Genital Schistosomiasis

Clinical description

• Acquired by skin contact with water from places with water snails (intermediate host). S. haematobium is highly prevalent across Malawi; 27% of women in a population survey in Southern Malawi had female genital schistosomiasis (FGS) lesions.
• May be asymptomatic or clinically indistinguishable from STIs/cervical cancer.
• Men: haematuria, dysuria, dyspareunia, lower abdominal pain, proctitis.
• Women: abnormal vaginal discharge, abdominal/pelvic pain, dyspareunia, post-coital/contact bleeding. Complications: infertility, ectopic pregnancies, abortion, premature birth.
• FGS may increase risk of HIV and HPV acquisition.

Treatment

Consider schistosomiasis in all women with AVD, LAP, vaginal ulcers/bleeding, vaginal/cervical tumours; in men with haematuria, dysuria, dyspareunia, lower abdominal pain; in patients with ARI failing to improve; and particularly if symptoms persist after STI syndromic treatment.

Empirical treatment

• Praziquantel 40 mg/kg oral stat as single dose.

Routinely add to STI syndromic treatment if symptoms are compatible and praziquantel is available. Although the risk is likely low, avoid praziquantel in the first pregnancy trimester.