Authors

SA Kayuni²; L Cunningham¹; D Kumwenda⁴; B Mainga⁵; D Lally²; P Chammudzi²; D Kapira²; G Namacha²; A Chisale²; T Nchembe²; L Kinley⁶; E Chibwana⁶; J Archer¹; A Juhasz¹; S Jones¹; J Chiphwanya³; P Makaula²; EJ Lacourse¹; J Musaya²; JR Stothard¹;  ¹ Liverpool School of Tropical Medicine, UK;  ² Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Malawi;  ³ National Schistosomiasis and STH Control Program, CHSU, Ministry of Health, Malawi;  ⁴ Obstetrics & Gynaecology Department, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi;  ⁵ Laboratory Department, Mangochi District Hospital, Ministry of Health, Mangochi, Malawi;  ⁶ Radiology Department, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi

Discussion

BACKGROUND:

Genital schistosomiasis remains an ignored chronic consequence of urogenital schistosomiasis, affecting the genital system of afflicted men and women. So far, this has not been fully described in hybrid infection, an emerging public health concern in endemic areas. As part of a 2-year longitudinal study on Hybridization of UroGenital Schistosomiasis (HUGS), we are conducting a sub-study to describe the morbidity associated schistosome hybrid infections in the male and female genital systems.

OBJECTIVES:

To assess the prevalence of male and female genital schistosomiasis (MGS and FGS) associated with schistosome hybrids and mixed infections among adults in two communities of Nsanje and Mangochi districts. Also, the study described the associated infections including sexually transmitted infections (STIs) among the participants.

METHODS:

Urine, cervicovaginal fluid and swabs, as well as semen samples were collected from study participants. These were analysed to determine schistosome infection by filtration and microscopy of the 10ml urine, direct microscopy of the cervicovaginal lavage and semen and thereafter their sediments after centrifugation, to visualise the Schistosoma eggs. Samples also underwent molecular analysis using novel qPCR assay for detection of human, zoonotic and hybrid schistosomes and other co-infections including STIs. Portable colposcopy and histopathology were also conducted.

RESULTS:

22 men and 87 women were recruited into the MGS-FGS sub-study. MGS was detected in 50.0% men on microscopy and 72.7% on qPCR while FGS was detected in 18.2% women on microscopy, 47.1% on colposcopy and 54.0% on on qPCR. In Nsanje, 50% men (n=8) and 65.5% women (n=29) had MGS and FGS on qPCR respectively while in Mangochi, it was in 85.7% men (n=14) and 48.3% women (n=58).

Five men with MGS had S. mattheei, 3 had S. mansoni while 1 had a mixed infection of S. mansoni and possible S. haematobium-S. mattheei hybrid. Only 5 women with FGS had S. mattheei co-infections. Among the women, 73.3% were co-infected with an STI, Trichomonas vaginalis detected by qPCR among others while 42.5% had detectable Human papilloma virus (HPV) with 27.0% having high-risk HPV 16 and 18 for invasive cervical cancer.

CONCLUSIONS:

Our findings indicate that genital schistosomiasis from human, zoonotic and hybrid schistosomes are prevalent in endemic areas, with significant burden of STIs which could pose a further challenge in control interventions being implemented by the National Control Program in the Ministry of Health. In addition, it could increase the risk of other infections like STIs and HIV in the country, and potential complications on women health.