Impact of female genital schistosomiasis and its social implications in endemic communities

A flamboyance of flamingos standing in a small lake with scrublands and a mountain range in the background.

This is the first of two posts from participants in Baylor College of Medicine’s National School of Tropical Medicine Summer Institute program with Baylor University. View the second post

A silent threat lurks within the waters of rural sub-Saharan Africa, where communities rely on the local rivers for daily activities. Female genital schistosomiasis (FGS), a neglected tropical disease caused by the parasite S. haematobium, silently affects women and girls living in endemic areas of sub-Sahara Africa who have daily contact with contaminated water. FGS is a neglected disease in part due to the lack of research, support and societal inequalities that women face in the endemic regions. This debilitating disease, which can lead to genital ulcers, tumors and infertility, thrives in resource-limited areas lacking adequate waste disposal and access to clean water.

Beyond the physical consequences, FGS bears a profound emotional and social cost to affected individuals, compounded by cultural beliefs and a lack of knowledge about the disease. It is estimated that 56 million women are currently infected in endemic countries, particularly in regions of sub-Sahara Africa. To better understand the parasite’s impact and to raise awareness, challenges posed by FGS need to be addressed.

Understanding the life cycle of the parasite S. haematobium sheds light on the complexities of combating FGS. The cycle begins innocuously. Eggs are deposited into the water from the infected host. The eggs hatch and release miracidia in the water, where they infect snails. Infectious cercariae are then released into the water by the snail intermediate host, ready to penetrate human skin. Once in the human body, the parasite circulates in the bloodstream before settling in the venous plexus of the genitourinary tract. The parasites mature into adults, form copulating pairs, and release highly immunogenic eggs through the genitourinary system, which are expelled from the body in the host’s urine. The parasite lifecycle continues when the urine contaminates the local water supply in the presence of the intermediate snail host.

However, not all S. haematobium eggs are released in the urine; several get stuck tranversing the genitourinary tissue and incite a host immune response. In females, this leads to the symptoms of FGS, such as bloody discharge, pelvic pain or itching, or bleeding and pain after intercourse. The long-term effects of FGS without treatment include genital ulcers, infertility, spontaneous abortions, premature births, tumors and an increase in the risk of acquiring HIV.

Early treatment with a single dose of praziquantel (PZQ) can significantly alleviate symptoms and prevent further complications. In fact, data supports that early preventative treatment in women under 20 can decrease the risk of schistosomiasis complications by 50% later in life. Despite the known benefits of praziquantel in highly endemic regions, there remains significant challenges in preventative treatment programs, including medication shortages, lack of trust in medical institutions and accessibility of medical institutions to supply the medication. These challenges highlight the need for comprehensive interventions that address medical treatment, community education, healthcare infrastructure and access to essential medications.

In rural, resource-limited areas, FGS is a prevalent but often overlooked problem due to challenges arising from community and healthcare facility awareness. A significant barrier to early diagnosis and treatment is a misconception that schistosomiasis only affects men. This misconception has lead to the false narrative that women contract schistosomiasis through sexual intercourse with an infected male, suggesting FGS is a sexually transmitted infection (STI). As a result, FGS is associated with significant stigma in endemic communities, even when involving young girls with no sexual history. Additionally, healthcare providers may be unaware that schistosomiasis can infect the genitourinary track, so the term FGS may remain relatively unfamiliar in some endemic regions. Lack of awareness as well as misconceptions and stigma regarding FSG, delays early diagnosis and treatment and discourages affected women from seeking treatment for their genitourinary symptoms (Kukula et al., 2019).

The societal implications of FGS are profound and far-reaching. Misconceptions surrounding the disease, often perceived as an STI, can lead to stigmatization, social ostracization and marital discord for affected women. Stigma can impact individual well-being, undermine confidence in public health efforts and impede efforts to address FGS effectively. Moreover, the lack of awareness and available resources within an endemic community may result in women and girls developing severe complications of FGS, such as infertility and cervical cancer. Closing the gap in awareness and recognition of FGS is imperative to improving early detection and treatment in endemic areas. Challenging misconceptions and combating stigma can pave the way for more accurate diagnoses and targeted interventions. Empowering women and girls to seek medical attention promptly and without fear of judgment is essential in the fight against this silent and neglected disease.

By Isabella Mora

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