The Global Burden of Female Genital Schistosomiasis

1. Background Female genital schistosomiasis (FGS) is a parasitical disease caused by Schistosoma species that reproduce in the genital plexus, causing pathology and damage to the female genitalia. Given this genital morbidity, FGS may have important repercussions on public health. It was the aim of this review to report the global burden of FGS, more specifically FGS prevalence and symptoms, co-infections with HIV, HPV, sexually transmitted diseases (STDs) and urinary tract infections (UTI), infertility and mortality.

2. Methods A systematic review of the available literature on FGS has been performed using the databases Pubmed and Embase. Only studies that reported on genital manifestations of schistosomiasis were included in this review.

3. Results The results on FGS showed a prevalence of 10.6%-75% in sub-Saharan Africa in schistosomiasis endemic areas, mainly attributed toS. haematobium. In South-America, FGS caused by S. mansoni was very low or even absent. FGS related pathology was significantly found in both the upper and lower genital tract, with a predisposition for the cervix. Morbidity due to FGS was high, but not specific. Most frequently observed signs and symptoms were abnormal vaginal discharge, vaginal itching, post-coital bleeding, menstrual disorders, dyspareunia and abdominal and pelvic pain. Furthermore, co-infections may contribute to an important global burden of FGS. There is a significant association between HIV and laboratory proven FGS. Furthermore, FGS was associated with high risk HPV-infection, but not with all HPV-types. No association was found for urogenital schistosomiasis and STDs such as syphilis, except for one study that reported a relation between FGS and Trichomonas vaginalis infection. FGS and infertility were significantly associated, both for S. haematobium and S. mansoni.

4. Conclusion Our findings suggest that FGS prevalence is high in schistosomiasis endemic areas in Sub-Saharan Africa, especially for FGS due to S. haematobium. Here, FGS is responsible for an important morbidity in both the lower and upper genital tract, with a predilection site of FGS in the cervix. Furthermore, FGS contributes to long term repercussions, given FGS is associated with Trichomonas vaginalis, HIV, high-risk HPV, infertility. Longitudinal results are needed to ascertain a causal relationship.