Abstract
BackgroundUrogenital schistosomiasis, caused by infection with Schistosoma haematobium, is widespread and causes substantial morbidity on the African continent. The infection has been suggested as an unrecognized risk factor for incident HIV infection. Current guidelines recommend preventive chemotherapy, using praziquantel as a public health tool, to avert morbidity due to schistosomiasis. In individuals of reproductive age, urogenital schistosomiasis remains highly prevalent and, likely, underdiagnosed. This comprehensive literature review was undertaken to examine the evidence for a cause-effect relationship between urogenital schistosomiasis and HIV/AIDS. The review aims to support discussions of urogenital schistosomiasis as a neglected yet urgent public health challenge.Methodology/Principal FindingsWe conducted a systematic search of the literature including online databases, clinical guidelines, and current medical textbooks. We describe plausible local and systemic mechanisms by which Schistosoma haematobium infection could increase the risk of HIV acquisition in both women and men. We also detail the effects of S. haematobium infection on the progression and transmissibility of HIV in co-infected individuals. We briefly summarize available evidence on the immunomodulatory effects of chronic schistosomiasis and the implications this might have for populations at high risk of both schistosomiasis and HIV.Conclusions/SignificanceStudies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects. In those who become HIV-infected, schistosomal co-infection may accelerate HIV disease progression and facilitate viral transmission to sexual partners. Establishing effective prevention strategies using praziquantel, including better definition of treatment age, duration, and frequency of treatment for urogenital schistosomiasis, is an important public health priority. Our findings call attention to this pressing yet neglected public health issue and the potential added benefit of scaling up coverage of schistosomal treatment for populations in whom HIV infection is prevalent.
Highlights
An estimated 207 million people worldwide are infected with schistosomes [1], and 85% of these cases occur in Africa [1,2,3]
Reported symptoms of female genital schistosomiasis include infertility, pelvic discomfort, dyspareunia, contact and spontaneous bleeding, itching, and giant granulomata that appear as tumors [10,11,29,30]
Schistosomiasis in the female genital tract has been postulated to pose a greater risk than bacterial genital ulcer disease because, unlike many common sexually-transmitted infections (STIs), it often is not restricted to a single localized sore that allows the rest of the vulval, vaginal or cervical epithelium to remain intact [33]
Summary
An estimated 207 million people worldwide are infected with schistosomes [1], and 85% of these cases occur in Africa [1,2,3]. Individuals living in endemic countries are most commonly infected during childhood, and the prevalence peaks between the ages of 10 and 20 years [5,6] For those who are continually reinfected by contaminated water, schistosomiasis causes a chronic disease over decades. While the mortality caused by schistosomiasis is low, the morbidity is high, and includes anemia, stunted growth, and decreased ability to learn in children [1]. In individuals of reproductive age, urogenital schistosomiasis remains highly prevalent and, likely, underdiagnosed. The review aims to support discussions of urogenital schistosomiasis as a neglected yet urgent public health challenge
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