Urogenital schistosomiasis, primarily caused by the presence of Schistosoma haematobium eggs, results in significant damage to the bladder and genital tract. These eggs can induce chronic lesions in the urinary bladder and genital regions, leading to a condition known as female genital schistosomiasis (FGS). FGS occurs when schistosome eggs are deposited in various parts of the female genital tract, including the vagina, cervix, vulva, uterus, ovaries, and fallopian tubes. In contrast to FGS, urinary schistosomiasis manifests primarily as painless or painful hematuria, and the presence of S. haematobium eggs in the urine makes it easily identifiable. This disease is endemic in sub-Saharan Africa and is generally better recognized in clinical settings compared to FGS, which remains largely overlooked.
Despite its importance, FGS has not garnered as much attention as urinary schistosomiasis, both in terms of public awareness and healthcare focus in affected regions. Diagnosis of FGS is currently based on visual examination of the cervix and vaginal walls during pelvic exams, often aided by colposcopy. Characteristic signs include sandy patches, rubbery papules, and abnormal blood vessels, which are indicative of chronic schistosome egg deposition. Although this visual diagnosis is endorsed by the World Health Organization (WHO), it is not considered the gold standard. S. haematobium is most commonly associated with FGS due to its prevalence in endemic areas and its anatomical proximity to the genital tract, particularly the vesical and utero-vaginal plexus.
Globally, approximately 230 million people are affected by both urinary schistosomiasis and FGS, with S. haematobium being responsible for the majority of cases across 54 countries. The prevalence of FGS among women in sub-Saharan Africa is alarming, with estimates suggesting that between 20 and 56 million women and girls are infected. However, due to the often silent nature of the disease, many cases go undiagnosed. The inflammatory response triggered by schistosome eggs in the genital tract can result in symptoms such as vaginal discharge, itching, post-coital bleeding, prepubertal bleeding, and painful intercourse (dyspareunia). If left untreated, FGS can lead to severe complications, including an increased susceptibility to HIV, ectopic pregnancy, and infertility.
Infertility associated with FGS is primarily due to the chronic inflammatory lesions caused by schistosome eggs, leading to conditions like cervicitis, endometritis, and blockage of the fallopian tubes. Studies have shown a clear association between FGS and infertility, particularly in regions where schistosomiasis is endemic. Infertility, defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse, is particularly prevalent in sub-Saharan Africa. Tubal pathologies, commonly associated with FGS, are identified as a major cause of infertility in this region. While imaging techniques like ultrasound and hysterosalpingography are frequently used to detect tubal blockages, further microbiological investigations are often limited, meaning underlying causes such as Chlamydia, Gonorrhea, and tuberculosis often remain undiagnosed.
In Ghana, where both infertility and schistosomiasis are endemic, the prevalence of infertility ranges from 2% to 14%, and urinary schistosomiasis affects up to 60% of populations in certain areas. However, data on the prevalence of FGS in Ghana remains scarce. The most recent report, from 2011, found a prevalence of 10.7% in the lower Volta Basin. Despite this, no studies have yet explored the potential link between FGS and infertility in Ghana, highlighting the need for further research. This study aims to fill this gap by assessing the burden of FGS among women experiencing infertility in the Volta region.
By investigating the potential connection between FGS and infertility in this region, the study seeks to deepen our understanding of the public health burden posed by both diseases, providing a foundation for future interventions and increased awareness in endemic areas.
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