Cultural Expressions of Koro-Like Syndrome in Tanzania: A Multi-City Case Series

Cultural Expressions of Koro-Like Syndrome in Tanzania: A Multi-City Case Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Cultural Expressions of Koro-Like Syndrome in Tanzania: A Multi-City Case Series Pedro Pallangyo, Zabella Mkojera, Loveness Mfanga, Makrina Komba, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9459553/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Koro syndrome is a culture-bound psychogenic condition characterized by acute anxiety involving perceived genital retraction accompanied by fear of imminent death. There remains a relative paucity of literature from sub-Saharan Africa, where such outbreaks are often linked to culturally embedded beliefs and accusations of genital theft, resulting in social unrest and violence. In April 2026, Tanzania experienced a sudden and widespread emergence of Koro-like symptoms across multiple geographically distinct regions. This case series aims to characterize the clinical features, sociocultural context, and public health consequences of this unprecedented event. Case presentations: We report over 30 cases identified across multiple geographically distinct regions. The majority of affected individuals were males aged 20–35 years, with only one female case documented. A consistent narrative emerged in which individuals believed that being touched on the shoulder triggered genital retraction. Protective behaviours included the use of improvised devices such as a safety pin attached to a rubber band, believed to prevent retraction. Individuals suspected of causing genital retraction were targeted by mobs and subjected to severe physical assaults, resulting in multiple injuries and fatalities. Conclusion: This first documented cluster of Koro-like syndrome in Tanzania highlights the potential for rapid community spread and escalation into interpersonal violence. These findings underscore the importance of integrated cultural, behavioural, and public health communication frameworks, and the need for further research to inform timely, coordinated public health and security responses. Koro-like syndrome Genital retraction syndrome Mass psychogenic illness Mass sociogenic illness Tanzania Background Since its first description in the medical literature in 1895, Koro syndrome has been recognized as a culture-bound psychogenic condition characterized by acute anxiety involving perceived genital retraction accompanied by fear of imminent death. 1-4 Although predominantly reported in Southeast Asia (including Indonesia, Malaysia, Singapore, Thailand, and Vietnam), sporadic cases continue to be encountered in routine clinical practice. 1-3 Despite reports of Koro-like presentations from Ghana, Nigeria, South Africa, and Sudan, there remains a relative paucity of literature from sub-Saharan Africa, where such outbreaks are often linked to superstitious beliefs and accusations of genital theft, resulting in social unrest and violence. 5-9 Although the incidence and pathogenesis of Koro remain unclear, with the clinical course typically being self-limiting, sporadic outbreaks are often driven by the rapid dissemination of rumours through interpersonal communication and media channels. 10-12 Between 1 st and 4 th April 2026, Tanzania experienced a sudden and widespread emergence of Koro-like symptoms across multiple geographically distinct regions. This case series aims to characterize the clinical features, sociocultural context, and public health consequences of this unprecedented event. Case Presentations At least 30 cases were reported during the four-day period. The index cases were first identified in Tunduma - Songwe region before rapidly propagating to seven additional geographically distinct regions including; Dar es Salaam, Dodoma, Iringa, Mbeya, Mtwara, Rukwa, and Zanzibar. With only one female case recorded, males aged 20-35 years constituted the vast majority. Individuals reported an acute onset of anxiety following perceived intentional physical contact, typically described as being touched on the shoulder by a stranger in crowded environments, notably markets and bus stands. Within a few minutes, this was followed by a subjective sensation of genital retraction accompanied by panic, palpitations, and fear of impending death within three days. Some individuals were taken to nearby healthcare facilities for evaluation of reported genital retraction; however, no clinical evidence supporting such claims was identified. Amid the spread of rumours and escalating fear, communities adopted shared protective behaviours rooted in circulating cultural beliefs. A widely reported protective measure involved attaching a safety pin connected to a rubber band to the wrist or biceps, based on the belief that it could prevent genital retraction. This behavioural response was rapidly adopted and disseminated, facilitated by social media and reinforced through word-of-mouth communication. The outbreak was marked by significant social disruption. Individuals suspected of causing genital retraction were targeted by mobs and subjected to severe physical assaults. More than 20 suspects were injured, and nine fatalities were reported. These violent incidents necessitated urgent intervention by law enforcement authorities, resulting in restoration of order. Discussion This case series documents the first known occurrence of a Koro-like syndrome in Tanzania, characterized by perceived genital retraction, rapid geographic spread, and substantial social disruption. The term “Koro-like syndrome” is used to reflect the phenomenological resemblance to classical Koro syndrome while acknowledging its occurrence outside traditionally endemic regions. The pronounced spatiotemporal clustering over a short temporal window observed in this outbreak suggests that its emergence and propagation were driven by prevailing social narratives, fear contagion, and culturally mediated interpretations of bodily sensations. Notably, by virtue of its multi-city scale, this outbreak represents a novel presentation in the East African context. A striking feature of this outbreak was the consistent narrative linking perceived intentional tactile contact (particularly shoulder contact by strangers) as the precipitating event for genital retraction. In this context, a benign tactile stimulus was reinterpreted through pre-existing cultural schemas, reflecting a process of symptom misattribution. These observations align with previously reported Koro syndrome epidemics, in which symptom initiation and propagation have often been linked to specific external triggers encompassing culturally constructed cues such as physical contact, visual exposure, social interaction, situational contexts, and internal somatic sensations. 5 , 7 , 13 The uniformity of externally anchored triggers in the present case series and in the literature suggests a high degree of sociocognitive alignment, which plays a critical role in mass sociogenic processes within affected communities. The emergence and adoption of protective practices, including improvised physical safeguards such as safety pins and rubber bands, reflects the translation and reinforcement of shared belief systems into culturally sanctioned coping strategies that likely served to reduce immediate anxiety. The accelerating influence of word-of-mouth communication and social media on behavioural contagion in this case series is reflected in the rapid uptake and dissemination of these practices. Similarly, previously reported Koro-like outbreaks have documented a range of protective behavioural strategies aimed at preventing perceived genital retraction, including manual traction, use of ligatures, application of herbal remedies, and engagement in traditional interventions. 5 , 7 , 13 The use of improvised devices such as safety pins connected to rubber bands, as observed in this series, represents a novel but conceptually similar culturally mediated protective strategy. A major public health concern of this outbreak was the escalation of psychogenic symptoms into vigilante attacks on suspected individuals, resulting in multiple injuries and fatalities. This progression underscores the interaction between mass sociogenic reactions, moral panic dynamics, and blame attribution behaviours, as reported in previous outbreaks of genital retraction syndrome. Similar dynamics have been documented in African settings, where uncertainty surrounding perceived “genital theft” has legitimised public assaults and, in some instances, fatalities. 5 , 7 , 13 These findings highlight the importance of early identification of rumour-driven events and the implementation of coordinated public health and law enforcement system responses to prevent escalation to severe morbidity and mortality. Although this case series emphasizes the need for early risk communication strategies, the rapid and effective containment of this outbreak following law enforcement intervention underscores the importance of coordinated multisectoral engagement. Such successful containment is consistent with observations from previous Koro epidemics, where timely and integrated responses have been critical in curbing both symptom spread and associated social disruption, particularly in African settings. 7 , 8 , 13 Conclusion Despite its classification as a culture-bound syndrome, the Koro phenomenon persists in contemporary settings, extending into community contexts and carrying significant social consequences. The escalation into interpersonal violence underscores the need for integrated cultural, behavioural, and public health communication frameworks in responding to similar phenomena. These observations highlight the need for further research into the psychological triggers, transmission dynamics, and vulnerability factors underlying such outbreaks to inform timely, coordinated public health and security responses. Declarations Ethics approval and consent to participate. Ethical approval was not required in accordance with institutional and national guidelines, as this case series was based on routine clinical and public health case identification. Written informed consent to participate was obtained from all individuals included in this case series. Consent for publication. Consent for publication was waived by the Jakaya Kikwete Cardiac Institute Ethics Committee/IRB, as the data were collected as part of a routine public health investigation and all information was fully anonymised. Competing interests. The authors declare that they have no competing interests. Funding. Not applicable. Availability of data and materials. Not applicable. Author Contributions. PP, ZM, LM, MK, and PRK contributed to the collection of clinical data and patient follow-up. PP drafted the initial manuscript. All authors critically reviewed the manuscript and contributed to its final approval. Top of FormBottom of Form Acknowledgments. The authors acknowledge healthcare workers, surveillance teams, and authorities for their support during case identification and outbreak response, and thank the individuals included in this case series and their families for their cooperation. Author details. 1 : Department of Research & Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. 2 : Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. References Strong YN, Cao DY, Zhou J, et al. Koro syndrome: epidemiology, psychiatric and physical risk factors, clinical presentation, diagnosis, and treatment options. Health Psychol Res. 2023;11:70165. Sharma S, Jaiswal A. Cultural expressions of Koro syndrome: a case series from North India. Cureus. 2025;17(11):e96981. Jani M, Savani C, Bhatia HS. Koro syndrome in female: a case report of a rare anxiety disorder with cultural influence on psychopathology. Cureus. 2025;17(1):e106266. Patel R, Ashraf A, Myers N, Bhatt N. Cultural concepts of distress: a dive into presentation and avenues for management. Innov Clin Neurosci. 2025;22(7-9):14-17. Dzokoto VA, Adams G. Understanding genital shrinking episodes in West Africa: Koro, juju, or mass psychogenic illness? Cult Med Psychiatry. 2005;29(1):53–78. de-Graft Aikins A, Dzokoto VA, Yevak E. Mass media constructions of “socio-psychological epidemics” in sub-Saharan Africa: the case of genital shrinking in 11 countries. Public Underst Sci. 2015;24(8):988–1006. Bartholomew RE, Wessely S. Protean nature of mass sociogenic illness: from possessed nuns to chemical and biological terrorism fears. Br J Psychiatry. 2002; 180:300–6. Boss LP. Epidemic hysteria: a review of the published literature. Epidemiol Rev. 1997;19(2):233–43. Dzokoto VA. Genital-shrinking panic in Ghana: a cultural psychological analysis. Cult Psychol. 2007;13(1):83–104. Bartholomew RE, Sirois F. Occupational mass psychogenic illness: a transcultural perspective. Transcult Psychiatry. 2000;37(4):495–524. Jones TF. Mass psychogenic illness: role of the individual physician. Am Fam Physician. 2000;62(12):2649–2653. Halimi A, Mosavi Jarrahi A, Kian N, et al. Factors related to the occurrence of mass psychogenic illness in schools: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2025. Chowdhury AN. Koro: clinical and historical developments of the culturally defined genital retraction disorder. Cham: Springer; 2021. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9459553","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":627494360,"identity":"23d90a4c-6f13-418e-89ec-0632db248a9e","order_by":0,"name":"Pedro Pallangyo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYHACAzDJxw7hyYGIAw+I0cLGDOEZg7UkkKIlsQFE4tNizt687cMHhjvybMzMzx5+bbNJnx92+CHQFjs53QbsWix7jhXPnMHwzLCNmc3cWLYtLXfj7TQDoJZkY7MDOFx1I8eYmYfhMGMbM4OZtGTb4dyNsxNAWg4kbsOl5f4bsBb7Nmb2byAt6Yaz0z/g13KDB6wlsY2Zx0zyY9vhBHnpHPy2WPakFTPOMHiWDNRSJs1wLs1wg3ROwYEEA9x+MWc/vJnhQ8Ud23729m2SP8ps5OVnp2/+8KHCTg6n9yEkRJaZlw3GNsCuHEkKooXxxx8GBvkG3KpHwSgYBaNgZAIAJhldUG68o20AAAAASUVORK5CYII=","orcid":"","institution":"Jakaya Kikwete Cardiac Institute","correspondingAuthor":true,"prefix":"","firstName":"Pedro","middleName":"","lastName":"Pallangyo","suffix":""},{"id":627494361,"identity":"9681de49-0500-4e81-98e0-672f5023fc2c","order_by":1,"name":"Zabella Mkojera","email":"","orcid":"","institution":"Jakaya Kikwete Cardiac Institute","correspondingAuthor":false,"prefix":"","firstName":"Zabella","middleName":"","lastName":"Mkojera","suffix":""},{"id":627494362,"identity":"14bed77d-778c-4580-b632-c8f9c22dbc8e","order_by":2,"name":"Loveness Mfanga","email":"","orcid":"","institution":"Jakaya Kikwete Cardiac Institute","correspondingAuthor":false,"prefix":"","firstName":"Loveness","middleName":"","lastName":"Mfanga","suffix":""},{"id":627494363,"identity":"e7d50592-c113-410c-99a0-148f18486f67","order_by":3,"name":"Makrina Komba","email":"","orcid":"","institution":"Jakaya Kikwete Cardiac Institute","correspondingAuthor":false,"prefix":"","firstName":"Makrina","middleName":"","lastName":"Komba","suffix":""},{"id":627494364,"identity":"6580ce38-86e0-41ae-a47f-6cbefc43810e","order_by":4,"name":"Peter R. Kisenge","email":"","orcid":"","institution":"Jakaya Kikwete Cardiac Institute","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"R.","lastName":"Kisenge","suffix":""}],"badges":[],"createdAt":"2026-04-19 05:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9459553/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9459553/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107706313,"identity":"141e4cc8-26bf-467a-9c8a-e3d33c932f89","added_by":"auto","created_at":"2026-04-24 09:17:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":123350,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9459553/v1/d9e203c2-ad6c-4d6f-a89c-d0fa1e2807dc.pdf"},{"id":107594638,"identity":"3253ed3e-4cea-4748-9ef2-53789637b6c2","added_by":"auto","created_at":"2026-04-23 04:37:12","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":498238,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-9459553/v1/297afddeca8d0f2deac543aa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cultural Expressions of Koro-Like Syndrome in Tanzania: A Multi-City Case Series","fulltext":[{"header":"Background","content":"\u003cp\u003eSince its first description in the medical literature in 1895, Koro syndrome has been recognized as a culture-bound psychogenic condition characterized by acute anxiety involving perceived genital retraction accompanied by fear of imminent death.\u003csup\u003e1-4\u003c/sup\u003e Although predominantly reported in Southeast Asia (including Indonesia, Malaysia, Singapore, Thailand, and Vietnam), sporadic cases continue to be encountered in routine clinical practice.\u003csup\u003e1-3\u003c/sup\u003e Despite reports of Koro-like presentations from\u0026nbsp;Ghana,\u0026nbsp;Nigeria,\u0026nbsp;South Africa, and Sudan, there remains a relative paucity of literature from sub-Saharan Africa, where such outbreaks are often linked to superstitious beliefs and accusations of genital theft, resulting in social unrest and violence.\u003csup\u003e5-9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAlthough the incidence and pathogenesis of Koro remain unclear, with the clinical course typically being self-limiting, sporadic outbreaks are often driven by the rapid dissemination of rumours through interpersonal communication and media channels.\u003csup\u003e10-12\u003c/sup\u003e Between 1\u003csup\u003est\u003c/sup\u003e and 4\u003csup\u003eth\u003c/sup\u003e April 2026, Tanzania experienced a sudden and widespread emergence of Koro-like symptoms across multiple geographically distinct regions. This case series aims to characterize the clinical features, sociocultural context, and public health consequences of this unprecedented event.\u003c/p\u003e"},{"header":"Case Presentations","content":"\u003cp\u003eAt least 30 cases were reported during the four-day period. The index cases were first identified in Tunduma - Songwe region before rapidly propagating to seven additional geographically distinct regions including; Dar es Salaam, Dodoma, Iringa, Mbeya, Mtwara, Rukwa, and Zanzibar. With only one female case recorded, males aged 20-35 years constituted the vast majority.\u0026nbsp;Individuals reported an acute onset of anxiety following perceived\u0026nbsp;intentional\u0026nbsp;physical contact, typically described as being touched on the shoulder by a stranger in crowded environments, notably markets and bus stands. Within a few minutes, this was followed by a subjective sensation of genital retraction accompanied by panic, palpitations, and fear of impending death within three days.\u0026nbsp;Some individuals were taken to\u0026nbsp;nearby healthcare facilities\u0026nbsp;for evaluation of reported genital retraction; however, no clinical evidence supporting\u0026nbsp;such\u0026nbsp;claims was identified.\u003c/p\u003e\n\u003cp\u003eAmid the spread of rumours and escalating fear, communities adopted shared protective behaviours rooted in circulating cultural beliefs. A widely reported protective measure involved attaching a safety pin connected to a rubber band to the wrist or biceps, based on the belief that it could prevent genital retraction. This behavioural response was rapidly adopted and disseminated, facilitated by social media and reinforced through word-of-mouth communication.\u003c/p\u003e\n\u003cp\u003eThe outbreak was marked by significant social disruption. Individuals suspected of causing genital retraction were targeted by mobs and subjected to severe physical assaults. More than 20 suspects were injured, and nine fatalities were reported. These violent incidents necessitated urgent intervention by law enforcement authorities, resulting in restoration of order.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case series documents the first known occurrence of a Koro-like syndrome in Tanzania, characterized by perceived genital retraction, rapid geographic spread, and substantial social disruption. The term \u0026ldquo;Koro-like syndrome\u0026rdquo; is used to reflect the phenomenological resemblance to classical Koro syndrome while acknowledging its occurrence outside traditionally endemic regions. The pronounced spatiotemporal clustering over a short temporal window observed in this outbreak suggests that its emergence and propagation were driven by prevailing social narratives, fear contagion, and culturally mediated interpretations of bodily sensations. Notably, by virtue of its multi-city scale, this outbreak represents a novel presentation in the East African context.\u003c/p\u003e \u003cp\u003eA striking feature of this outbreak was the consistent narrative linking perceived intentional tactile contact (particularly shoulder contact by strangers) as the precipitating event for genital retraction. In this context, a benign tactile stimulus was reinterpreted through pre-existing cultural schemas, reflecting a process of symptom misattribution. These observations align with previously reported Koro syndrome epidemics, in which symptom initiation and propagation have often been linked to specific external triggers encompassing culturally constructed cues such as physical contact, visual exposure, social interaction, situational contexts, and internal somatic sensations.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The uniformity of externally anchored triggers in the present case series and in the literature suggests a high degree of sociocognitive alignment, which plays a critical role in mass sociogenic processes within affected communities.\u003c/p\u003e \u003cp\u003eThe emergence and adoption of protective practices, including improvised physical safeguards such as safety pins and rubber bands, reflects the translation and reinforcement of shared belief systems into culturally sanctioned coping strategies that likely served to reduce immediate anxiety. The accelerating influence of word-of-mouth communication and social media on behavioural contagion in this case series is reflected in the rapid uptake and dissemination of these practices. Similarly, previously reported Koro-like outbreaks have documented a range of protective behavioural strategies aimed at preventing perceived genital retraction, including manual traction, use of ligatures, application of herbal remedies, and engagement in traditional interventions.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The use of improvised devices such as safety pins connected to rubber bands, as observed in this series, represents a novel but conceptually similar culturally mediated protective strategy.\u003c/p\u003e \u003cp\u003eA major public health concern of this outbreak was the escalation of psychogenic symptoms into vigilante attacks on suspected individuals, resulting in multiple injuries and fatalities. This progression underscores the interaction between mass sociogenic reactions, moral panic dynamics, and blame attribution behaviours, as reported in previous outbreaks of genital retraction syndrome. Similar dynamics have been documented in African settings, where uncertainty surrounding perceived \u0026ldquo;genital theft\u0026rdquo; has legitimised public assaults and, in some instances, fatalities.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e These findings highlight the importance of early identification of rumour-driven events and the implementation of coordinated public health and law enforcement system responses to prevent escalation to severe morbidity and mortality.\u003c/p\u003e \u003cp\u003eAlthough this case series emphasizes the need for early risk communication strategies, the rapid and effective containment of this outbreak following law enforcement intervention underscores the importance of coordinated multisectoral engagement. Such successful containment is consistent with observations from previous Koro epidemics, where timely and integrated responses have been critical in curbing both symptom spread and associated social disruption, particularly in African settings.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite its classification as a culture-bound syndrome, the Koro phenomenon persists in contemporary settings, extending into community contexts and carrying significant social consequences. The escalation into interpersonal violence underscores the need for integrated cultural, behavioural, and public health communication frameworks in responding to similar phenomena. These observations highlight the need for further research into the psychological triggers, transmission dynamics, and vulnerability factors underlying such outbreaks to inform timely, coordinated public health and security responses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was not required in accordance with institutional and national guidelines, as this case series was based on routine clinical and public health case identification. Written informed consent to participate was obtained from all individuals included in this case series.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was waived by the Jakaya Kikwete Cardiac Institute Ethics Committee/IRB, as the data were collected as part of a routine public health investigation and all information was fully anonymised.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePP, ZM, LM, MK, and PRK contributed to the collection of clinical data and patient follow-up. PP drafted the initial manuscript. All authors critically reviewed the manuscript and contributed to its final approval.\u003c/p\u003e\n\u003cp\u003eTop of FormBottom of Form\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgments.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge healthcare workers, surveillance teams, and authorities for their support during case identification and outbreak response, and thank the individuals included in this case series and their families for their cooperation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003e: Department of Research \u0026amp; Training, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e: Department of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eStrong YN, Cao DY, Zhou J, et al. Koro syndrome: epidemiology, psychiatric and physical risk factors, clinical presentation, diagnosis, and treatment options. Health Psychol Res. 2023;11:70165.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSharma S, Jaiswal A. Cultural expressions of Koro syndrome: a case series from North India. Cureus. 2025;17(11):e96981.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJani M, Savani C, Bhatia HS. Koro syndrome in female: a case report of a rare anxiety disorder with cultural influence on psychopathology. Cureus. 2025;17(1):e106266.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatel R, Ashraf A, Myers N, Bhatt N. Cultural concepts of distress: a dive into presentation and avenues for management. Innov Clin Neurosci. 2025;22(7-9):14-17.\u003c/li\u003e\n \u003cli\u003eDzokoto VA, Adams G. Understanding genital shrinking episodes in West Africa: Koro, juju, or mass psychogenic illness? Cult Med Psychiatry. 2005;29(1):53\u0026ndash;78.\u003c/li\u003e\n \u003cli\u003ede-Graft Aikins A, Dzokoto VA, Yevak E. Mass media constructions of \u0026ldquo;socio-psychological epidemics\u0026rdquo; in sub-Saharan Africa: the case of genital shrinking in 11 countries. Public Underst Sci. 2015;24(8):988\u0026ndash;1006.\u003c/li\u003e\n \u003cli\u003eBartholomew RE, Wessely S. Protean nature of mass sociogenic illness: from possessed nuns to chemical and biological terrorism fears. Br J Psychiatry. 2002; 180:300\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eBoss LP. Epidemic hysteria: a review of the published literature. Epidemiol Rev. 1997;19(2):233\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eDzokoto VA. Genital-shrinking panic in Ghana: a cultural psychological analysis. Cult Psychol. 2007;13(1):83\u0026ndash;104.\u003c/li\u003e\n \u003cli\u003eBartholomew RE, Sirois F. Occupational mass psychogenic illness: a transcultural perspective. Transcult Psychiatry. 2000;37(4):495\u0026ndash;524.\u003c/li\u003e\n \u003cli\u003eJones TF. Mass psychogenic illness: role of the individual physician. Am Fam Physician. 2000;62(12):2649\u0026ndash;2653.\u003c/li\u003e\n \u003cli\u003eHalimi A, Mosavi Jarrahi A, Kian N, et al. Factors related to the occurrence of mass psychogenic illness in schools: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2025.\u003c/li\u003e\n \u003cli\u003eChowdhury AN. Koro: clinical and historical developments of the culturally defined genital retraction disorder. Cham: Springer; 2021.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Koro-like syndrome, Genital retraction syndrome, Mass psychogenic illness, Mass sociogenic illness, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-9459553/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9459553/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Koro syndrome is a culture-bound psychogenic condition characterized by acute anxiety involving perceived genital retraction accompanied by fear of imminent death. There remains a relative paucity of literature from sub-Saharan Africa, where such outbreaks are often linked to culturally embedded beliefs and accusations of genital theft, resulting in social unrest and violence. In April 2026, Tanzania experienced a sudden and widespread emergence of Koro-like symptoms across multiple geographically distinct regions. This case series aims to characterize the clinical features, sociocultural context, and public health consequences of this unprecedented event.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentations:\u003c/strong\u003e We report over 30 cases identified across multiple geographically distinct regions. The majority of affected individuals were males aged 20–35 years, with only one female case documented. A consistent narrative emerged in which individuals believed that being touched on the shoulder triggered genital retraction. Protective behaviours included the use of improvised devices such as a safety pin attached to a rubber band, believed to prevent retraction. Individuals suspected of causing genital retraction were targeted by mobs and subjected to severe physical assaults, resulting in multiple injuries and fatalities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This first documented cluster of Koro-like syndrome in Tanzania highlights the potential for rapid community spread and escalation into interpersonal violence. These findings underscore the importance of integrated cultural, behavioural, and public health communication frameworks, and the need for further research to inform timely, coordinated public health and security responses.\u003c/p\u003e","manuscriptTitle":"Cultural Expressions of Koro-Like Syndrome in Tanzania: A Multi-City Case Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 04:37:08","doi":"10.21203/rs.3.rs-9459553/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0a6a5a4c-8865-4446-b191-df3bfca9fd6b","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T04:37:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 04:37:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9459553","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9459553","identity":"rs-9459553","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}