Gynecological Manifestations, Histopathological Findings, and Schistosoma-Specific Polymerase Chain Reaction Results Among Women With Schistosoma haematobium Infection: A Cross-sectional Study in Madagascar

Schistosoma haematobium may cause pathology in the urinary and genital tracts. In the urinary tract, morbidity is correlated with intensity of infection, as indicated by the number of eggs excreted in the urine [1]. Up to 75% of women excreting S. haematobium ova in the urine may have ova in the lower genital tract. However, female genital schistosomiasis (FGS) may also occur in the absence of urinary egg excretion [2, 3]. FGS is rarely seen without use of a colposcope and is often overlooked even by those who have this tool. In remote areas, where most patients live, the cost of the equipment, the logistical difficulties associated with light sources, electricity, and clean instruments, as well as the invasive nature of the biopsy and gynecological examination, may result in failure to diagnose FGS. Furthermore, identification of lesions requires several weeks of training and inspection of the entire intravaginal surfaces, including the fornices and the anterior and posterior vaginal walls [3]. The clinical pathology of FGS was described in 1949, but there is still a lack of diagnostic standards, partly because of the ethical limitations in obtaining specimens appropriate for analysis [3, 4]. Therefore, the pathophysiology of FGS is only partially understood [3, 5–7]. Furthermore, neither gynecology nor infectious diseases textbooks contain information about the macroscopic manifestations of the disease. This study aims to describe the clinical manifestations and histopathological characteristics of genital mucosal schistosomiasis lesions and to study these findings in relation to Schistosoma DNA in genital tissue. The diagnostic potential of specimens collected from the surfaces of the vagina and the cervix were evaluated in women with high- and low-intensity S. haematobium infection and in those without urinary S. haematobium egg excretion.