Editorial: Female genital schistosomiasis: research needed to raise awareness and deliver action

Editorial on the Research Topic
Female genital schistosomiasis: research needed to raise awareness and deliver action

Female Genital Schistosomiasis (FGS) is a serious yet overlooked condition within the field of Neglected Tropical Diseases (NTDs), and it significantly affects the health of women and girls worldwide. This disease occurs when eggs from the parasite Schistosoma haematobium are deposited in the genital tract. FGS has been associated with gynecological symptoms, infertility, and HIV. Several studies have reported a lack of awareness about the condition among healthcare providers teachers and community members.

Globally, substantial gaps remain in our understanding of the epidemiology, natural history, and burden of FGS along with the diagnostic and treatment pathways for the disease. Endemic areas also require FGS surveillance to understand the local burden of this condition and increased access to education and training for healthcare workers. Strategies that decrease the stigma associated with sexual and reproductive health issues would benefit those who experience FGS.

For this Research Topic, we sought original research focused on the natural history and/or epidemiology of FGS, including the consequences of FGS infection, FGS infection in vulnerable populations (e.g., adolescents, pregnant women, and women living with HIV), FGS treatment, FGS diagnostics, Education and training of healthcare professionals, community workers, and other key groups related to FGS. In addition, we were interested in the integration of FGS services into existing healthcare structures or programs (e.g., family planning, youth services, antenatal care, cervical cancer screening, and HIV care)

We identified 77 contributors for this Research Topic. Sixteen authors confirmed their intention to submit, three declined, 45 failed to respond and 13 studies were withdrawn. We finally received contributions from 15 authors representing a wide range of institutions and countries in the global North and South. After deliberating, we are pleased to present the final 14 manuscripts that comprise this Research Topic.

With studies published between October 2023 and October 2024, this Research Topic begins with a case report by Marchese et al. who performed an experimental screening via colposcopy for FGS at primary healthcare centers (PHCCs) in the Boeny region of Madagascar, allowing for the detection of patients with both FGS signs and HPV-related dysplasia (HPV-dy). The first two cases highlight how strengthening the competency of healthcare providers in both the diagnosis and clinical management of precancerous lesions, in addition to providing accessible and applicable local guidelines for the providers of health services, could improve the quality of integrated screening and clinical management processes for both FGS and CC. The third case, on the other hand, despite the accessibility of free health services, decided not to use them owing to the discovery of a pregnancy and fear of the possible clinical consequences if the follow-up continued. The authors show that the screening for FGS using colposcopy, as recommended by the WHO atlas, can contribute to the early identification of CC or precancerous lesions, despite current diagnostic limitations.

In their 5 year retrospective histopathologic review of FGS cases in South Africa, Mwazha et al. were surprised to find schistosomiasis present in the appendix, uterine cervix, urinary bladder, lung, liver, fallopian tube and prostate, with FGS forming 49% of the cases emphasizing the need for care providers to be aware of how to identify, diagnose, and treat FGS.

Praziquantel has been and continues to be the main treatment for Schistosomiasis. Interestingly, in the Arenholt et al. study on repeated versus single praziquantel dosing regimens in the treatment of female genital schistosomiasis, it showed no difference in efficacy. The authors observed that Irrespective of the dosing regimen, pelvic exam abnormalities and urogenital complaints saw equal reductions at follow-up. They emphasize the need for the initiation of praziquantel early in life and maintaining it throughout childhood and adolescence to prevent lesions from developing.

Integration of NTD into routine service delivery and other sexual and reproductive health services has been a matter of interest if Universal health coverage is to be achieved. It was therefore a pleasure reading the articles by Rogers et al., Preston et al. and Pillay et al. as they assessed various ways to integrate FGS into the healthcare system in Zambia and the Ivory Coast and into Reproductive health services through a virtual international workshop that brought together health practitioners from various sectors. Lessons from the FAST package, an integrated approach to dealing with FGS implemented in Ghana and Madagascar, were reported by Krentel et al. and Manyeh et al. As interest in involving men in reproductive health issues increases, Lambert et al. reported on the value of engaging men to promote FGS education in mainland Tanzania. They conclude that including men more explicitly in FGS community education efforts could facilitate the provision of high-quality sexual and reproductive healthcare for women living in many communities where FGS is endemic but access to care is limited.

Approximately 10 years ago, the first FGS workshop was held in South Africa where many scientists gathered to discuss the diagnosis of FGS, among other things. The first available diagnostic guide was the WHO FGS Atlas. In our series we present papers by Cunningham et al., Kayuni et al., Softeland et al., Dragsbaek et al. and Randriansolo et al. who share their experiences using various screening and diagnostic approaches to identify FGS in African women.

We would like to thank all those who submitted article proposals, the authors of the included manuscripts and our reviewers who kindly gave up their valuable time and used their expertise to improve the quality of this Research Topic. We are sure that after reading this Research Topic the readers will have a better understanding of FGS, a gynecological condition and an NTD that is increasingly being brought to the forefront of the global health agenda. Taken together, the studies underscore the importance of working together across disciplines and health sectors in order to address this hidden condition experienced by women.

Author contributions

MG: Conceptualization, Writing – review & editing, Writing – original draft.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

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