Genital manifestations and reproductive health in female residents of a Wuchereria bancrofti-endemic area in Tanzania

Abstract

To assess the significance of lymphatic filariasis for the development of chronic genital manifestations and for reproductive health in women, we conducted a cross-sectional study of 2 villages in north-eastern Tanzania including interview and gynaecological examination of adult women, focusing primarily on reproductive history and genital health. In a population of 2165 residents, prevalence of Wuchereria bancrofti microfilaraemia was 28%, and geometric mean intensity of microfilariae (mf) was 722 mf/mL. Leg lymphoedema (elephantiasis) was present in 4.2% of adults aged > or = 15 years, and hydrocoele in 26.5% of adult males. Five hundred and thirty women completed an interview, and 404 of these completed a gynaecological examination. Most women were Muslims (72%), polygamy was common (29%), and 49% of women had undergone circumcision (clitoridectomy). Presence of microfilaraemia did not influence fertility or fertility-related variables including age at menarche, parity, spontaneous abortion, stillbirth, Caesarean section and premature labour, nor presence of primary or secondary infertility. Mf status was strongly correlated with abnormal menstruation pattern in the 30+ years age-group (P = 0.001), but not in the < 30 years age-group. Cervical, vaginal and vulval pathology was unrelated to mf status. Two women, aged 46 and 77 years, had vulval oedema of probable filarial origin, both were mf negative. Overall, microfilaraemia appeared to have no influence on genital disease or reproductive health, and chronic manifestations of lymphatic filariasis of the genitals does not appear to be a substantial problem in women.

“Can It Be That God Does Not Remember Me”:A Qualitative Study on the Psychological Distress, Suffering, and Coping of Dominican Women With Chronic Filarial Lymphedema and Elephantiasis of the Leg

“…Similar to studies in Haiti, India, Thailand, and Africa, the narratives we examined demonstrated the detrimental effect of lymphedema of the leg on psychological and emotional well-being (Bernhard et al, 2000;Coreil et al, 1998;Gyapong, Gyapong, Adjei, Vlassoff, & Weiss, 1996;Rauyajin, Kamthornwachara, & Yablo, 1995). While some variation was expressed, women in this study described similar underlying negative psychological states, emotional reactions, and cognitive responses in the interviews.…”

Description of the parasite Wucheria Bancrofti Microfilariae identified in follicular fluid following transvaginal oocyte retrieval

“…Others maintain that filariasis may cause implantation failure of the embryo at the level of the endometrium [7]. Even though pregnancy did not occur through IVF in our reported case, previous cases of W. Bancrofti infections successfully resulted in a complication-free pregnancy following appropriate treatment [12]. One study enrolling 2,165 patients, of which 28% were infected with W. Bancrofti, showed no impact on fertility or pregnancy related complications in infected women [12].…”

“…Even though pregnancy did not occur through IVF in our reported case, previous cases of W. Bancrofti infections successfully resulted in a complication-free pregnancy following appropriate treatment [12]. One study enrolling 2,165 patients, of which 28% were infected with W. Bancrofti, showed no impact on fertility or pregnancy related complications in infected women [12]. Therefore, one would not expect a history of W. Bancrofti infection, following treatment, to negatively impact fertility.…”

A 41‐Year‐Old Woman from Cameroon with Infertility

“…The patient described here had idiopathic endometrial inflammation; an additional endometrial biopsy performed after antifilarial treatment was nondiagnostic. The possible association between filarial infection and infertility is an intriguing observation that may deserve further investigation [11]. …”