Clinical findings in female genital schistosomiasis in Madagascar

Abstract

SummaryTo assess the morbidity of S. haematobium infection in women of reproductive age (15-49 years) in the western part of Madagascar, the village of Betalatala with a prevalence of urinary schistosomiasis in women of 75.6% (95% confidence limit 69.3 to 81.9%) was compared with a neighbouring village with similar socio-economic characteristics and a prevalence of 5.0% (95% confidence limit 0 to 11.75%). The women were questioned in Malagasy about obstetrical history and urogynecological symptoms. They were examined gynaecologically, parasitologically and by ultrasonography. Important STDs were excluded by appropiate diagnostics. In Betalatala significantly more women reported a history of spontaneous abortion (P Ͻ 0.01), complaints of irregular menstruation (P Ͻ 0.001), pelvic pain (Ͻ0.05), vaginal discharge (P Ͻ 0.0001), dysuria (P Ͻ 0.05) and haematuria (P Ͻ 0.01) than in the control village. Biopsies were obtained from the cervix of 36 women with macroscopical lesions, and in 12 cases S. haematobium eggs were found by histological sectioning (33.3%). In the control village no eggs were detected in the histological sections of biopsies taken from 14 women. (P Ͻ 0.05). Infections with Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis and Treponema pallidum were found in similar frequencies in both villages. In 9.8% of the women in Betalatala abnormalities of the upper reproductive tract were revealed by ultrasonography versus none in the women from the control village (P Ͻ 0.05). Echographic abnormalities of the urinary tract were present in 24% and 3% of the women in the study village and in the control village, respectively (P Ͻ 0.0001). These findings were accompanied by an elevated frequency of haematuria (55% versus 20%) and proteinuria (70.4% versus 25%) in the study population (P Ͻ 0.0001). Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract, but also frequently in the lower and upper reproductive tract.

Urogenital schistosomiasis in females from some suburban communities of Jos, north central Nigeria

“…Similar results were recorded in Ezza communities of Ebonyi State (22.1%) [11]. While some other studies reported a 100% (hospital-based study) in Malawi; 76% in Madagascar; 42% in Tanzania and 47-62% in Osun State of Nigeria respectively [31,32,33,34,14] . In contrast, [35] reported a 2.07% among some residents of Gwong and Kabong in Jos north LGA while [36] reported a 6.4% in school children in Langai community in Mangu LGA of Plateau State.…”

Cofactor infections and HIV epidemics in developing countries: implications for treatment

“…Worms and ova of S. hematobium infect the reproductive tract of both men and women. They create lesions-open portals for HIV-and inflammation of the genital area (Attili et al, 1983;Feldmeier et al, 1995;Marble and Key, 1995;Leutscher et al, 1998). A recent trial in Zimbabwe found that genital lesions of schistosomiasis increased HIV risk in women three-fold (Kjetland et al, 2006).…”

Diagnosis of genital cervical schistosomiasis: comparison of cytological, histopathological and parasitological examination.

“…[4][5][6][7] Communitybased studies have shown that cervical schistosomiasis is very common in women infected with S. haematobium with frequencies ranging from 33% to 75%. [8][9][10][11] Clinically, schistosomiasis of the cervix shows diverse features, all of which result from granulomatous inflammation. Cauliflower-like growth, nodular hypertrophy, ulcerative and polypoid lesions have been documented.…”