A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa

Abstract

Male genital schistosomiasis (MGS) is a gender specific manifestation of urogenital schistosomiasis (UGS) first described in 1911 by Madden in Egypt. Today, while affecting millions of men and boys worldwide, MGS receives insufficient attention, especially in sub-Saharan Africa (SSA). To provide a systematic review with an epidemiological update of MGS, we inspected both online and hardcopy resources in our appraisal. A total of 147 articles were eventually identified, only 31 articles were exclusively focused on MGS with original or targeted research. From these, we discuss pertinent clinico-pathological features of MGS, highlight the possible connection and interplay with HIV, and assess current diagnostic techniques alongside consideration of their use and application in SSA. To appreciate the burden of MGS more fully, especially in endemic areas, there is a clear need for better surveillance and longitudinal population research to investigate the best point-of-care (POC) diagnostic and its performance through time. Furthermore, to optimise individual case management, exploration of alternative praziquantel dosing regimens is needed for MGS in men with or without HIV co-infection.

A systematic review and meta-analysis to assess the association between urogenital schistosomiasis and HIV/AIDS infection

“…There are limited studies looking at UGS in men and HIV. In a systematic review done on MGS, only 31 research articles were identified that exclusively focused on MGS [5]. Another systematic review on MGS identified 40 publications that were dominated by case reports and observational studies that focused on MGS [39].…”

“…About 75% of women in SSA with S. haematobium infections have vulva, vagina and cervical ulceration secondary to urogenital schistosomiasis [4]. In males, ulcerative lesions have been observed in the seminal vesicle lumen with mucosal thickening and enlargement [5].…”

Freshwater snails of biomedical importance in the Niger River Valley: evidence of temporal and spatial patterns in abundance, distribution and infection with Schistosoma spp.

“…Schistosomiasis is present throughout West Africa, including Niger. Urogenital schistosomiasis is endemic in the Niger River Valley (NRV), and is caused by S chistosoma haematobium , the most widespread and prevalent human schistosome species across Africa, which displays often severe pathologies [3–6]. Schistosoma bovis , a pathogen of domestic livestock and some non-domestic artiodactyls [7] is also prevalent in the region [8–11].…”

Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition

“…In females, cervicovaginal schistosome egg-containing tissue is exposed to semen containing HIV-1. The prostate and seminal vesicles are commonly affected by S. haematobium in men ( Kayuni et al., 2019 ), internal structures that are not exposed during sexual contact. Authors finding a difference in the association between schistosomiasis and HIV-1 infection by sex hypothesize that this may be due to differential contact of egg-containing tissues in female versus male genital tissues during sexual contact ( Downs et al., 2017 ).…”