Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa

Abstract

Abstract:Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16-22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis.

Treating schistosomiasis among South African high school pupils in an endemic area, a qualitative study

“…The modes of transmission for schistosomiasis (through water) and sexually transmitted diseases are completely different [ 36 , 37 ], but S. haematobium (urogenital schistosomiasis) causes symptoms that are also typical of sexually transmitted diseases [ 38 , 39 ]. This has been well documented in females but is largely unexplored in males [ 40 – 43 ].…”

Evaluating diagnostic indicators of urogenital Schistosoma haematobium infection in young women: A cross sectional study in rural South Africa

“…In screening large numbers of patients, the diagnostic tools should be sensitive rather than specific, as this would minimize the risk of leaving infected patients without treatment [ 35 ]. A simple questionnaire may be relatively cheap, does not require any expertise, is less time-consuming and requires minimum training [ 36 ]. However, the listed symptoms may be caused by a long list of diseases and for clinical settings, and a confirmatory test is necessary lest we abuse scarce resources.…”

“…haematobium may cause morbidity in the urinary or genital tracts from the time of the infection, through the ovum-laying period and for decades after he immunological reaction to the dead and calcified ova [ 8 ]. In our population, even though they were all adolescents, they probably represented a continuum from active to past infections as the exposure to fresh water happened at different ages [ 36 ]. The different manifestations and durations of urogenital schistosomiasis could not be detected in a consistent fashion and all the diagnostic indicators used in the study therefore had limited accuracy.…”

Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer

“…Early signs of the disease are a burning sensation in the genitals, spot bleeding, abnormal discharge smell, bloody discharge, stress incontinence and lower abdominal pain. 6 The disease can rapidly progress towards swellings or ulcerations of the vulva and vagina, causing genital bleeding, pain and dyspareunia. 7 The symptoms can gradually evolve towards reproductive organ damage, characterized by sub- or infertility, ectopic pregnancy, spontaneous abortion, premature birth and low birth weight.…”