Female and male genital schistosomiasis (FGS & MGS): A neglected public health and gender equity challenge

What is genital schistosomiasis?

Genital schistosomiasis is a severe and often overlooked consequence of Schistosoma haematobium infection. It is a chronic and debilitating condition resulting from infection with Schistosoma haematobium, a parasitic worm transmitted through contact with freshwater infested with cercariae (larval forms). These larvae penetrate human skin and migrate through the bloodstream, eventually lodging in the venous plexuses of the pelvic organs. Over time, the eggs released by adult worms cause granulomatous inflammation and fibrosis in the genital and urinary tracts, leading to a range of reproductive and urogenital complications.

FSG

Female Genital Schistosomiasis (FGS) occurs when S. haematobium eggs are deposited in the cervix, vagina, vulva, uterus, or fallopian tubes. It is characterized by symptoms such as vaginal discharge, bleeding, pelvic pain, genital ulcers, and dyspareunia. FGS also presents with distinctive cervical and vaginal lesions that can be misdiagnosed as sexually transmitted infections or precancerous changes, contributing to mismanagement and stigma. Female Genital Schistosomiasis (FGS) affects an estimated 56 million women and girls in sub-Saharan Africa. It causes lesions, chronic pain, infertility, and increases HIV and HPV susceptibility by up to 3–4 times. 

MSG

In Male Genital Schistosomiasis (MGS), eggs may affect the seminal vesicles, prostate, and testicular tissues, leading to hematospermia, genital pain, erectile dysfunction, and in some cases, infertility. MGS, though less documented, is linked to infertility, genital ulcers, and enhanced HIV transmission.

Intersection with sexual and reproductive health

The intersection of urogenital schistosomiasis with sexual and reproductive health (SRHR) is profound. FGS increases the risk of HIV acquisition by up to three to four times due to compromised genital mucosa and inflammation, and it is also associated with increased susceptibility to HPV and potentially cervical cancer. MGS may contribute to male infertility and facilitate viral shedding in semen, further increasing HIV transmission risk. Despite these serious implications, both FGS and MGS remain largely invisible in SRHR services and HIV prevention programs.

Despite these serious impacts, FGS and MGS are frequently misdiagnosed as sexually transmitted infections (STIs) or remain undiagnosed due to limited health worker awareness and lack of appropriate diagnostic tools. The under-recognition of urogenital schistosomiasis represents a significant gap in public health response. Integrating diagnosis and treatment into primary care, SRHR, and HIV platforms is essential for reducing morbidity, addressing gender inequities, and moving toward universal health coverage.