Authors

Discussion

Urogenital schistosomiasis (UGS), and in particular female genital schistosomiasis (FGS), is a waterborne disease caused by Schistosoma haematobium. It is endemic throughout Africa, with a major burden of disease in sub-Saharan Africa. The direct burden on sexual and reproductive health is poorly investigated. In most endemic regions, such as Cameroon, urogenital schistosomiasis is covered by a control plan that excludes considerations relating to female genital schistosomiasis, due in part to insufficient knowledge of the frequency of lesions and associated symptoms. Identifying associations between cervical lesions, the presence of eggs and urine color could improve management during routine consultations by health professionals. The aim of this study was to determine the frequency of Schistosoma cervical lesions associated with observed signs and symptoms, in order to provide information for improved control.

After selective questioning about FGS symptoms,109 women aged between 20 and 65 Years were recruited after signing an informed consent, at the Loum District Hospital in the Littoral Region of Cameroon. Women who voluntary accepted to participate were examined for urogenital schistosomiasis by microscopy after urinary filtration, and for clinical genital schistosomiasis by visual inspection using a high-resolution smartphone. Lesions observed were classified according to the WHO pocket atlas for genital schistosomiasis in women.

The overall prevalence of SGU and cervical SGF lesions, as well as their association with women's signs and symptoms, were recorded and imported into analysis software to study bi-variate and multivariate logistic regressions of the statistical distribution.

The prevalence of SUG was 14.7% (16/109), while the prevalence of cervical SGF lesions was 44.0% (48/109), with a predominance of lesions with an “abnormal blood vessel” appearance (31.2%). The clinical manifestations observed were significantly associated with the pathognomonic cervical lesions of FGS. Vaginal discharge (VD), bleeding during intercourse (BI), ectopic pregnancy (EP) and fertility disorders (FD) were respectively associated with 10%, 10%, 11% and 13% of the cervical lesions observed in FMS. The presence of crystals in the urine was associated with 11% of “sand-grain” cervical lesions.

In conclusion, the presence of crystals in urine as well as VD, BI, EP and FD are potential indicators of the existence of FGS cervical lesions and sexual and reproductive health that can be exploited during routine consultations among women in Schistosomiasis endemic areas.

Key words: prevalence, female genital schistosomiasis, cervical lesions.