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To better understand risk factors for hydrocele as a consequence of Wuchereria bancrofti infection, 342 men more than 15 years of age in an endemic area in Papua New Guinea were evaluated. Thirty-four subjects (9.9%) had hydrocele by physical examination. Ultrasound examination detected hydroceles in 57 men (16.7%). Compared with ultrasonography, the sensitivity of physical examination was 44.3%, the specificity was 98.2%, and the positive predictive value was 73.5%. Hydrocele was independently associated with age (odds ratio [OR] = 3.3, P < 0.01) and intensity of infection as determined by filarial antigenemia (OR = 2.3, P = 0.07). Dilation of spermatic cord lymphatics detectable by ultrasound did not correlate with hydrocele, but was associated with the presence of infection. These observations suggest that filarial pathology of the male genitalia is under-reported when evaluated by physical examination alone and that duration and intensity of infection are risk factors for hydrocele.
Received December 13, 2002. Accepted for publication March 19, 2003.
Acknowledgments: We appreciate the assistance that Will Kastens and Lysaght Griffin provided along with the rest of the Papua New Guinea Institute of Medical Research staff. We also appreciate the help that Absalom Mai contributed in measuring circulating antigen levels. We are also grateful to all of the village members for their help, support, and willingness to participate in this study. We appreciate the help of Daniel Tisch, who assisted in the logistic regression analysis, and Dr. Thomas Herbner, who trained the ultrasound examiner and reviewed videotapes from the examinations. We also appreciate discussions with David Addiss and Gerusa Dreyer in the design and interpretation of the study. The results of this study were presented in part at the Annual Meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, GA, November 2001 (abstract no. 795).
Financial support: This work was supported by National Institutes of Allergy and Infectious Diseases Grant AI-33061.
Authors’ addresses: Aaron A. R. Tobian, James W. Kazura, and Christopher L. King, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106-4983. Nandao Tarongka, Moses Baisor, and Moses Bockarie, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
Reprint requests: Christopher L. King, Center for Global Health and Diseases, Room W137, Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106-4983, Telephone: 216-368-4817, Fax: 216-368-4825, E-mail: cxk21{at}po.cwru.edu
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