The first community-based report on the effect of genital Schistosoma haematobium infection on female fertility

Kjetland, Eyrun Floerecke; Kurewa, Edith Nyaradzai; Mduluza, Takafira; Midzi, Nicholas; Gomo, Exnevia; Friis, Henrik; Gundersen, Svein Gunnar; Ndhlovu, Patricia D.

doi:10.1016/j.fertnstert.2009.12.050

Cited by 50 publications

(45 citation statements)

References 22 publications

(23 reference statements)

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“…The outcome corroborated findings from case reports of decreased fertility in women with schistosomiasis [26], [27], [28], [29], [30], [31], [32]. These reports had indicated the need for further investigation given they dealt with only two community-based studies [33], [34]. Travelers who contract schistosomiasis haematobia in endemic regions may be also at risk of infertility [35], [36].…”

Section: Discussionsupporting

confidence: 76%

Urinary Estrogen Metabolites and Self-Reported Infertility in Women Infected with Schistosoma haematobium

et al. 2014

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BackgroundSchistosomiasis is a neglected tropical disease, endemic in 76 countries, that afflicts more than 240 million people. The impact of schistosomiasis on infertility may be underestimated according to recent literature. Extracts of Schistosoma haematobium include estrogen-like metabolites termed catechol-estrogens that down regulate estrogen receptors alpha and beta in estrogen responsive cells. In addition, schistosome derived catechol-estrogens induce genotoxicity that result in estrogen-DNA adducts. These catechol estrogens and the catechol-estrogen-DNA adducts can be isolated from sera of people infected with S. haematobium. The aim of this study was to study infertility in females infected with S. haematobium and its association with the presence of schistosome-derived catechol-estrogens.Methodology/Principal FindingsA cross-sectional study was undertaken of female residents of a region in Bengo province, Angola, endemic for schistosomiasis haematobia. Ninety-three women and girls, aged from two (parents interviewed) to 94 years were interviewed on present and previous urinary, urogenital and gynecological symptoms and complaints. Urine was collected from the participants for egg-based parasitological assessment of schistosome infection, and for liquid chromatography diode array detection electron spray ionization mass spectrometry (LC/UV-DAD/ESI-MSn) to investigate estrogen metabolites in the urine. Novel estrogen-like metabolites, potentially of schistosome origin, were detected in the urine of participants who were positive for eggs of S. haematobium, but not detected in urines negative for S. haematobium eggs. The catechol-estrogens/ DNA adducts were significantly associated with schistosomiasis (OR 3.35; 95% CI 2.32–4.84; P≤0.001). In addition, presence of these metabolites was positively associated with infertility (OR 4.33; 95% CI 1.13–16.70; P≤0.05).Conclusions/SignificanceEstrogen metabolites occur widely in diverse metabolic pathways. In view of the statistically significant association between catechol-estrogens/ DNA adducts and self-reported infertility, we propose that an estrogen-DNA adduct mediated pathway in S. haematobium-induced ovarian hormonal deregulation could be involved. In addition, the catechol-estrogens/ DNA adducts described here represent potential biomarkers for schistosomiasis haematobia.

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Section: Discussionsupporting

confidence: 76%

Urinary Estrogen Metabolites and Self-Reported Infertility in Women Infected with Schistosoma haematobium

et al. 2014

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“…Hematuria and dysuria can develop within months of infection (due to bladder ulcerations}, occur intermittently, and hydronephrosis may develop within the first 3 years of infection [11, 152]. In women, eggs can also deposit around the cervix, vagina, and ovaries [151], and has been associated with infertility and increased susceptibility to HIV [153, 154]. While eosinophils may be elevated early in chronic infection, it typically decreases over subsequent years.…”

Section: Eosinophilia In Indigenous Population (Immigrant/refugeementioning

confidence: 99%

Eosinophilia in Infectious Diseases

O’Connell

Nutman

2015

Immunology and Allergy Clinics of North America

105

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“…Four other studies reported 30 to 75% of women in endemic areas had reproductive tract infections of schistosomiasis, with infestation of worms and ova in the vagina, uterus, vulva or cervix [65]. In a community in rural Zimbabwe, 46% of women had genital lesions caused by schistosomiasis [66,67]. Only a single STI-HIV trial [18] even mentions schistosomiasis (but without distinguishing between S. haematobium and Schistosoma mansoni ), and none administered the antischistosomal drug, praziquantel.…”

Section: Discussionmentioning

confidence: 99%

Rush to judgment: the STI‐treatment trials and HIV in sub‐Saharan Africa

Stillwaggon

Sawers

2015

Journal of the International AIDS Society

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IntroductionThe extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.DiscussionExamination of the trials reveals critical methodological problems sufficient to account for statistically insignificant outcomes in nine of the ten trials. Shortcomings of the trials include weak exposure contrast, confounding, non-differential misclassification, contamination and effect modification, all of which consistently bias the results toward the null. In any future STI-HIV trial, ethical considerations will again require weak exposure contrast. The complexity posed by HIV transmission in the genital microbial environment means that any future STI-HIV trial will face confounding, non-differential misclassification and effect modification. As a result, it is unlikely that additional trials would be able to answer the question of whether STI control reduces HIV incidence.ConclusionsShortcomings in published RCTs render invalid the conclusion that treating STIs and other cofactor infections is ineffective in HIV prevention. Meta-analyses of observational studies conclude that STIs can raise HIV transmission efficiency two- to fourfold. Health policy is always implemented under uncertainty. Given the known benefits of STI control, the irreparable harm from not treating STIs and the likely decline in HIV incidence resulting from STI control, it is appropriate to expand STI control programmes and to use funds earmarked for HIV prevention to finance those programmes.

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The first community-based report on the effect of genital Schistosoma haematobium infection on female fertility

Cited by 50 publications

References 22 publications

Urinary Estrogen Metabolites and Self-Reported Infertility in Women Infected with Schistosoma haematobium

Urinary Estrogen Metabolites and Self-Reported Infertility in Women Infected with Schistosoma haematobium

Eosinophilia in Infectious Diseases

Rush to judgment: the STI‐treatment trials and HIV in sub‐Saharan Africa

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