Spontaneous vesicovaginal fistula in a retroviral positive multiparous woman: a case report

Vesicovaginal fistula (VVF) is a major cause of morbidity with severe socio-economic consequences affecting the quality of life of women and their families. Prolonged obstructed labour remains the leading cause of VVF in sub-Saharan African and Southeast Asia. However, in rare cases VVF can occur spontaneously without an identifiable cause. In this report we describe a case of spontaneous simple VVF measuring 2 × 2 cm in the lower third of the anterior vaginal wall in a 47-year-old Nigerian woman who is HIV-positive and on Highly Active Antiretroviral Therapy (HAART). She has a history of three previous uncomplicated caesarean sections. Leakage of urine was noticed 13 months prior to presentation and at that time, her viral load was high with a low CD4 count. She was evaluated and had vaginal repair of the fistula. This report suggests the possibility of a potential association between chronic immunosuppression and fistula formation. Therefore, it is important for clinicians to consider the possibility of spontaneous fistula formation in HIV-positive patients, especially in the absence of more common causes.