Discussion

*jmusaya@mlw.mw Female genital schistosomiasis (FGS) is a neglected tropical disease caused by Schistosoma haematobium, affecting millions of women globally, particularly in low- and middle-income countries (LMICs) such as Malawi. FGS is associated with significant morbidity, including infertility, increased susceptibility to HIV, and chronic pelvic pain. Diagnosing FGS is challenging due to its non-specific symptoms and the need for specialized diagnostic tools. Current diagnostic methods include clinical examination, which involves visual inspection and colposcopy to reveal characteristic lesions, but these methods require trained personnel and are not widely available in LMICs like Malawi. Microscopy, which detects Schistosoma eggs in urine or genital specimens, is considered the gold standard but has low sensitivity, especially in chronic cases. Serological tests detect antibodies or antigens but cannot distinguish between active and past infections. Molecular techniques, such as PCR and other nucleic acid amplification tests, offer high sensitivity and specificity but are costly and require sophisticated laboratory infrastructure. Imaging techniques like ultrasound and MRI can identify organ involvement but are not practical for routine use in resource-limited settings. In Malawi, the primary dilemmas in diagnosing FGS include resource limitations, as the country lacks the infrastructure and trained personnel to implement advanced diagnostic techniques. The high costs of molecular and imaging techniques limit their accessibility. Non-specific symptoms that overlap with other gynecological conditions complicate diagnosis, and cultural and social stigmas associated with genital examinations deter women from seeking diagnosis and treatment. Addressing the diagnostic challenges of FGS in Malawi requires a multifaceted approach, including the development of affordable, sensitive, and specific diagnostic tools, capacity building, and community education to reduce stigma. Collaborative efforts between global health organizations, researchers, and local health systems are essential to improve the diagnosis and management of FGS in Malawi and worldwide.