Schistosomiasis of the uterine cervix

Abstract

Case reportThe cervical smear of a 28 year old nulliparous woman showed inflammation together with ova of Schistosoma haematobium (Fig. 1). Eighteen months earlier she had returned from a two year backpacking trip in Africa. She had visited Kenya, Uganda and Malawi. Four days had been spent on Lake Malawi swimming three times a day. She was asymptomatic. In particular, there had been no vaginal discharge, intermenstrual bleeding, postcoital bleeding, dyspareunia, urinary frequency or haematuria. She could not recollect having had pruritis or a fever during the five weeks following her African adventures.Abdominal and pelvic examinations were normal. Colposcopy showed numerous, cream-coloured, 2 4 mm diameter nodules within the squamous and metaplastic epithelium of the ectocervix. All the visible columnar epithelium was normal. Following the application of acetic acid, the nodules became relatively dark centrally with a surrounding pale halo (Fig. 2). The uptake of Schiller's iodine was reduced at these sites. There was also a small area of acetowhite epithelium showing mosaicism suggestive of high grade intraepithelial neoplasia. This area was well demarcated with iodine. No abnormalities were seen within vaginal or vulva1 skin.A punch biopsy taken from a cervical nodule contained many Schistosoma ova in the subepithelial stroma surrounded by a granulomatous reaction with multinucleate giant cells and eosinophils (Fig. 3). A worm pair was identified. A second biopsy confirmed the presence of grade 2 cervical intraepithelial neoplasia. No ova were found in two late morning urine specimens or in a sample of faeces. Her blood count was normal and her eosinophil count was not raised at 0 . 2 1~1 0~. A Schistosoma ELISA was positive at level 3. The Schistosoma infection was treated with a single 2 g dose of praziquantel. The intraepithelial neoplasia was managed by loop diathermy excision. No colposcopic abnormality was found at a six month follow up examination, but the Schistosoma ELISA was unchanged.

Association of Schistosoma haematobium and Human Papillomavirus in Cervical Cancer

“…Chronic disease may lead to obstructive uropathy, chronic bacteriuria, bladder carcinoma and bladder calcification. [17][18][19] None of these symptoms were present in our patient. This may be because Schistosoma can survive and produce eggs for many years in the human body.…”

Cervical Schistosomiasis and Neoplasia in HIV-Infected Patients

“…Infected women are usually asymptomatic but may present with a wide range of symptoms including hematuria, menstrual disturbances, dyspareunia, and dysmenorrhea (5). Schistosomiasis of the female genital tract is usually caused by S. haematobium; the ova in these cases have a characteristic terminal spine.…”

Esquistossomose endocervical

“…Entretanto, podem ocorrer sangramentos pós-coital, intermenstrual e pós-menstrual, infertilidade, corrimento vaginal e dismenorréia. Esses sintomas não são conseqüências diretas da esquistossomose, mas sim de uma cervicite secundária, que geralmente está associada a esses casos 7 . No presente relato, a paciente era assintomática, visto que sua infertilidade era decorrente de laqueadura tubárea prévia.…”

“…Coelho e cols encontraram carcinoma em 3 de 1.250 amostras de biópsia de colo provenientes de pacientes com esquistossomose, sugerindo uma associação entre essas patologias 2 . Esses dados, entretanto, foram posteriormente refutados por outros autores que alegaram que o carcinoma verificado nesses casos foi decorrente da co-infecção pelo papiloma vírus humano, e não pelo esquistossomo per se 7 .…”