Men with infected scrotums less desirable to women!

Stating the obvious, but still nice to have the data. Ours being a shallow society, the 'marriageability' of somebody with a filarial hydrocele (only click if you're not eating your breakfast and you have a strong stomach) is probably not that high. The severe impact on sexual function, as well as the obvious cosmetic challenges, make them low on the list of potential suitors for young ladies.

That's exactly what researchers in Orissa, India found, published in PLOS NTD this week, when they asked a community their thoughts on men with hydroceles, both sufferers and non-sufferers. Some background: filariasis is an mosquito-borne parasitic disease that is exceedingly common in tropical regions, India being especially affected. It classically causes elephantiasis, but can also cause hydrocele, a swelling of the scrotum. In endemic areas, most people are first infected in childhood, but don't manifest symptoms until later in life with a greater parasite load, typically between the ages of 18-30, the prime years for marriage. Unfortunately, once it's reached the point where it's visible and impacting one's life, there's likely enough scarring and lymphatic damage that medicines aren't helpful, and surgery is still unproven, even when available.

What the researchers in this study did is ask the community how they felt about people with hydroceles. The results are unsurprisingly sad. 94% of wives of patients were dissatisfied with their sexual life, and that these men are overwhelmingly the 'last choice' for marriage. 94% of the patients themselves reported sexual frustration, with 88% reporting severe pain during intercourse. The morbidity of this disease is clearly profound, and most of the sufferers don't have appropriate psycho-social support groups to help them out.

The best option we have, then, is for its prevention or early treatment. There's been a movement over the past few years towards eradication of the disease, with the Gates foundation being large funders. There are no other animal hosts, so if we treat it in humans, then we can conceivably control it altogether. Vector control through mosquito control is a challenge, as any malaria expert will tell you, although that is one focus, affecting both diseases. Our best hopes are through mass drug administration: in some places, once a year, in others, added to salt, with the hope of bringing down community-wide levels of parasite to slow down transmission and move towards eventual eradication. Significant progress is being made, so if you have a few extra dollars, make a donation - they're a great bunch of people, and are scaling up their projects in creative and exciting ways. I'm in India right now, working at a hospital, and have seen a few horrible cases of filariasis, and, as the researchers have shown, it's a debilitating disease.

One of the worrisome parts of the eradication campaign is that about 10% of filariasis is caused by the parasite B. malayi, while 90% is caused by W. bancrofti. The eradication campaign is effective against the latter, but not against the former, which has a large animal reservoir. Let's hope that we don't see a bump in filariasis incidence after we've eliminated W. bancrofti. It's unlikely, but something to be cognizant of as we move forward.

Babu, B., Mishra, S., & Nayak, A. (2009). Marriage, Sex, and Hydrocele: An Ethnographic Study on the Effect of Filarial Hydrocele on Conjugal Life and Marriageability from Orissa, India PLoS Neglected Tropical Diseases, 3 (4) DOI: 10.1371/journal.pntd.0000414