Association of urogenital symptoms with history of water contact in young women in areas endemic for <i>S. haematobium</i>:a cross-sectional study in rural South Africa

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 &lt; 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 &lt; 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 schistosomiasis

Genital symptoms in children in a Schistosomiasis haematobium endemic area

Abstract Objective: It is known that Schistosoma haematobium infection causes gynaecological lesions in women. We sought to explore genital symptoms in schoolgirls in an endemic area, and to determine the association between symptoms and risk factors for female genital schistosomiasis (FGS) infection; present urinary schistosomiasis infection and having high-risk water contact. Design and methods: A cross-sectional study with questionnaire and three urine specimens that were investigated for schistosome ova. The participants were 620 schoolgirls between the age of 9 and 13 years old, in rural Ugu district Kwa-Zulu Natal. Results: Half of the study population reported to have experienced genital symptoms. Having had high-risk water contact was associated with genital symptoms (chi-square; P <0,001). Bloody discharge, malodorous discharge and genital sores were associated with high-risk water contact (chi-square; p = 0,001, p < 0,001 and p = 0,003 respectively). Bloody discharge was also highly associated with urinary schistosomiasis (chi-square; p < 0,001). However, there were no significant associations between urinary schistosomiasis and the other genital symptoms. Prior schistosomiasis infection was reported by 31 % (189/602), and this was associated with current genital symptoms (chi-square; p < 0,001). Seventeen percent of the girls (105/620) reported to have received treatment previously, and treatment had no significant effect on the association between genital symptoms and urinary schistosomiasis or high risk waterbody contact. Conclusion: Young girls in an S. haematobium endemic area have genital symptoms, some of which are significantly associated with high-risk water contact, urinary schistosomiasis and prior schistosomiasis infection. One should consider anti-schistosomal treatment at young age in S. haematobium endemic areas to prevent genital damage

<em>S. haematobium</em> as a Common Cause of Genital Morbidity in Girls: A Cross-sectional Study of Children in South Africa

<div><p>Background</p><p><i>Schistosoma (S.) haematobium</i> infection is a common cause of genital morbidity in adult women. Ova in the genital mucosal lining may cause lesions, bleeding, pain, discharge, and the damaged surfaces may pose a risk for HIV. In a heterogeneous schistosomiasis endemic area in South Africa, we sought to investigate if young girls had genital symptoms and if this was associated with urinary <i>S. haematobium</i>.</p> <p>Methodology</p><p>In a cross-sectional study of 18 randomly chosen primary schools, we included 1057 schoolgirls between the age of 10 and 12 years. We interviewed assenting girls, whose parents had consented to their participation and examined three urines from each of them for schistosome ova.</p> <p>Principal findings</p><p>One third of the girls reported to have a history of genital symptoms. Prior schistosomal infection was reported by 22% (226/1020), this was associated with current genital symptoms (p<0.001). In regression analysis the genital symptoms were significantly associated both with urinary schistosomiasis (p<0.001) and water contact (p<0.001).</p> <p>Conclusions</p><p>Even before sexually active age, a relatively large proportion of the participating girls had similar genital symptoms to those reported for adult genital schistosomiasis previously. Anti-schistosomal treatment should be considered at a young age in order to prevent chronic genital damage and secondary infections such as HIV, sexually transmitted diseases and other super-infections.</p> </div

Association between the urogenital symptoms in rural 10–12 year old girls and urinary schistosomiasis.

<p>Eight separate multivariate analyses.</p><p>Age was forced into each model and did not influence the results (data not shown).</p>a<p>The presence of at least one schistosome ova in any of the urine examined specimens.</p>b<p>Odds ratio (OR) with 95% confidence interval (CI).</p>c<p>Adjusted odds ratio, different confounding variables were included in each multivariate analysis for the specific genital symptom.</p>d<p>Red urine as seen by the child.</p>**<p>If recalculated as ‘ever had the symptom’ it is significantly associated with urinary schistosomiasis.</p

Map of Ugu district in South Africa.

<p>The coastal areas are inhabited by the more affluent and the schools here were excluded.</p

Genital and urinary symptoms in girls of two <i>S. haematobium</i> positive groups and three negative risk groups.

<p>^aLikelihood ratio. ^bThree urines investigated for <i>S. haematobium</i> ova, all were negative. ^cMore than 50 <i>S. haematobium</i> ova per 10 ml urine. ^d1–49 ova per 10 ml urine. ^eThese girls have water body contact (e.g. river, dam or lake). ^fThese girls deny water body contact.</p