Gynecological Manifestations, Histopathological Findings, and Schistosoma-Specific Polymerase Chain Reaction Results Among Women With<i>Schistosoma haematobium</i>Infection: A Cross-sectional Study in Madagascar

Randrianasolo, Bodo; Jourdan, P; Ravoniarimbinina, Pascaline; Ramarokoto, Charles Emile; Rakotomanana, Fanjasoa; Ravaoalimalala, V. E.; Gundersen, Svein Gunnar; Feldmeier, Hermann; Vennervald, Birgitte J.; Lieshout, Lisette van; Roald, Borghild; Leutscher, Peter; Kjetland, Eyrun Floerecke

doi:10.1093/infdis/jiv035

Cited by 54 publications

(66 citation statements)

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“…This is in line with a recent FGS study from Madagascar where women between 15 and 35 years with Schistosoma negative urines had Schistosoma DNA in genital samples as well as cases in our study. [ 23 ] The important notion of this is that testing only urine samples for schistosomiasis may be insufficient to diagnose FGS.…”

Section: Discussionmentioning

confidence: 99%

Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction

et al. 2016

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Background:Female genital schistosomiasis (FGS) is a tissue reaction to lodged ova of Schistosoma haematobium in the genital mucosa. Lesions can make the mucosa friable and prone to bleeding and discharge. Women with FGS may have an increased risk of HIV acquisition, and FGS may act as a cofactor in the development of cervical cancer.Objectives:To explore cytology as a method for diagnosing FGS and to discuss the diagnostic challenges in low-resource rural areas. The correlation between FGS and squamous cell atypia (SCA) is also explored and discussed. Cytology results are compared to Schistosoma polymerase chain reaction (PCR) in vaginal lavage and urine and in urine microscopy.Materials and Methods:In a clinical study, 394 women aged between 16 and 23 years from rural high schools in KwaZulu-Natal, South Africa, underwent structured interviews and the following laboratory tests: Cytology Papanicolaou (Pap) smears for S. haematobium ova and cervical SCA, real-time PCR for Schistosoma-specific DNA in vaginal lavage and urine samples, and urine microscopy for the presence of S. haematobium ova.Results:In Pap smears, S. haematobium ova were detected in 8/394 (2.0%). SCA was found in 107/394 (27.1%), seven of these had high-grade squamous intraepithelial lesion (HSIL). Schistosoma specific DNA was detected in 38/394 (9.6%) of vaginal lavages and in 91/394 (23.0%) of urines. Ova were found microscopically in 78/394 (19.7%) of urines.Conclusion:Schistosoma PCR on lavage was a better way to diagnose FGS compared to cytology. There was a significant association between S. haematobium ova in Pap smears and the other diagnostic methods. In low-resource Schistosoma-endemic areas, it is important that cytology screeners are aware of diagnostic challenges in the identification of schistosomiasis in addition to the cytological diagnosis of SCA. Importantly, in this study, three of eight urines were negative but showed Schistosoma ova in their Pap smear, and one of them was also negative for Schistosoma DNA in urine. In this study, SCA was not significantly associated with schistosomiasis. HSIL detected in this young population might need future consideration.

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Section: Discussionmentioning

confidence: 99%

Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction

et al. 2016

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“…Large-scale surveys determining the prevalence of schistosomiasis in Madagascar have been scarce, and data has been derived from historical records or individual studies [ 21 , 22 ]. Several studies have highlighted the occurrence of genital S. haematobium infection that may represent an unrecognised burden of disease in women and men [ 23 , 24 ]. The recent WHO-led mapping surveys will address the lack of updated, nationwide prevalence data of schistosomiasis, and ensure appropriate resource allocation for NTD control in Madagascar.…”

Section: Discussionmentioning

confidence: 99%

Baseline prevalence and intensity of schistosomiasis at sentinel sites in Madagascar: Informing a national control strategy

et al. 2016

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BackgroundSchistosomiasis affects more than 800 million people, mostly in sub-Saharan Africa. A baseline sentinel site study was conducted in the Western half of Madagascar to determine the prevalence and intensity of schistosomiasis and soil-transmitted helminth (STH) infections prior to mass drug administration, and to explore the associations between infection and school attendance, and access to water, sanitation and hygiene (WASH) facilities.MethodsA three-stage, cluster-randomised cross-sectional study was conducted in 29 sentinel sites in October 2015. Twenty school attending and 4 non-attending children in each of the age groups from 7 to 10 years old were randomly selected at each site for detection of Schistosoma haematobium eggs in a single urine slide by filtration, and of S. mansoni, Ascaris lumbricoides, Trichuris trichiura and hookworm eggs in duplicate Kato-Katz slides from a single stool sample. School attendance was registered individually, and school-level access to WASH facilities was scored through pre-defined observed and reported factors. Logistic regression analysis was performed, adjusting for gender, age and study site. School-level WASH status was analysed using Spearman’s rank correlation coefficient.ResultsA total of 1,958 children were included. The prevalence of S. haematobium infection and heavy-intensity infection was 30.5 % and 15.1 %, respectively. The prevalence of S. mansoni infection and heavy-intensity infection was 5.0 % and 0.9 %, respectively. The prevalence of any STH infection was 4.7 %. There was no significant difference in prevalence of infection or heavy-intensity infection of either schistosome species between attending and non-attending children, apart from heavy-intensity S. mansoni infection that was significantly more common in children who did not attend school regularly (aOR = 7.5 (95 % CI = 1.1-49.5); p = 0.037). Only a minority of schools had adequate access to WASH facilities, and in this study, we found no significant association between school-level WASH status and schistosomiasis.ConclusionsThis study found an alarmingly high prevalence and intensity of schistosomiasis, and the results warrant urgent scale-up of the national NTD control programme that will need to include both non-attending and attending school-age children in order to reach WHO roadmap targets for the control of schistosomiasis by 2020.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1337-4) contains supplementary material, which is available to authorized users.

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“…At times routine Pap smear tests can reveal genital schistosomiasis (Figure 3). 4 Polymerase chain reaction 23 on vaginal lavage samples or urine was found to be a better was to diagnose female urogenital schistosomiasis compared to cytology. An abdominopelvic x-ray can reveal calcifications.…”

Section: Diagnosismentioning

confidence: 99%

Female Genital Schistosomiasis: A Neglected Tropical Disease

Ngwenya¹

2016

Gynecol Obstet Res Open J

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Female genital schistosomiasis is a neglected tropical disease. Few clinicians consider it in their differential diagnosis. Yet this disease affects hundreds of millions of people. Hundreds of thousands of them actually die annually. It significantly affects the reproductive health of women. Patients infected in childhood may carry the burden of disease throughout their lives without being detected. Global attention is occupied by new emerging diseases like Zika virus and female genital schistosomiasis is relegated to back of pages in the list of global worries.The importance of this disease on the health of women cannot be over-emphasied. The global attention must be focused so that it can be tackled adequately. Awareness among clinicians must be increased so that they consider it when women present to them with unusual symptomatology. Female genital schistosomiasis is a neglected tropical disease affecting millions of people. It causes significant morbidity and mortality in women. Awareness among clinicians is low as most cases are discovered fortuitously while undergoing investigations for other conditions.

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Gynecological Manifestations, Histopathological Findings, and Schistosoma-Specific Polymerase Chain Reaction Results Among Women WithSchistosoma haematobiumInfection: A Cross-sectional Study in Madagascar

Cited by 54 publications

References 28 publications

Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction

Cervical cytology as a diagnostic tool for female genital schistosomiasis: Correlation to cervical atypia and Schistosoma polymerase chain reaction

Baseline prevalence and intensity of schistosomiasis at sentinel sites in Madagascar: Informing a national control strategy

Female Genital Schistosomiasis: A Neglected Tropical Disease

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