Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa.

Mahala Livingston,Silindile Gagai,Leiv Sandvik,Svein Gunnar Gundersen,Myra Taylor,Patricia Ndhlovu,Siphosenkosi Gift Zulu,Hashini Nilushika Galappaththi-Arachchige,Elisabeth Kleppa,Birgitte Vennervald,Pavitra Pillay,Jane Dene Kvalsvig,Eyrun F Kjetland

doi:10.4269/ajtmh.20-0679

Abstract

.Women with female genital schistosomiasis (FGS) have been found to have genital symptoms and a three-fold higher risk of HIV infection. Despite WHO recommendations, regular antischistosomal mass drug administration (MDA) has not yet been implemented in South Africa possibly because of the lack of updated epidemiological data. To provide data for future prevention efforts against FGS and HIV, this study explored Schistosoma haematobium prevalence in girls and young women and the effects of antischistosomal MDA, respectively. Urinary schistosomiasis and genital symptoms were investigated in 70 randomly selected secondary schools in three districts within KwaZulu-Natal and 18 primary schools. All study participants were treated for schistosomiasis, and schools with the highest urinary prevalence were followed up after 1 and 4 years of MDA. At baseline, urine analysis data showed that most schools were within the moderate-risk prevalence category where biennial antischistosomal MDA is recommended, as per WHO guidelines. Young women had high prevalence of genital symptoms (36%) after correcting for sexually transmitted infections. These symptoms may be caused by infection with schistosomes. However, FGS cannot be diagnosed by urine analysis alone. In KwaZulu-Natal rural schools, this study suggests that antischistosomal MDA with praziquantel could prevent genital symptoms in more than 200,000 young women. Furthermore, it is feasible that more than 5,000 HIV infections could be prevented in adolescent girls and young women by treatment and prevention of FGS.

Highlights

Schistosomiasis (Bilharzia) is a waterborne parasitic infection found around the world but predominantly in subSaharan Africa, where more than 800 million people are estimated to be currently at risk of infection.[1]
Our findings suggest that the morbidity of S. haematobium infection does not necessarily decrease with age but may become more difficult to detect through urine sampling.[7,37]
By conservative estimates, treating for urogenital schistosomiasis infections in endemic areas of this region could cost-effectively prevent more than 53,000 new cases of HIV the decade.[6,47]

Summary

Introduction

Schistosomiasis (Bilharzia) is a waterborne parasitic infection found around the world but predominantly in subSaharan Africa, where more than 800 million people are estimated to be currently at risk of infection.[1] Schistosomiasis is estimated to account for more than 200,000 deaths in this continent annually. This infection is associated with pain and sometimes causes debilitating morbidity in both adults and children.[1]. The ensuing host inflammation is composed of immunological cells, fibrosis, and angiogenesis.[3,4,5] The female genital manifestations of S. haematobium, noted as female genital schistosomiasis (FGS), have previously been reported to affect a mean of 54% (range 33–75%) of women and girls living in schistosome-endemic areas.[6,7] The presence of schistosome eggs in genital tissue is classically associated with a burning sensation in the genitals, malodorous discharge, and pain as well as infertility, ectopic pregnancies, and miscarriage.[7]

Methods

Results

Discussion

Conclusion