Secondary Studies

Several large-scale surveys addressed self-reported genitourinary conditions among Gulf War deployed and nondeployed military personnel. For the purpose of this review, these studies are considered secondary, mostly because of the lack of objective medical measures.

The first wave of the National Survey of Gulf War Veterans and Their Families conducted in 1995 sampled 15,000 Gulf War deployed veterans and 15,000 nondeployed era veterans (Kang et al., 2000). Responses from 11,441 Gulf War veterans (75% response) and 9476 Gulf War Era veterans (64% response) were used to estimate the population prevalence of chronic medical conditions within the previous 12 months. Gulf War veterans reported bladder infections (difference in prevalence proportions 1.54%, 95% CI 1.49-1.59) and “any disease of the genital organs” (difference in prevalence proportion 2.51%, 95% CI 2.45-2.57) slightly more frequently than nondeployed veterans. A follow-up survey was conducted in this same population in 2005 (Kang et al., 2009). The prevalence of self-reported conditions 14 years after the war was re-examined among 6111 Gulf War veterans (40% response) and 3859 Gulf War era veterans (27% response). Consistent with the previous findings in this cohort, an increased prevalence of bladder infections (prevalence ratio 1.32, 95% CI 1.17-1.49) and “any disease of the genital organs” (prevalence ratio 1.23, 95% CI 1.10-1.38) was observed among Gulf War veterans.

In a 1997-1999 study of all US Navy Seabees (Gray et al., 2002), deployment was associated with increased self-reports of physician-diagnosed conditions (with onset after August 1991) including impotence (OR 3.06, 95% CI 1.95-4.83), prostatitis (OR 1.54, 95% CI 1.07-2.21), and urinary tract infection (OR 2.50, 95% CI 1.83-3.44), but not kidney disease or kidney stones. A total of 11,868 (62.6%) of 18,945 Seabees responded to the mailed questionnaire: 3831 Gulf War deployed, 4933 deployed elsewhere, and 3104 nondeployed Seabees.

A survey of UK veterans conducted between 1998 and 2001 compared self-reported health outcomes among 23,358 male Gulf War veterans (53% response) and 17,730 male Gulf War era veterans (42% response) (Simmons et al., 2004). Reports of new medical conditions since 1990 were collected using open-ended questions and coded into 36 categories based loosely on ICD-10 classifications. The prevalence of genitourinary system disorders was higher among Gulf War veterans (OR 1.8, 95% CI 1.5-2.1). More specifically this category consisted of genital system and bladder problems (OR 2.2, 95% CI 1.7-2.7) and kidney disease or symptoms (OR 1.5, 95% CI 1.2-1.9). The subgroup of “genital system and bladder problems” included 13 reports of “burning semen” among Gulf War veterans and 1 among nondeployed veterans (0.1% vs 0.0%).

Proctor et al. (1998) compared the frequency of self-reported symptoms classified into nine groups of body systems. Using responses to a 52-item symptom checklist, the prevalence of genitourinary symptoms was evaluated among 186 Gulf War veterans from the New England area, 66 Gulf War veterans from the New Orleans area, and 48 Gulf War era veterans deployed to Germany. The Gulf War deployed veterans reported a higher prevalence of individual genitourinary symptoms, which included frequent urination and pain during intercourse, when compared to the group deployed to Germany. The frequency of each symptom was reported on a scale of 0-4 (0 = no symptom, 1 = rarely, 2 = some, 1-2 times/week, 3 = often, several times/week, 4 = very often, almost every day), and the frequencies were also summed to create “body-system symptom” scores for each system. Of the nine symptom categories assessed, genitourinary system symptom scores were the only system scores that were not statistically



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