Abstract
Background Schistosoma (S.) haematobium infection is a common cause of genital morbidity in adult women. Ova in the genital mucosal lining may cause lesions, bleeding, pain, discharge, and the damaged surfaces may pose a risk for HIV. In a heterogeneous schistosomiasis endemic area in South Africa, we sought to investigate if young girls had genital symptoms and if this was associated with urinary S. haematobium.MethodologyIn a cross-sectional study of 18 randomly chosen primary schools, we included 1057 schoolgirls between the age of 10 and 12 years. We interviewed assenting girls, whose parents had consented to their participation and examined three urines from each of them for schistosome ova.Principal findingsOne third of the girls reported to have a history of genital symptoms. Prior schistosomal infection was reported by 22% (226/1020), this was associated with current genital symptoms (p<0.001). In regression analysis the genital symptoms were significantly associated both with urinary schistosomiasis (p<0.001) and water contact (p<0.001).ConclusionsEven before sexually active age, a relatively large proportion of the participating girls had similar genital symptoms to those reported for adult genital schistosomiasis previously. Anti-schistosomal treatment should be considered at a young age in order to prevent chronic genital damage and secondary infections such as HIV, sexually transmitted diseases and other super-infections.
Highlights
Urogenital schistosomiasis causes gynecological morbidity in adult women [1,2]
Even before sexually active age, a relatively large proportion of the participating girls had similar genital symptoms to those reported for adult genital schistosomiasis previously
Anti-schistosomal treatment should be considered at a young age in order to prevent chronic genital damage and secondary infections such as HIV, sexually transmitted diseases and other super-infections
Summary
Urogenital schistosomiasis causes gynecological morbidity in adult women [1,2]. Schistosoma (S.) haematobium is primarily known for its effect on the urinary tract, but in endemic areas schistosomiasis may be the most common cause of genital morbidity and mucosal lesions [3]. S. haematobium ova when deposited in the female reproductive tract seem to be distributed in the different genital parts, but are most commonly identified in the cervix and the vagina [6,7,8,9] Both viable and dead ova may cause tissue reactions, morbidity and symptoms long after contact with infested waters [10,11]. In young girls there have only been a few case reports, hypothesizing that the pre-pubertal predilection site is in the vulva [7,8,9,13,14] This may partly be because gynecological inspections are not prioritized in rural areas, controversial in virgins, and because the causal relationship between schistosomiasis and genital lesions in young females has not been explored on a large scale [14,15]. In a heterogeneous schistosomiasis endemic area in South Africa, we sought to investigate if young girls had genital symptoms and if this was associated with urinary S. haematobium
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