Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi

Abstract

Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men. Despite the first formal description of MGS in 1911 by Madden, its epidemiology, diagnostic testing and case management of today are not well-described. However, since several interactions between MGS and the Human Immunodeficiency Virus (HIV) are known, there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi, to document its prevalence and assess mens' knowledge, attitudes and practices (KAP). After providing informed written consent, fishermen (n = 376) aged 18+ years (median age: 30 years, range: 18–70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP, with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0 eggs per ml, range: 0.1–30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 eggs per 10 ml, range: 0.1–186.0) and 3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infection. Just under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = −0.25, n = 100, p = 0.01). In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions. This will improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi.

An Assessment of Implementation of Mass Drug Administration for Prevention and Control of Schistosomiasis and Soil-Transmitted Helminths in Selected Southern Malawi Districts

“…However, despite the high coverage rates obtained in the study districts over the two years there is only slow progress towards achievement of the goal to reduce burden of schistosomiasis and STH to levels of no public health importance in Malawi by 2025. Recent prevalence studies done across Malawi after introduction of MDA in 2012, including in the study districts have pointed to persistent infections [6, [13][14][15][16][17][37][38][39][40][41][42] and reinfections [37][38][39][40][41][42] occurring within a year despite sustained annual MDA campaigns implemented throughout the country. These persistent infections and reinfections are similar to those observed in other studies carried out in Cote d'Ivoire, Kenya, Mozambique, Tanzania [43] and Togo [44].…”

Epididymal bilharzia simulating a testicular tumor: A case report

“…It mainly affects poor populations living in endemic areas with hygiene and sanitation problems. The organs usually most affected by schistosomiasis are the bladder and the colon [1] , [2] , [3] , [4] , [5] , [6] . Rarer locations have been described in the literature, including the appendix, prostate, ovaries, fallopian tubes and cervix [6] , [9] , [10] , [11] .…”

“…It is caused by a hematophagous trematode of the genus Schistosoma, first described by Theodor Bilharz in 1851. The evolutionary cycle of the parasite was established in 1915 by Leiper who specified that the intermediate host was a freshwater snail [1] , [2] , [3] . The definitive host, i.e.…”

“…Schistosoma has a known carcinogenic effect in the bladder and has been implicated in other types of cancer such as cervical cancer. In addition, Schistosoma infection increases the risk of contracting other types of urogenital tract infections such as HIV and human papillomavirus [1] , [2] , [3] . Testicular involvement by Schistosoma is very rare and is caused by Schistosoma mansoni and Schistosoma haematobium [6] .…”

The parasitology of female genital schistosomiasis

“…It is important at this point to note that while S. haematobium is the most implicated species in FGS, there are also reports of FGS being caused by S. mansoni ( Kjetland et al., 2012 ; Christinet et al., 2016 ; Leandro et al., 2021 ) and possibly from mixed infections and interactions of S. haematobium and S. mansoni ( Cunin et al., 2003 ; Gouvras et al., 2013 ). Eggs migrating to the male genital tract resulting in male genital schistosomiasis (MGS) have also been reported, initially in 1911 in Egypt and more recently in other parts of Africa, affecting boys and men and causing various debilitating urogenital symptoms such as pelvic, coital and ejaculatory pain, haemospermia and others ( Vilana et al., 1997 ; Leutscher et al., 2008 ; Kayuni et al., 2019a , 2019b , 2021 ).…”