather than parotid. |
| Infectious mononucleosis (EBV) | Sore throat, posterior cervical lymphadenopathy, marked fatigue, sometimes splenomegaly. |
| Other viral parotitis | Parainfluenza, influenza, coxsackie, adenovirus, HIV seroconversion – clinically similar; context and testing distinguish. |
| Cervical lymphadenopathy / parotid tumour | A discrete node does not obliterate the angle of the jaw; a tumour is persistent, painless and slowly growing. |
|
⚠️ Common pitfall Dismissing mumps because the patient is "fully vaccinated". Two doses of MMR are only about 88% effective against mumps and protection wanes over time, which is precisely why outbreaks occur in vaccinated young adults. A documented vaccination history reduces the probability but does not exclude the diagnosis – in a compatible presentation, still test and notify. |
Source: UK Health Security Agency · NHS
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