Discussion

We present four cases of male genital schistosomiasis (MGS) within children and adolescents opportunistically encountered as part of a wider screening programme for imported schistosomiasis in Germany and community outreach screening in Mali. Such genital manifestations in young children and adolescents are often overlooked but can include hydrocele, hypogonadism, varicocele, cutaneous granulomata on the penis and scrotum, echogenic spots in the prostate and the epididymis, alongside testicular masses. Though these cases appear sporadic, from our scoping literature review, they draw fresh attention on MGS in young children and highlight wider confusion with other congenital, neoplastic and infectious disease. These might include an insufficient closure of the tunica vaginalis, malignancies or lymphatic filariasis. Frequently hematuria is not present. One typical sign indicating MGS in adults, i.e. hematospermia is not present before puberty. Another reason of missing MGS cases may be that screening with transabdominal ultrasonography is less sensitive for revealing prostatic lesions as compared to transrectal ultrasonography and scrotal ultrasonography is not accepted unless the reason for it is not extensively explained beforehand.
Keywords: Schistosoma, schistosomiasis, male genital schistosomiasis, children, adolescents, minors, hydrocele, testicular masses, hypogonadism, varicocele, ultrasound