Background
Schistosomiasis, a water-borne parasitic infection caused by flatworms (trematodes) of the Schistosoma genus, is endemic in 78 countries, mainly in Africa (90% of cases), but also in Asia, South America and the Caribbean. It is estimated to affect more than 250 million people and is responsible for between 24,067 and 200,000 deaths worldwide each year.
Pathological lesions resulting from inflammatory responses to the deposition of Schistosoma eggs in tissues by adult female worms are known to be a major cause of chronic liver disease, portal hypertension and bladder cancer in sub-Saharan Africa. Schistosomiasis also affects the genital tract. In women, urogenital schistosomiasis may cause vaginal discharge, bleeding, pain during sexual intercourse, nodules in the vulva, pregnancy complications or infertility –described as female genital schistosomiasis (FGS). It is estimated that 56 million women worldwide are affected by FGS. However, this is likely to be an underestimate, as every woman infected with S. haematobium is likely to develop FGS. In men, male genital schistosomiasis (MGS) symptoms include ejaculatory pain, haematospermia, pain during urination, orchitis, epididymitis, prostatitis, fibrosis and calcification in organs and infertility.
Praziquantel is used to treat schistosomiasis and acts by killing the adult worms, thereby resolving active infections. As an anti-inflammatory, it may also alleviate symptoms, however, scant evidence is available measuring its effectiveness at reversing existing pathologies once chronic fibrotic or calcified lesions have developed.
FGS diagnosis is challenging. FGS can be mistaken for other conditions, such as cervical cancer or sexually transmitted infections. WHO and UNAIDS published an advocacy document in 2019 to raise awareness of FGS and call for integrated sexual and reproductive health interventions: No more neglect — Female genital schistosomiasis and HIV — Integrating sexual and reproductive health interventions to improve women’s lives | UNAIDS.
Noting evidence on co-morbidities with HIV and HPV, the new NTD roadmap highlighted the need for collaboration with other health sectors to integrate FGS into primary health care, and the need for research into diagnosis, treatment and evaluation of the impact of FGS. This is reiterated and reinforced by the UNAIDS strategy (End Inequalities. End AIDS. Global AIDS Strategy 2021-2026), which identifies female genital schistosomiasis as a risk factor for HIV acquisition in areas where schistosomiasis is endemic. Preventive treatment of schistosomiasis, together with HIV prevention and promotion of sexual and reproductive health, is important to protect the health of women and girls. The documents set a target that 90% of school-aged young girls in priority countries should have access to HPV vaccination and to screening and/or treatment for female genital schistosomiasis (S. haematobium) in areas where schistosomiasis is endemic. Combining the screening and diagnosis of HIV/AIDS, Sexually Transmitted Infections (STIs) and cervical cancer with FGS can greatly contribute to the detection of this chronic health problem affecting girls and women in sub-Saharan Africa.
The first WHO informal consultation on urogenital schistosomiasis was held in 2009 with a focus then on highlighting its association with HIV. Since then, significant research and progress have been made in understanding the burden and morbidity of urogenital schistosomiasis, with a particular focus on FGS, diagnosis, awareness and integration at health facility and community levels.
The aim of the meeting is to review progress to date on interventions against urogenital schistosomiasis, to make public health recommendations for accelerating implementing of interventions, identify global priorities to address genital schistosomiasis, and to advocate for support for prevention and treatment for genital schistosomiasis as the focused entry point for addressing schistosomiasis morbidity and its associations in all populations.
Objectives
The overall objective of the consultation is to convene researchers, national coordinators and programme managers with a relevant expertise to review evidence, discuss technical updates, identify global priorities and the way forward to address genital schistosomiasis. The consultation will also explore its implication for national control programmes for HIV, STIs, human papillomavirus (HPV), reproductive health, and child health. The specific objectives are:
- To review current evidence and consolidate updates on burden of disease, diagnostic methods, and treatment options and make recommendations to address the morbidity due to genital schistosomiasis
- To identify global priority actions and research gaps and make recommendations on the way forward
- To identify practical opportunities for integrating FGS prevention and treatment into national health systems and other relevant health programmes
- Make recommendations for programmatic actions and identify priorities research gap to address urogenital schistosomiasis.
Expected outcomes
- Plan for a way forward for genital schistosomiasis activities for WHO and partners
- Recommendations on interventions for integration of genital schistosomiasis into existing service delivery platforms and national health information systems
- Recommendations on research needs for genital schistosomiasis
- Publication of a WHO technical report on urogenital schistosomiasis, with a focus on genital forms.
- Sensitization of donors and other reproductive health programmes to support actions for implementation of interventions against urogenital schistosomiasis and research.