Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa

Mahala Livingston, Pavitra Pillay, Siphosenkosi Gift Zulu, Leiv Sandvik, Jane Dene Kvalsvig, Silindile Gagai, Hashini Nilushika Galappaththi-Arachchige, Elisabeth Kleppa, Patricia Ndhlovu, Birgitte Vennervald, Svein Gunnar Gundersen, Myra Taylor, Eyrun F Kjetland Link Women with female genital schistosomiasis (FGS, Bilharzia) have been found to have genital symptoms and a 3-fold higher risk of HIV infection. In South Africa, in KwaZulu-Natal rural schools, this study indicates that Bilharzia treatment could prevent genital symptoms in more than 200,000 young women. Furthermore, it is feasible that more than 5,000 HIV infections could be prevented in adolescent girls and young women by treatment and prevention of...

Detection of Schistosoma DNA in genital specimens and urine: A comparison between five female African study populations originating from S. haematobium and/or S. mansoni endemic areas.

Pillay P, Downs JA, Changalucha JM, Brienen EAT, Ramarokoto CE, Leutscher PDC, Vennervald BJ, Taylor M, Kjetland EF, Van Lieshout L. Acta Trop. 2020;204:105363. Download publication Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic...

Reproductive health problems in rural South African young women: risk behaviour and risk factors.

Galappaththi-Arachchige HN, Zulu SG, Kleppa E, Lillebo K, Qvigstad E, Ndhlovu P, Vennervald BJ, Gundersen SG, Kjetland EF, Taylor M. Download publication BACKGROUND: South African young women continue to be vulnerable, with high prevalence of teenage pregnancy, HIV, sexually transmitted infections (STIs) and female genital schistosomiasis (FGS). This study seeks to examine the underlying factors that may be associated with these four adverse reproductive health outcomes. METHODS: In a cross-sectional study of 1413 sexually active of young women, we explored these four adverse reproductive health outcomes by considering socio-demographic factors, socio-economic factors, sexual risk behaviour, substance abuse and knowledge about reproductive health by using a questionnaire. Consenting participants were asked about previous pregnancies and were tested for HIV, STIs and FGS. Multivariable regression analyses were used to explore the factors associated with these four reproductive health outcomes. RESULTS: Early pregnancy: Among the young women, 44.4% had already been pregnant at least once. Associated factors were hormonal contraceptives, (adjusted odds ratio (AOR): 17.94, 95% confidence interval (CI): 12.73-25.29), and sexual...

Environment and schistosomiasis

Banhela N, Taylor M, Zulu SG, Strabo LS, Kjetland EF, Gundersen SG Download publication Full list Schistosoma haematobium infection is reported to facilitate the development of urogenital diseases. Its symptoms include haematuria, dysuria and tiredness, and it may cause cognitive decline in children. The prevalence of S. haematobium infection needs to be known in endemic areas and a mass treatment programme against the disease implemented. The aim of this study was to investigate the prevalence and intensity of S. haematobium infection in ILembe and uThungulu health districts, using the major symptom, haematuria, as an indicator. A total of 6 265 urine samples, from 96 rural schools, was collected for analysis using dipsticks. The prevalence of haematuria in the ILembe health district was 37% (95% CI, 35–39%) for boys and 39% (95% CI, 37–41%) for girls. The prevalence of haematuria in the uThungulu health district was 56% (95% CI, 53–59%) and 53% (95% CI, 50–56%) for girls and boys, respectively. Light-intensity infection was the most common infection level in both health districts. A negative relationship was observed between prevalence and altitude (r = −0.262, p = 0.009); whereas, we found a slight, though significant, positive association with mid-summer temperatures (r = 0.234, p = 0.021). Associations between prevalence and distance of school to the nearest river were...

Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa.

Galappaththi-Arachchige HN, Hegertun IEA, Holmen S, Qvigstad E, Kleppa E, Sebitloane M, Ndhlovu PD, Vennervald BJ, Gundersen SG, Taylor M, Kjetland EF Download publication Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16-22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital...