Genital leech infestation presenting with vaginal bleeding in a 55-year-old Ethiopian woman: Case report and literature review.

BACKGROUND: Genital leech infestations, primarily occurring in tropical and subtropical areas with untreated water, present clinical challenges due to their hematophagous nature and the chemicals they emit for attachment and bleeding. This report details a case of vaginal leech infestation, noting its rarity and the complications it poses, particularly with symptoms such as vaginal hemorrhage. It includes a comprehensive description of clinical presentation, diagnosis, treatment, and outcomes, supplemented by literature to enhance understanding, differential diagnosis, and prevention strategies.

CLINICAL PRESENTATION: A 55-year-old postmenopausal Ethiopian woman presented with painless, moderate vaginal bleeding for one week and symptomatic anemia. No history or signs of trauma or systemic illness were found. Upon evaluation, she was a well-looking woman with stable vital signs apart from an increased pulse rate, 116 bpm; pale conjunctivae; and a thorough genital evaluation with vaginal irrigation revealed a live leech, which was successfully removed, stopping the bleeding. The lady was discharged in good health with guidance on hygiene and avoiding untreated water.

CONCLUSION: Postmenopausal bleeding in rural, low-resource areas may often be mistakenly attributed to various causes, with leech attachment identified as a significant risk due to their anticoagulant properties. This can result in severe anemia or hypovolemic shock in affected women. The recommended treatment includes direct visualization and careful removal of leeches, alongside supportive care such as fluid resuscitation and blood transfusion. Public health initiatives are crucial in promoting safe water access and raising awareness about the risks of untreated surface water exposure.