Female Genital Schistosomiasis, a Neglected Differential of Cervical Precancerous and Cancerous Lesion: a Wakeup Call for on-Job Training for Healthcare Workers in Endemic Areas

Abstract

Background: Female genital schistosomiasis is a gynecological disease caused by Schistosoma haematobium. The uterine cervix appears to be the most affected area with most cases found in sub-Saharan Africa. Though both males and females can be affected, the consequences of genital schistosomiasis are more pronounced in females with reported increased risk of HIV transmission and malignancy of female genitalia. Female genital schistosomiasis of the cervix shares similarities in presentation to those of cervical intraepithelial neoplasm and sexual transmitted infections, making diagnosis challenging and requiring high degree of suspicion. Case Presentation: We report three cases of African women referred to our facility with a presumptive diagnosis of cervical precancerous/cancerous lesion. Initial workout at our facility was in keeping with early stages of cervical precancerous/cancerous lesion that necessitated excision as per standardized protocol. Histopathological analysis of excised tissue revealed schistosomiasis of the cervix. Conclusion: Schistosomiasis of the cervix shares similarities with cervical precancerous/cancerous lesions and should be suspected in women presenting with chronic inflammatory conditions of the cervix or features suggestive of precancerous/cancerous cervical lesions. Screening for female genital schistosomiasis should be incorporated in an already existing screening protocol for cervical cancer and sexual transmitted diseases.

Case Report: Three cases of suspected female genital schistosomiasis and precancerous lesions for cervical cancer in a highly endemic country—from clinical management to public health implications

“…The association between CC and FGS has been speculated on several times but there is no strong scientific evidence supporting this hypothesis. The relationship between the two conditions remains controversial and needs to be clearly understood (16)(17)(18)(19)(20)(21). In particular, based on a few studies of specific populations (i.e., individuals with early-onset CC), it has been hypothesized that FGS may influence HPV acquisition, and indirectly the risk of CC, at two stages: (i) at the acquisition of the infection, as the FGS-associated erosions and ulcerations of the cervical mucosa may facilitate the entrance of the virus (18), and (ii) during viral clearance (22).…”