Authors

D Kumwenda⁴; S Kayoni¹; L Cunningham¹; B Mainga⁵; D Lally²; P Chammudzi²; D Kapira²; G Namacha²; A Chisale²; T Nchembe²; L Kinley⁶; E Chibwana⁶; B Ntaba²; G Chapweteka³; W Khumalo³; H Chibowa⁷; V Kumfunda⁷; J Archer¹; A Juhasz¹; S Jones¹;  ¹ Liverpool School of Tropical Medicine, UK;  ² Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Malawi;  ³ Nsanje District Hospital, Ministry of Health, Nsanje, Malawi;  ⁴ Queen Elizabeth Central Hospital, Ministry of Health, Malawi;  ⁵ Department of Laboratory Services, Mangochi District Hospital, Ministry of Health, Malawi;  ⁶ Department of Radiology, Queen Elizabeth Central Hospital, Ministry of Health, Malawi;  ⁷ Institute of Medical Microbiology, Semmelweis University,, Hungary

Discussion

Background: Female Genital Schistosomiasis (FGS) is a neglected tropical disease often misdiagnosed as a sexually transmitted infection (STI) due to similar symptoms. An earlier survey in Southern Malawi, MORBID-FGS study revealed that 28% of women with Schistosoma eggs in Malawi had hidden FGS. This longitudinal study, part of the Hybridisation in Urogenital Schistosomiasis (HUGS) project, investigated FGS prevalence and co-existence with trichomoniasis among women in Mangochi and Nsanje districts. Objective: To determine the prevalence of FGS and its co-existence with trichomoniasis among women in Malawi. Methodology: Eighty-seven women aged 18 and above with microscopic evidence of schistosoma eggs in their urine were enrolled. They underwent colposcopic examination, tissue sampling, DNA analysis, cervical cancer screening, and ultrasound examinations. Results: FGS was detected in 18.2% of women on microscopy, 71.2% on colposcopy, and 54.0% on qPCR. Five women had S. mattheei co-infections. Strikingly, 73.3% had Trichomonas vaginalis co-infections, and 42.5% had detectable Human papilloma virus (HPV). All women with cervical tissue biopsies had histologically confirmed FGS. Conclusion: These results indicate a high burden of FGS and trichomoniasis among women in this region. The importance of screening for FGS when treating women for STIs in schistosomiasis-endemic areas is also highlighted. It also calls for the integration of FGS screening and treatment into existing sexual and reproductive health services.