Abstract
Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16–22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis.
Highlights
It is estimated that more than 112 million people worldwide are infected with the freshwater parasite Schistosoma haematobium [1]
In a young population of women living in an S. haematobium endemic area of KwaZulu-Natal, South Africa, we found an association between self-reported unsafe water contact and urogenital schistosomiasis in young women
We argue that in S. haematobium endemic areas, urogenital schistosomiasis should be considered as a differential diagnosis in all women presenting with symptoms of sexually transmitted diseases
Summary
It is estimated that more than 112 million people worldwide are infected with the freshwater parasite Schistosoma haematobium [1]. S. haematobium is thought to be the main etiological agent of urogenital schistosomiasis [2]. This disease is mostly endemic in Sub-Saharan Africa, the Middle East and most recently an outbreak was reported in Corsica, France [3,4]. The cercariae penetrate the skin, enter the bloodstream and follow it to the liver [6] They mature and mate before they migrate as male and female couples to the venous plexa surrounding the urogenital organs where the female starts producing ova [6]. The urogenital morbidity seen with S. haematobium infection is largely due to the host’s immune response to the schistosome ova [6]
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