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Female genital schistosomiasis (FGS) remains an often overlooked chronic complication of urogenital schistosomiasis in adolescent girls and women. Moreover, the role of zoonotic or hybrid schistosome infection(s) is poorly appreciated, but is increasingly becoming an emerging public health concern in sub-Saharan Africa. In Southern Malawi, during the “Hybridization in UroGenital Schistosomiasis (HUGS)” study visit, we describe the case of a 33-year-old woman with suspected FGS who partook in a detailed external assessment with internal cervical examination using a portable colposcope. She provided several biological samples for analysis with traditional and molecular parasitological methods—urine, cervicovaginal lavage (CVL), cervical swabs, and external mass and cervical biopsies—alongside provision of detailed demographic information after a thorough medical history questionnaire and an in-depth interview. These samples were screened for the presence of Schistosoma ova on microscopy and DNA genotyping using a novel real-time PCR assay in parallel to pre-published probe-based PCR assays capable of identifying and discriminating up to six named Schistosoma species. A further molecular screen of sexually transmitted infections (STIs) including Trichomonas vaginalis, Chlamydia spp., and human papilloma virus (HPV) was conducted on her genital swab and CVL. Overt FGS was diagnosed on clinical colposcopy alongside inspection of the cervical biopsy by microscopy, real-time PCR, and histopathology. The urine filtration, microscopy and real-time PCR of the CVL and swab were negative. This evidences the typical diagnostic challenge, and cases such as this will pose an unmet need in satisfactory patient management. In addition to Schistosoma haematobium, the presence of the zoonotic species Schistosoma mattheei and concurrent STIs raise questions as to the long-term effectiveness of the current control strategies of the National Control Programme to eliminate schistosomiasis as a public health problem. Improved availability of and regular accessibility to praziquantel treatment for women at risk such as this are urgently needed. Furthermore, targeted health education, increased community awareness, and dovetailing of synergistic activities and strategies with other health stakeholders such as those in sexual and reproductive health, as well as HIV/AIDS programs in the Ministry of Health, are needed here and in neighboring countries.

Background Schistosomiasis is a neglected tropical disease caused by trematodes of the genus Schistosoma. Schistosoma haematobium causes urogenital schistosomiasis (UGS), a chronic disease characterized by pathology of the urogenital tract leading to potentially severe morbidity for which the treatment is poorly standardized. We conducted a survey in TropNet centres on the clinical presentations and management strategies of complicated urogenital schistosomiasis (cUGS). Methods We reviewed the clinical records of patients seen at TropNet centres over a 20-year timespan (January 2001–December 2020). Case definition for cUGS included the presence of urogenital cancer, obstructive uropathy, kidney insufficiency of all grades and female or male genital involvement leading to infertility. Collected data included demographic information, patient category (traveller or migrant), imaging data, microbiological data (serology results and presence/absence of eggs in urine), histological features and outcome at last visit recorded. Results Eight centres contributed with at least one case. Overall, 31 patients matched the inclusion criteria. Sub-Saharan Africa was the most likely place of infection for included patients. Median age was 30.6 years (range 21–46, interquartile ranges, IQR 27–33). Most patients (28/31, 90.3%) were males. Hydronephrosis was the most frequent complication, being present in 18 (58.1%) patients, followed by cancer, present in 5 patients (16.1%); 27 patients (87.1%) required surgical management of some sort. Use of praziquantel varied across centres, with six different regimens employed. Discussion Very few cases of cUGSs were found in our survey, possibly indicating underdiagnosis of this condition. Hydronephrosis was the most frequently observed urogenital complication, and most patients required invasive procedures. Infection by S. haematobium can result in considerable morbidity, resulting in clinically challenging presentations requiring a multidisciplinary approach. As such, development of common protocols for early diagnosis and treatment is urgently needed. [ABSTRACT FROM AUTHOR]

Background: Genital schistosomiasis (GS) is a debilitating neglected tropical disease caused by Schistosoma haematobium. Despite its significant impact on reproductive health, awareness and knowledge of GS among healthcare providers, especially in Sub-Saharan Africa, remain inadequate, leading to underdiagnosis and mistreatment., Methods: This study conducted a cross-sectional online survey to assess the awareness and knowledge of GS among 139 primary healthcare providers in Northern Nigeria. A semi-structured self-administered questionnaire was utilized, covering various aspects of GS including its aetiopathogenesis, clinical features, complications, diagnosis, and prevention/treatment. Respondents were scored based on their answers, with an overall score of ≥35 considered indicative of good awareness., Results: Most respondents were aged 31-50 years (41.0%), male (59.7%), married (84.9%), and working in the public sector (97.8%). Mean scores indicated varying levels of awareness across different aspects of GS, with higher awareness regarding aetiopathogenesis (13.99 ±3.275) and prevention/treatment (11.27±1.592). However, awareness of complications remained comparatively lower. Overall, 43.9% of respondents demonstrated good awareness of GS. Regional disparities in awareness were observed, with the North-western region exhibiting the highest awareness (52.6%) followed by the Northeast (40.6%) and Northcentral regions (36.0%)., Conclusion: The study underscores the urgent need for targeted educational interventions to enhance healthcare providers' knowledge of GS, particularly in regions with lower awareness levels. Improving awareness and knowledge among primary healthcare providers can facilitate early detection, appropriate management, and prevention strategies, thus alleviating the burden of GS on affected communities in Northern Nigeria and beyond., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2024 by West African Journal of Medicine.)

Female genital schistosomiasis is not uncommon in endemic areas for schistosomiasis, but there are few reports in the Brazilian medical literature. Here, we describe the case of a 31-year-old woman with lower abdominal pain who was diagnosed as presenting a fallopian tube tumor caused by Manson's schistosomiasis. The diagnosis was delayed because her symptoms were considered nonspecific. Involvement of the parietal peritoneum of the ovarian fossa was observed during laparoscopy and confirmed by histological analysis. The left tube and the tumor were excised and schistosomiasis was treated with praziquantel. She presented a full recovery and options for future reproduction are under evaluation.Esquistossomose genital feminina não é incomum em áreas endêmicas para esquistossomose, mas, há poucos relatos na literatura médica brasileira. Descrevemos aqui, o caso de uma paciente de 31 anos com dor abdominal no baixo ventre que recebeu o diagnóstico de tumor da trompa de falópio causada pela esquistossomose mansônica. O diagnóstico foi retardado porque os sintomas foram considerados inespecíficos. Havia envolvimento do peritônio parietal da fossa ovárica durante a laparoscopia, confirmado à histologia. A tuba esquerda e o tumor foram extirpados e a esquistossomose foi tratada com praziquantel. A paciente apresentou recuperação completa e opções para reprodução futura estão sob avaliação.

In 2000, the World Health Organization (WHO) published an ultrasound field protocol for assessing morbidity due to schistosomiasis. The present study aims to review the acceptance of the WHO protocol for Schistosoma haematobium. A PubMed literature research using the keywords 'ultrasound OR ultrasonography (US) AND schistosomiasis,' 'US AND S. haematobium,' 'US AND urinary schistosomiasis' from 2001 through 2014 was performed. Thirty-eight eligible publications reporting on 17,861 patients from 13 endemic and 2 non-endemic countries were analysed. Of these, 33 referred to field studies on 17,317 patients. The Niamey protocol was applied to 15,367/17,317 (88.74 %) patients in 23/33 (69.70 %) of field studies (all studies: 15,649/17,861 [87.61 %] patients (25/38 [68.42 %] studies). The acceptance of the protocol by single country in field studies varied from 0 to 100 %. It varied over time between 55.56 % (5/9) in the period from 2001 to 2004, to 87.50 % (7/8) from 2005 to 2008, to 62.50 % (5/8) from 2009 to 2011 and 75.00 % (6/8) from 2012 through 2014 (all studies: 50 % [5/10], 88.89 % [8/9], 62.50 % [5/8], 63.64 % [7/11], respectively). The Niamey protocol was applied also in 2/5 hospital studies in 282/544 (51.84 %) patients. The usefulness of the WHO protocol for S. haematobium infections is confirmed by its worldwide acceptance. Some simplifications might facilitate its use also for focused ultrasound examinations performed by less skilled examiners. Organ abnormalities due to schistosomiasis detectable by ultrasonography not yet covered by the WHO protocol should be added to the additional investigations section. [ABSTRACT FROM AUTHOR]

Objective Epidemiological studies have observed that genital schistosomiasis increases the risk of HIV infection in Africa. We analysed the correlation between Schistosoma haematobium prevalence and HIV prevalence across sub-Saharan African countries. Design Regression analysis of prevalence of HIV and S. haematobium across sub-Saharan African countries. Methods Using compiled country-level S. haematobium prevalence, HIV prevalence and other demographic and economic data from published sources, we applied univariate and multivariate regression models to assess the correlations between S. haematobium prevalence and HIV prevalence while controlling for risk factors associated with each infection. Results In 43 sub-Saharan African countries, the mean prevalence of S. haematobium was 22.4% [standard deviation ( SD): 9.8%] and for HIV was 6.21% ( SD: 5.71%). In multivariate analysis, adjusted for prevalence of male circumcision, years since a country's first HIV/ AIDS diagnosis, geographical region and immunization coverage, each S. haematobium infection per 100 individuals was associated with a 2.9% (95% CI: 0.2-5.8%) relative increase in HIV prevalence. S. haematobium was not associated with Schistosoma mansoni, HSV-2, hepatitis C, malaria or syphilis. Conclusions Schistosoma haematobium prevalence was associated with HIV prevalence in sub-Saharan Africa. Controlling S. haematobium may be an effective means of reducing HIV transmission in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Genital schistosomiasis may be a risk factor for HIV, but chronic lesions in adults may be refractory to standard treatment. We aimed to investigate young girls’ risk factors for gynaecological schistosomiasis, possible protective factors and possibilities for behavioural change and mass treatment in rural Tanzania. A standardised questionnaire was used to interview females between 5 and 20 years of age in a small cross-sectional study. One third of the girls were found to be at risk of acquiring schistosomal infection. Younger and older girls were engaged in more risk behaviour than the 10–14-year-olds. Knowledge of the parasite was associated with less risky water contact, and most of the girls had acquired this knowledge through primary school education. Mass treatment for gynaecological schistosomiasis should be done in collaboration with the school system as a joint venture with the health system in order to reach non-enrolled girls who may be at particular risk. Research is still needed to assess the preventive effect of treatment on genital lesions and on HIV incidence. [ABSTRACT FROM AUTHOR]

Objective To examine the association between schistosomiasis and reproductive tract symptoms. Method A cross-sectional study was conducted in a Schistosoma haematobium-endemic area of rural Zimbabwe. A total of 483 permanently resident adult women of Mupfure Ward aged 20–49 were interviewed and examined clinically, each providing three consecutive urine samples. Logistic regression analysis was used to control for sexually transmitted diseases (STDs). Results Women with genital sandy patches had significantly more genital itch ( P = 0.009) and perceived their discharge as abnormal ( P = 0.003). Eighty percent of the women who had genital itch, yellow discharge, and childhood or current waterbody contact had sandy patches. Fifty-two percent of the women with genital sandy patches did not have detectable S. haematobium ova in urine. Genital schistosomiasis was associated with stress incontinence and pollakisuria, but not with menstrual irregularities, current or previous ulcers, or tumours. Conclusion Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A case description of a rare incidence of female genital schistosomiasis related to vulva squamous cell carcinoma in a 76-year-old woman from the schistosomiasis-endemic region of Gombe State, Nigeria. Physicians should be aware of the high incidence rate of female genital schistosomiasis (FGS) in women and girls in schistosomiasis-endemic areas, which is often related to gynecological morbidity and the risk of HIV infection to avoid unnecessary interventions., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

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