Table 1

Male genital manifestations of infection with Wuchereria bancroftii

Lymphangiectasia of lymphatics round the spermatic cordsEarliest sign of infection. Detectable by ultrasound in 80% of men found to have microfilaraemia. Initially asymptomatic
Acute hydroceleDevelops when adult worms die naturally or as a result of therapy
Chronic hydroceleDetectable in up to 40% of males in areas hyperendemic for filariasis10
ChyloceleCollection of chyle that forms when a lymphatic ruptures into a hydrocele
Lymph scrotumSuperficial scrotal lymphangiomatosis which may ooze chyle through deformed scrotal skin
Acute inflammation of scrotum and penisMay be triggered by death of adult worms or superimposed bacterial infection. Tender scrotal nodules or irregularity of spermatic cords may be felt
Elephantiasis of scrotum (fig 1)Late hypertrophy and fibrosis that results from repeated bacterial infections. Urine flow not affected
Inguinal adenitisDevelops acutely when adult worms die. Also triggered by bacterial infections in genitalia or legs. Occasionally filarial abscess develops