Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease

AbstractIn recent years, control of neglected tropical diseases has been increasingly gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance of female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women’s health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease

The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of men.

OBJECTIVES In Switzerland, universal health insurance does not cover any routine testing for sexually transmitted infections (STIs), not even in individuals at high risk, and extra-genital swabbing is not standard of care. We determined the prevalence and incidence of human immunodeficiency virus (HIV), viral hepatitis and non-viral STIs in a multicentre prospective observational cohort of multi-partner men who have sex with men (MSM) and other men. MATERIALS AND METHODS Between January 2016 and June 2017, we offered free STI testing to all men with multiple  sexual partners (three or more in the previous 12 months), with follow-up examinations every 6 months. We used multiplex polymerase chain-reaction testing (for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium) on pooled swabs (pharynx, urethra/vagina, anus), and antibody tests for HIV and Treponema pallidum at every visit, and for hepatitis B/C at baseline. RESULTS We screened 779 multi-partner MSM and 92 other men. Previously undiagnosed HIV was found in 0.5% vs 0.0%, respectively and T. pallidum antibodies in 15.3% vs 1.1%. STIs requiring antibiotic treatment comprised: active syphilis 1.7% vs 0.0%; N. gonorrhoeae 10.3% vs 0.0%; C. trachomatis 8.7% vs 1.1%. One in four MSM versus 1 in 100 other multi-partner men had any of these three STIs at baseline. 10.4% vs 1.3% had a history of hepatitis B, 31.9% vs 47.3% had no immunity (HBs-AB <10 IU/l). Ten MSM had HCV antibodies (1.4%), with 8 out of the 10 being MSM with HIV; HCV seroprevalence was 0.3% among HIV-negative MSM. In MSM, incidence of the three bacterial STIs was 25.5 per year over 333 person years of follow-up, HIV incidence was 0.3%. Non-condom-use (in the last 3 months) for anal/vaginal sex was not associated with STIs. Independent risk factors were sex with men (adjusted odds ratio [aOR] 16.4) and the number of sexual partners (aOR 2.3 for >20). CONCLUSION Among MSM, but not among other multi-partner men, STIs, mostly asymptomatic, are common. Given the high risk of onward transmission, low-cost or free routine screening of multi-partner MSM is a public health priority

Incidence of sexually transmitted infections and association with behavioural factors: Time-to-event analysis of a large pre-exposure prophylaxis (PrEP) cohort.

OBJECTIVES Our objective was to obtain long-term data on the incidence of sexually transmitted infections (STIs) and their association with behavioural factors after widespread pre-exposure prophylaxis (PrEP) implementation. METHODS This was a time-to-event analysis of a national PrEP cohort in Switzerland (SwissPrEPared study). Participants were people without HIV interested in taking PrEP with at least two STI screening visits. Primary outcomes were incidence rate of gonorrhoea, chlamydia, and syphilis. The association between behavioural factors and STI diagnosis was expressed using hazard ratios. We adjusted for testing frequency and calendar year. RESULTS This analysis included 3907 participants enrolled between April 2019 and April 2022, yielding 3815.7 person-years of follow-up for gonorrhoea (15 134 screenings), 3802.5 for chlamydia (15 141 screenings), and 3858.6 for syphilis (15 001 screenings). The median age was 39 years (interquartile range [IQR] 32-47), 93.8% (n = 3664) identified as men who have sex with men (MSM). The incidence was 22.8 (95% confidence interval [CI] 21.3-24.4) per 100 person-years for gonorrhoea, 26.3 (95% CI 24.7-28.0) for chlamydia, and 4.4 (95% CI 3.8-5.1) for syphilis. Yearly incidence rates decreased between 2019 (all bacterial STIs: 81.6; 95% CI 59.1-109.9) and 2022 (all bacterial STIs: 49.8; 95% CI 44.6-55.3). Participants reporting chemsex substance use were at higher risk of incident STIs, as were those reporting multiple sexual partners. Younger age was associated with a higher risk of gonorrhoea and chlamydia. CONCLUSIONS Incidence rates of bacterial STIs decreased over time. Young MSM, those with multiple partners, and those using chemsex substances were at increased risk of STIs

Incidence of sexually transmitted infections and association with behavioural factors: Time-to-event analysis of a large pre-exposure prophylaxis (PrEP) cohort

OBJECTIVES: Our objective was to obtain long-term data on the incidence of sexually transmitted infections (STIs) and their association with behavioural factors after widespread pre-exposure prophylaxis (PrEP) implementation. METHODS: This was a time-to-event analysis of a national PrEP cohort in Switzerland (SwissPrEPared study). Participants were people without HIV interested in taking PrEP with at least two STI screening visits. Primary outcomes were incidence rate of gonorrhoea, chlamydia, and syphilis. The association between behavioural factors and STI diagnosis was expressed using hazard ratios. We adjusted for testing frequency and calendar year. RESULTS: This analysis included 3907 participants enrolled between April 2019 and April 2022, yielding 3815.7 person-years of follow-up for gonorrhoea (15 134 screenings), 3802.5 for chlamydia (15 141 screenings), and 3858.6 for syphilis (15 001 screenings). The median age was 39 years (interquartile range [IQR] 32-47), 93.8% (n = 3664) identified as men who have sex with men (MSM). The incidence was 22.8 (95% confidence interval [CI] 21.3-24.4) per 100 person-years for gonorrhoea, 26.3 (95% CI 24.7-28.0) for chlamydia, and 4.4 (95% CI 3.8-5.1) for syphilis. Yearly incidence rates decreased between 2019 (all bacterial STIs: 81.6; 95% CI 59.1-109.9) and 2022 (all bacterial STIs: 49.8; 95% CI 44.6-55.3). Participants reporting chemsex substance use were at higher risk of incident STIs, as were those reporting multiple sexual partners. Younger age was associated with a higher risk of gonorrhoea and chlamydia. CONCLUSIONS: Incidence rates of bacterial STIs decreased over time. Young MSM, those with multiple partners, and those using chemsex substances were at increased risk of STIs

La PrEP en Suisse romande entre anxiété et confiance. Utilisation des antirétroviraux en prévention du VIH

The preventive properties of antiretrovirals have been recognized for many years, and pre-exposure prophylaxis (PrEP) has been used in Switzerland since 2016 to prevent HIV acquisition by HIV-negative people. The aim of this article is to provide an overview of PrEP uses in French-speaking Switzerland from the experience of users of this preventive drug. The main results of our research highlight the existence of two experiential versions of PrEP, i.e. subjective definitions shared by the people concerned by the indication. The first version relates to the effects of PrEP on anxiety, where taking a preventive drug drastically reduces the fear of contamination, and the second version relates to the capacity of the drug to modulate trust between individuals

Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease

In recent years, control of neglected tropical diseases has been increasing gaining momentum and interventions against schistosomiasis are being progressively scaled-up through expansion of donated praziquantel and preventive chemotherapy campaigns. However, the public health importance of female genital schistosomiasis is not fully recognised nor its control is adequately addressed. Taking a clinical and anatomopathological perspective, we evaluated the available literature to highlight the importance female genital schistosomiasis and its connections with two sexually transmitted infections of global importance, Human Immunodeficiency Virus (HIV) and Human Papilloma Virus. Outside the long list of clinical descriptive reports beginning in 1899, there is presently a shocking gap in epidemiological assessment and a significant underestimation of the burden of FGS remains. The scarcity of integrated approaches to address female genital schistosomiasis calls for more concerted action in its detection, treatment and prevention alongside other concomitant women’s health issues, otherwise female genital schistosomiasis will remain a neglected gynaecological disease

Projet pilote pour l'accès au dépistage et à la prise en charge du col de l'utérus dans le district de santé d'Akonolinga : Difficultés et perspectives

International audienceLe cancer du col de l'utérus est le 2 e cancer le plus fréquent chez la femme camerounaise, il est responsable d'environ 1120 décès par an. Ces chiffres pourraient être réduits grâce au dépistage systématique avec prise en charge appropriée des cas détectés. Il est donc nécessaire de proposer des stratégies alternatives à l'examen cytologique recommandé qui nécessite plusieurs consultations et qui est difficilement accessible au plan financier. OBJECTIFS Présenter la stratégie adoptée et les difficultés de mise en oeuvre d'un service innovant de dépistage et de prise en charge du cancer du col dans le district de santé d'Akonolinga. METHODOLOGIE Une salle de consultation gynécologique opérationnelle à Akonolinga depuis 21 mois (mars 2017 à novembre 2018), propose un dépistage du cancer du col aux femmes de 25 ans et plus (8495 femmes en âge de se faire dépister dans le district de santé) par inspection visuelle à l'acide acétique et au lugol (méthode recommandée par l'OMS pour les pays à ressources limitées). Les femmes dépistées négatives sont revues après 3 ans. En cas de positivité, une biopsie du col est réalisée et acheminée à Yaoundé pour histopathologie. Dans un 1 er temps la prise en charge reposait sur une surveillance semestrielle des dysplasies de bas grade faute de matériel pour la thermoablation, une résection des lésions à l'anse diathermique face à des dysplasies de haut grade et une hystérectomie pour les cancer-micro-invasifs. L'acquisition du WISAP en Octobre 2018 pour le traitement immédiat des lésions par thermoablation a permis d'améliorer la qualité du suivi des patientes par une approche « test and treat » pour les lésions VIA/VILI positives. Un triage par screening du HPV est prévu pour Juin 2019. Après 21 mois d'activité, 276 femmes âgées entre 25 et 55 ans se sont faites dépistées, soit 3% de la cible. Ce faible taux est lié à une sensibilisation communautaire insuffisante, au manque d'implication de certains personnels de santé du district, en plus de l'éloignement géographique de certaines populations. Des VIA/VILI réalisés, 27 % se sont avérés positifs. Néanmoins seul 53 % des analyses histopathologiques ont été réalisées car la subvention des frais d'examen dans leur totalité ne date que de Juillet 2018 (près de 50 % des femmes étaient sans-emploi). On recense 3 cas de cancers invasifs (1,1%), 2 de cancers micro-invasifs (0,7%), 20 cas de dysplasies cervicales confirmés dans la population dépistées soit 13,8 % (7 de haut grade et 13 de bas grade). A ce stade, seul 19 % des femmes dépistées positives ont été traitées car le « test and treat » n'étant effectif que depuis Octobre 2018, plusieurs patientes ont été perdues de vue malgré la relance de celles-ci par appel téléphonique. WISAP® Exemple de VIA Positives Exemple de VILI Positives Exemple de col après résection à l'anse diathermique Exemple de col après thermoablation 73% 27% PROPORTION DES DÉPISTAGES POSITIFS APRES INSPECTION VISUELLE (VIA/VILI) VIA/VILI néga-tifs VIA/VILI positifs 3% 97% PROPORTION DU DEPISTAGE DU CANCER DU COL DE L'UTERUS DANS LA VILLE D'AKONOLINGA ENTRE JANVIER 2017 ET NOVEMBRE 2018 pourcentage de femmes dépistées pourcentage de femmes non dépis-tées 19% 81% PROPORTION DES PATIENTES PRESENTANT UN VIA/VILI POSITIF AYANT ETE TRAITEES patientes traitées patientes non trai-tées CONCLUSION Malgré une stratégie innovante nous observons des difficultés dans la mise en oeuvre: le manque d'adhésion à la démarche du dépistage dû aux connaissances limitées de la pathologie, le coût financier de la prise en charge et la non disponibilité du plateau technique dans son entièreté durant les premiers mois d'activité. Néanmoins les résultats obtenus révèlent l'ampleur du problème dans cette communauté et témoigne de l'importance de l'action menée. La mise sur pied d'un plan de sensibilisation ciblé, l'implication d'un maximum d'acteurs de la santé, en plus de la subvention du coût de la prise en charge ainsi que l'acquisition de l'ensemble du matériel (déjà effectif), sont les mesures qui permettront d'atteindre l'objectif de prévention de la maladie

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection

In West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment