The discussions, during the 22nd International AIDS Conference in Amsterdam, Netherlands on 23–27 July 2018, follows an unpublished WHO/UNAIDS study that links FGS with serious infections such as HIV. It is estimated that each week, around 5500 young women and adolescent girls are infected with HIV in sub-Saharan Africa, where schistosomiasis is also highly prevalent.
"Complications arising from FGS carry huge risks and can include miscarriages, ectopic pregnancy (1) and infertility and increase the risk for other sexually transmitted diseases," said Dr Amadou Garba, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. "Medical practitioners are generally unaware of FGS and signs of this infection are often wrongly understood and misdiagnosed, with no appropriate treatment given."
FGS, which is estimated to affect almost 56 million girls and women in sub-Saharan Africa can also cause pelvic inflammation, the obstruction of fallopian tubes and related morbidity.
Clinical (urinary and gastrointestinal) manifestations of human schistosomiasis (also known as bilharzia) are widely known. In rural settings, women doing domestic chores in infested water, such as washing clothes, are mostly at risk of developing genital schistosomiasis. Infection of genital organs with schistosomes can seriously affect women (and men (2)).
Common symptoms include vaginal (bloody) discharge, bleeding during intercourse, genital itching or burning sensation, pelvic pain or pain during intercourse. Besides infertility and ectopic pregnancy, other complications involve involuntary urination (for example when coughing, laughing or jumping), genital ulcers and tumours.
"When examining female patients in countries endemic for schistosomiasis, doctors should consider diagnosis of FGS. Although current laboratory techniques are inadequate, detection of FGS can be made through visual inspection of characteristic lesions on the cervix and vaginal wall," added Dr Amadou Garba.
Addressing multiple health problems simultaneously can help to tackle FGS. The positive side is that this infection can be effectively managed. The gold standard to treat schistosomiasis is a single dose (40 mg/kg) of praziquantel. It is crucial that early, regular treatment of school-age children be extended to adults, prioritized in national programmes and included in interventions that target diseases such as AIDS, cervical cancer and other sexually transmitted infections.
Many endemic countries are eligible for free praziquantel donated through WHO; where the medicine is not available freely, it can be procured for less than US$ 0.13 (cents). Treatment with praziquantel kills the causative adult worms and provides regression of inflammatory lesions.
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(1) Ectopic pregnancy occurs when the implantation of the embryo occurs outside the uterine cavity, most frequently in one of the two fallopian tubes (or rarely in the abdominal cavity).
(2) In men, symptoms include epididymitis (an inflammation of the epididymis at the back of the testicle) and associated funiculitis and possible fistulization, haemospermia and pain during urination prostatitis.