Receiver operating characteristic curve analyses were performed to determine viability cut-off values for M. leprae expression of hsp18, esxA, and 16S transcripts. To verify these values, immunocompetent BALB/c mice were inoculated in the footpads with a high dose of viable M. leprae. Footpads were harvested on Day 1 and at various timepoints up to 12 months post infection. M. leprae viability was determined by MVA or by sub-inoculating bacilli into passage mice per Shepard’s MFP assay.

Cut-off levels for expression of each transcript for M. leprae viability were established with high confidence (CI = 99%, P < 0.0001). In the high-dose infection assay, M. leprae exhibited a significant decrease in transcript detection by three months post-infection. Expression of hsp18 and esxA transcripts by M. leprae correlated with bacterial growth in the MFP assay. In contrast, 16S transcripts were detected in M. leprae populations confirmed dead by the MFP assay.

The MVA, which is a sensitive, specific, and rapid viability indicator, was directly validated by the MFP assay. This study confirms the accuracy of the MVA for determining M. leprae viability.

We used a cross-sectional comparative study design with a qualitative approach. Three groups of married women were interviewed in-depth: (1) women affected by leprosy, (2) women without leprosy, but with physical disabilities, and (3) women without leprosy or disabilities (a control group). The ABC-X Model of family stress and coping was used to develop the interview guide and to analyse the data. The data were analysed by two independent researchers by means of deductive thematic analysis.

Twenty-four women participated in the study. Most women in all groups had positive experiences regarding their marital relationships and support received from their husbands. Negative (physical) effects of leprosy on sexual health were present: over half of the women said they were reluctant to have sexual intercourse, either because they felt unwell because of their condition or because they were afraid of infecting their husband. It appeared that leprosy-affected women were more dissatisfied with their sexual health compared to the other two groups. Coping strategies to deal with difficulties in the marital relationship included silence, venting, religion, positive thinking, humour and acceptance.

Most participants perceived their marital relationship as satisfactory. However, findings from this study show leprosy can negatively impact sexual health. The results point to a compelling need to develop interventions to address sexual health of persons affected by leprosy in Indonesia. 

Male patients at the Los Angeles County + University of Southern California Medical Center Hansen’s Disease Clinic were surveyed regarding sexual and reproductive history and sexual function via Sexual Health Inventory for Men (SHIM) scores. Survey topics included erectile dysfunction (ED), sexual function, libido, reproductive history before and after leprosy diagnosis, and SHIM scores. SHIM scores were compared with age matched controls without leprosy.

Forty men with leprosy were interviewed, with a mean age of 53 years. The average age at leprosy diagnosis was 39 years. Thirteen (32.5%) men reported ED, 12 (30%) ejaculatory dysfunction, 6 (15%) impaired libido, and seven (17.5%) primary infertility post-leprosy diagnosis. SHIM scores consistent with mild to severe ED were found in 22/40 (55%) patients and were significantly lower in leprosy patients compared to age matched controls (20/25 versus 23/25, p < 0.001). Lower SHIM scores were also associated with the presence of other neurologic deficits (p = 0.029). Participants with SHIM scores suggestive of ED were no more likely to have had hormone analysis testing done than those with unimpaired SHIM scores.

Men with leprosy had a range of sexual and reproductive issues. Nearly half reported de novo sexual symptoms, and males with leprosy had lower SHIM scores compared to controls. Men with leprosy should be screened routinely for sexual dysfunction and asked about their reproductive goals.