Discussion

Female genital schistosomiasis (FGS) is a neglected gynecological disease that can result from infection with the parasitic trematode Schistosoma haematobium. In addition to dis- abling FGS-associated pathologies, S. haematobium infection has also been associated with sexually transmitted infections (STIs), cervical dysplasia and HIV transmission. Accurate diagnosis of FGS is crucial for effective case management, surveillance and con- trol. However, current methods for diagnosis and morbidity assessment can be inaccessi- ble to those at need, labour intensive, costly and unreliable. Molecular techniques such as PCR can be used to reliably diagnose FGS via the detection of Schistosoma DNA using cer- vicovaginal lavage (CVL) samples as well as lesser-invasive vaginal self-swab (VSS) and cervical self-swab samples. PCR is, however, currently unsuited for use in most endemic settings. As such, in this study, we assessed the use of a rapid and portable S. haematobium recombinase polymerase amplification (Sh-RPA) molecular diagnostic assay, coupled with simplified sample preparation methods that can be carried out in resource-poor set- tings, to diagnose FGS using CVL and VSS samples. Performance of the Sh-RPA was excellent when compared to real-time PCR across all comparisons, even when using sim- plified sample preparation methods. Of note, optimal performance of the Sh-RPA may be achieved when used with the lesser-invasive VSS samples. The Sh-RPA therefore shows promise as a rapid and sensitive diagnostic tool capable of diagnosing FGS at the point-of- care in schistosomiasis-endemic settings.