Female genital schistosomiasis and HIV/AIDS: Reversing the neglect of girls and women

Since the 2000s, we have known that female genital schistosomiasis (FGS) is likely the most neglected gynecologic condition and HIV/AIDS cofactor across sub-Saharan Africa. To date, the global health and HIV/AIDS communities have not used the opportunity to prevent new HIV/AIDS infections through highly cost-effective schistosomiasis control and elimination in Africa. But recently, this situation may be shifting toward the better.

FGS is caused by the terminal-spine parasite eggs released from the female Schistosoma haematobium parasite. When the eggs are deposited in the tissues of the cervix and lower female genital tract, the presence of the eggs, combined with host inflammation and increased vascularity in the cervicovaginal mucosa, produces typical intravaginal lesions that result in genital itching and pain, bleeding, and dyspareunia. In addition, eggs deposited in the uterus and fallopian tubes can result in infertility. There are also associated and profound mental health effects from social stigma, such as depression and marital discord, and the condition frequently gets confounded with sexually transmitted infections.

FGS is also incredibly common. Approximately two-thirds of Africa’s 200 million schistosomiasis cases are caused by S. haematobium, and it is estimated that up to three-quarters of girls and women with S. haematobium infection have FGS. On this basis, FGS may represent sub-Saharan Africa’s most common gynecologic condition, affecting tens of millions of girls and women. Yet, FGS in not mentioned in most medical textbooks, nor in the lay press, which has further compounded the very low awareness about the condition.