Medscape is available in 5 Language Editions – Choose your Edition here.


Onchocerciasis Treatment & Management

  • Author: Mary D Nettleman, MD, MS; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Nov 05, 2015

Medical Care

Because most of the pathogenesis of onchocerciasis is secondary to microfilariae, the goal of therapy is to eliminate the microfilarial stage of disease to improve symptoms, to prevent progression of eye lesions, and to interrupt disease transmission.

Ivermectin is considered to be the drug of choice as a microfilaricidal agent.[32, 33] Repeated dosing at intervals of 3–12 months is recommended for at least 10-12 years. More frequent dosing is reserved for patients who experience frequent symptomatic recurrences.

Ivermectin is usually well-tolerated. Dying microfilaria may result in pruritus and adenopathy (Mazzotti reaction), leading to angioedema in rare cases. Ocular inflammation may also be triggered by dying microfilariae. To minimize this in individuals with microfilariae observed during slit-lamp examination, some experts recommend using a short course of prednisone (2-3 d) along with ivermectin. More frequent dosing with ivermectin (every 3 mo instead of every 12 mo) may reduce inflammatory complications because it does not permit microfilarial numbers to build, thus reducing the number of dead organisms after treatment.

Concomitant infection with L loa should be ruled out, as ivermectin may precipitate toxic encephalopathy in these patients.

Ivermectin has little effect on adult worms. It reduces the burden of microfilaria and the risk of complications but does not cure the disease. Ivermectin may have a modest effect on infection rates with selected intestinal helminths, such as ascaris, although it is not effective against hookworm.[34]

Targeting endosymbiotic Wolbachia species has emerged as an exciting new approach in the control of onchocerciasis. Studies of doxycycline therapy (100–200 mg/d for 6 wk) have shown great promise.[35, 36, 37, 38] Doxycycline interrupts microfilarial embryogenesis, dramatically decreasing or eliminating microfilaria for at least 18 months after treatment. The drug has modest activity against adult worms, reducing numbers by approximately 50%-60%. The combination of doxycycline and ivermectin given together is more effective than either drug alone.[39] However, doxycycline has side effects and must be given daily, which limits its usefulness for large scale treatment programs.[40]

Investigators have also studied rifampin and azithromycin, but early results appear to be inferior to those of doxycycline.[41, 42, 43] Moxidectin is an antiparasitic drug that is currently being studied by the WHO for use in onchocerciasis.[44] Moxidectin is closely related to ivermectin, but animal studies suggest it might cause more sustained reduction in microfilarial levels.


Surgical Care

Nodulectomy can result in cure only if excision eliminates all adult worms. Thus, this is not a practical choice in patients with multiple nodules or in patients in whom nodules are not clinically evident.



See the list below:

  • Infectious disease specialist
  • Ophthalmologist
  • Dermatologist
Contributor Information and Disclosures

Mary D Nettleman, MD, MS MACP, Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.


Apoorv Kalra, MD Assistant Professor of Medicine, Michigan State University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Daniel R Lucey, MD, MPH, MD, MPH 

Daniel R Lucey, MD, MPH, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians

Disclosure: Nothing to disclose.

  1. Burnham G. Onchocerciasis. Lancet. 1998 May 2. 351(9112):1341-6. [Medline].

  2. Hoerauf A, Büttner DW, Adjei O, Pearlman E. Onchocerciasis. BMJ. 2003 Jan 25. 326(7382):207-10. [Medline].

  3. Udall DN. Recent updates on onchocerciasis: diagnosis and treatment. Clin Infect Dis. 2007 Jan 1. 44(1):53-60. [Medline].

  4. Klion AD. Filarial infections in travelers and immigrants. Curr Infect Dis Rep. 2008 Mar. 10(1):50-7. [Medline].

  5. Nguyen JC, Murphy ME, Nutman TB, Neafie RC, Maturo S, Burke DS. Cutaneous onchocerciasis in an American traveler. Int J Dermatol. 2005 Feb. 44(2):125-8. [Medline].

  6. Richards F Jr, Rizzo N, Diaz Espinoza CE, Morales Monroy Z, Crovella Valdez CG, de Cabrera RM, et al. One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone. Am J Trop Med Hyg. 2015 Oct 26. [Medline].

  7. Vlaminck J, Fischer PU, Weil GJ. Diagnostic Tools for Onchocerciasis Elimination Programs. Trends Parasitol. 2015 Oct 9. [Medline].

  8. World Health Organization. Onchocerciasis (river blindness). Wkly Epidemiol Rec. 2001 Jul 6. 76(27):205-10. [Medline].

  9. World Health Organization. Onchocerciasis and its control. Report of a WHO Expert Committee on Onchocerciasis Control. World Health Organ Tech Rep Ser. 1995. 852:1-104. [Medline].

  10. World Health Organization. Onchocerciasis (river blindness). Report from the Fourteenth InterAmerican Conference on Onchocerciasis, Atlanta, Georgia, United States. Wkly Epidemiol Rec. 2005 Jul 29. 80(30):257-60. [Medline].

  11. World Health Organization. Onchocerciasis (river blindness). Wkly Epidemiol Rec. 2001 Jul 6. 76(27):205-10. [Medline].

  12. Dimomfu BL, Lubeji DK, Noma M, Sékétéli A, Boussinesq M. African Programme for Onchocerciasis Control (APOC): sociological study in three foci of central Africa before the implementation of treatments with ivermectin (Mectizan). Trans R Soc Trop Med Hyg. 2007 Jul. 101(7):674-9. [Medline].

  13. Hotez PJ. Control of onchocerciasis--the next generation. Lancet. 2007 Jun 16. 369(9578):1979-80. [Medline].

  14. Sauerbrey M. The Onchocerciasis Elimination Program for the Americas (OEPA). Ann Trop Med Parasitol. 2008 Sep. 102 Suppl 1:25-9. [Medline].

  15. Amazigo U. The African Programme for Onchocerciasis Control (APOC). Ann Trop Med Parasitol. 2008 Sep. 102 Suppl 1:19-22. [Medline].

  16. Boatin B. The Onchocerciasis Control Programme in West Africa (OCP). Ann Trop Med Parasitol. 2008 Sep. 102 Suppl 1:13-7. [Medline].

  17. Krotneva SP, Coffeng LE, Noma M, Zouré HG, Bakoné L, Amazigo UV, et al. African Program for Onchocerciasis Control 1995-2010: Impact of Annual Ivermectin Mass Treatment on Off-Target Infectious Diseases. PLoS Negl Trop Dis. 2015 Sep. 9 (9):e0004051. [Medline].

  18. Pion SD, Kamgno J, Demanga-Ngangue, Boussinesq M. Excess mortality associated with blindness in the onchocerciasis focus of the Mbam Valley, Cameroon. Ann Trop Med Parasitol. 2002 Mar. 96(2):181-9. [Medline].

  19. Enk CD. Onchocerciasis--river blindness. Clin Dermatol. 2006 May-Jun. 24(3):176-80. [Medline].

  20. Kayembe DL, Kasonga DL, Kayembe PK, Mwanza JC, Boussinesq M. Profile of eye lesions and vision loss: a cross-sectional study in Lusambo, a forest-savanna area hyperendemic for onchocerciasis in the Democratic Republic of Congo. Trop Med Int Health. 2003 Jan. 8(1):83-9. [Medline].

  21. Timmann C, van der Kamp E, Kleensang A, König IR, Thye T, Büttner DW, et al. Human genetic resistance to Onchocerca volvulus: evidence for linkage to chromosome 2p from an autosome-wide scan. J Infect Dis. 2008 Aug 1. 198(3):427-33. [Medline].

  22. Kayembe DL, Kasonga DL, Kayembe PK, Mwanza JC, Boussinesq M. Profile of eye lesions and vision loss: a cross-sectional study in Lusambo, a forest-savanna area hyperendemic for onchocerciasis in the Democratic Republic of Congo. Trop Med Int Health. 2003 Jan. 8(1):83-9. [Medline].

  23. Lipner EM, Dembele N, Souleymane S, Alley WS, Prevots DR, Toe L, et al. Field applicability of a rapid-format anti-Ov-16 antibody test for the assessment of onchocerciasis control measures in regions of endemicity. J Infect Dis. 2006 Jul 15. 194(2):216-21. [Medline].

  24. Weil GJ, Steel C, Liftis F, Li BW, Mearns G, Lobos E. A rapid-format antibody card test for diagnosis of onchocerciasis. J Infect Dis. 2000 Dec. 182(6):1796-9. [Medline].

  25. Nde PN, Pogonka T, Bradley JE, Titanji VP, Lucius R. Sensitive and specific serodiagnosis of onchocerciasis with recombinant hybrid proteins. Am J Trop Med Hyg. 2002 May. 66(5):566-71. [Medline].

  26. Rodríguez-Pérez MA, Domínguez-Vázquez A, Méndez-Galván J, Sifuentes-Rincón AM, Larralde-Corona P, Barrera-Saldaña HA, et al. Antibody detection tests for Onchocerca volvulus: comparison of the sensitivity of a cocktail of recombinant antigens used in the indirect enzyme-linked immunosorbent assay with a rapid-format antibody card test. Trans R Soc Trop Med Hyg. 2003 Sep-Oct. 97(5):539-41. [Medline].

  27. Guzmán GE, Lavebratt C, Luján R, Akuffo H. Diagnosis of onchocerciasis using highly specific and sensitive native proteins. Scand J Infect Dis. 2002. 34(8):583-90. [Medline].

  28. Ayong LS, Tume CB, Wembe FE, Simo G, Asonganyi T, Lando G. Development and evaluation of an antigen detection dipstick assay for the diagnosis of human onchocerciasis. Trop Med Int Health. 2005 Mar. 10(3):228-33. [Medline].

  29. Boatin BA, Toé L, Alley ES, Dembélé N, Weiss N, Dadzie KY. Diagnostics in onchocerciasis: future challenges. Ann Trop Med Parasitol. 1998 Apr. 92 Suppl 1:S41-5. [Medline].

  30. Ozoh G, Boussinesq M, Bissek AC, Kobangue L, Kombila M, Mbina JR, et al. Evaluation of the diethylcarbamazine patch to evaluate onchocerciasis endemicity in Central Africa. Trop Med Int Health. 2007 Jan. 12(1):123-9. [Medline].

  31. Toè L, Adjami AG, Boatin BA, Back C, Alley ES, Dembélé N. Topical application of diethylcarbamazine to detect onchocerciasis recrudescence in west Africa. Trans R Soc Trop Med Hyg. 2000 Sep-Oct. 94(5):519-25. [Medline].

  32. Basáñez MG, Pion SD, Boakes E, Filipe JA, Churcher TS, Boussinesq M. Effect of single-dose ivermectin on Onchocerca volvulus: a systematic review and meta-analysis. Lancet Infect Dis. 2008 May. 8(5):310-22. [Medline].

  33. Reddy M, Gill SS, Kalkar SR, Wu W, Anderson PJ, Rochon PA. Oral drug therapy for multiple neglected tropical diseases: a systematic review. JAMA. 2007 Oct 24. 298(16):1911-24. [Medline].

  34. Gutman J, Emukah E, Okpala N, Okoro C, Obasi A, Miri ES. Effects of annual mass treatment with ivermectin for onchocerciasis on the prevalence of intestinal helminths. Am J Trop Med Hyg. 2010 Sep. 83(3):534-41. [Medline].

  35. Hoerauf A, Mand S, Volkmann L, Büttner M, Marfo-Debrekyei Y, Taylor M, et al. Doxycycline in the treatment of human onchocerciasis: Kinetics of Wolbachia endobacteria reduction and of inhibition of embryogenesis in female Onchocerca worms. Microbes Infect. 2003 Apr. 5(4):261-73. [Medline].

  36. Hoerauf A, Specht S, Büttner M, Pfarr K, Mand S, Fimmers R, et al. Wolbachia endobacteria depletion by doxycycline as antifilarial therapy has macrofilaricidal activity in onchocerciasis: a randomized placebo-controlled study. Med Microbiol Immunol. 2008 Sep. 197(3):295-311. [Medline].

  37. Hoerauf A, Mand S, Adjei O, Fleischer B, Büttner DW. Depletion of wolbachia endobacteria in Onchocerca volvulus by doxycycline and microfilaridermia after ivermectin treatment. Lancet. 2001 May 5. 357(9266):1415-6. [Medline].

  38. Taylor MJ, Hoerauf A, Townson S, Slatko BE, Ward SA. Anti-Wolbachia drug discovery and development: safe macrofilaricides for onchocerciasis and lymphatic filariasis. Parasitology. 2014 Jan. 141 (1):119-27. [Medline].

  39. Linehan M, Hanson C, Weaver A, et al. Integrated implementation of programs targeting neglected tropical diseases through preventive chemotherapy: proving the feasibility at national scale. Am J Trop Med Hyg. 2011 Jan. 84(1):5-14. [Medline].

  40. Turner JD, Tendongfor N, Esum M, et al. Macrofilaricidal activity after doxycycline only treatment of Onchocerca volvulus in an area of Loa loa co-endemicity: a randomized controlled trial. PLoS Negl Trop Dis. 2010 Apr 13. 4(4):e660. [Medline]. [Full Text].

  41. Specht S, Mand S, Marfo-Debrekyei Y, Debrah AY, Konadu P, Adjei O, et al. Efficacy of 2- and 4-week rifampicin treatment on the Wolbachia of Onchocerca volvulus. Parasitol Res. 2008 Nov. 103(6):1303-9. [Medline].

  42. Hoerauf A, Marfo-Debrekyei Y, Büttner M, Debrah AY, Konadu P, Mand S, et al. Effects of 6-week azithromycin treatment on the Wolbachia endobacteria of Onchocerca volvulus. Parasitol Res. 2008 Jul. 103(2):279-86. [Medline].

  43. Bah GS, Ward EL, Srivastava A, Trees AJ, Tanya VN, Makepeace BL. Efficacy of three-week oxytetracycline or rifampicin monotherapy compared with a combination regimen against the filarial nematode Onchocerca ochengi. Antimicrob Agents Chemother. 2013 Nov 18. [Medline].

  44. Siva N. WHO researchers start trial on a new drug for river blindness. BMJ. 2009. 339:b2755. [Medline].

  45. Report from the 2009 Inter-American Conference on Onchocerciasis: progress towards eliminating river blindness in the Region of the Americas. Wkly Epidemiol Rec. 2010 Aug 13. 85(33):321-6. [Medline].

  46. Schneider MC, Aguilera XP, Barbosa da Silva Junior J, et al. Elimination of neglected diseases in latin america and the Caribbean: a mapping of selected diseases. PLoS Negl Trop Dis. 2011 Feb 15. 5(2):e964. [Medline]. [Full Text].

Simulium fly (black fly).
Histopathology of an Onchocerca volvulus nodule. Image courtesy of the CDC and Dr. Mae Melvin.
Simplified life cycle of Onchocerciasis volvulus.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.