More cases of the mumps at Temple University were reported Tuesday, with the number of confirmed and probable cases rising to 23, officials said.

Temple reported that there were 11 confirmed cases and 12 probable cases. The Philadelphia Department of Public Health said it was now counting the two categories as one because the outbreak of the highly infectious disease is established and the agency has stopped recommending that people get tested for confirmation.

“If someone reports to Student Health with symptoms consistent with mumps we are counting them as a case,” said agency spokesperson James Garrow.

On Feb. 28, the university announced that four students had tested positive for mumps and issued a warning to 40,000 students and several thousand faculty on the eve of spring break.

Mumps is a contagious viral disease. Common symptoms include swollen salivary glands, fever, headache, muscle aches, and loss of appetite. While serious complications are rare, especially in people who were vaccinated as children, mumps can cause inflammation of the brain, deafness, or sterility. Similarly to the flu, there is no treatment. But for most people, symptoms fade after 10 days.