Vaginal schistosomiasis in an Australian returning from overseas travel presenting to a sexual health centre

We believe this to be the first reported case of vaginal schistosomiasis due to Schistosoma haematobium in an Australian traveller returning from an endemic area. A 20-year-old woman presented to the sexual health centre with vaginal lumps and an E coli urinary tract infection upon return from vacation in Western Europe and Africa. She had protected sexual contact with an American male while travelling in Western Europe. She was found to have granulomatous areas on the left lateral vaginal wall and the posterior fornix. A viral culture taken from the granulomatous areas was negative. Three vaginal biopsies contained numerous parasites and the findings were reported as typical of viable ova of Schistosoma haematobium. Ova were also detected in the urine and schistosoma antibodies were detected by enzyme immunoassay at a titre of 1.304 (high). At review the patient reported that she had swum in Lake Malawi but did not recall a skin itch. She was treated with praziquantel 600 mg orally taken twice in one day. One month after treatment the vagina was macroscopically normal and no schistosoma ova were found in urine specimens taken at 1, 3 and 4 months. This unusual presentation of genital schistosomiasis to a sexual health centre highlights the importance of a careful travel history in returning overseas travellers. (author abstract)