title: Gender disparity between cutaneous and non-cutaneous manifestations of Lyme borreliosis.
abstract: Cutaneous manifestations of Lyme borreliosis in Europe include erythema migrans (EM) and acrodermatitis chronica atrophicans (ACA); the most common non-cutaneous manifestations are Lyme neuroborreliosis (LNB) and Lyme arthritis. The purpose of this study was to evaluate the gender distribution of patients with these clinical manifestations of Lyme borreliosis. Data on gender were obtained from the clinical records of patients with Lyme borreliosis aged ≥15 years who had been evaluated at the University Medical Center Ljubljana, Ljubljana, Slovenia. Among 10,539 patients diagnosed with EM, 6,245 (59.3%) were female and among 506 ACA patients 347 (68.6%) were female. In contrast, among the 60 patients with Lyme arthritis only 15 (25%) were female (p<0.0001 for the comparison of gender with EM or ACA) and among the 130 patients with LNB only 51 (39.2%) were females (p<0.0001for the comparison of gender with EM or ACA). Although the proportion that was female in the LNB group was greater than that of patients with Lyme arthritis, this difference did not reach statistical significance (p = 0.10). Although older individuals are more likely to be female in the general Slovenian population, the age of patients with cutaneous versus non-cutaneous manifestations was not the explanation for the observed differences in gender. In conclusion, patients with cutaneous manifestations of Lyme borreliosis were predominantly female, whereas those with non-cutaneous manifestations were predominantly male. This provocative finding is unexplained but may have direct relevance to the pathogenesis of Lyme borreliosis.
authors.affiliation: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Franc
authors.initials: F
authors.lastname: Strle
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
authors.forename: Paul
authors.initials: P
authors.lastname: Mead
authors.forename: Kanthi
authors.initials: K
authors.lastname: Dhaduvai
authors.forename: Michael V
authors.initials: MV
authors.lastname: Longo
authors.forename: Omosalewa
authors.initials: O
authors.lastname: Adenikinju
authors.forename: Sandeep
authors.initials: S
authors.lastname: Soman
authors.forename: Yodit
authors.initials: Y
authors.lastname: Tefera
authors.forename: Vera
authors.initials: V
authors.lastname: Maraspin
authors.forename: Stanka
authors.initials: S
authors.lastname: Lotrič-Furlan
authors.forename: Katarina
authors.initials: K
authors.lastname: Ogrinc
authors.forename: Jože
authors.initials: J
authors.lastname: Cimperman
authors.forename: Eva
authors.initials: E
authors.lastname: Ružić-Sabljić
authors.forename: Daša
authors.initials: D
authors.lastname: Stupica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012871:Skin Diseases / Q000150:complications*; D017524:Slovenia / Q000453:epidemiology; D055815:Young Adult