S. haematobium as a common cause of genital morbidity in girls: a cross-sectional study of children in South Africa

Abstract

Background: Schistosoma (S.) haematobium infection is a common cause of genital morbidity in adult women. Ova in the genital mucosal lining may cause lesions, bleeding, pain, discharge, and the damaged surfaces may pose a risk for HIV. In a heterogeneous schistosomiasis endemic area in South Africa, we sought to investigate if young girls had genital symptoms and if this was associated with urinary S. haematobium.

Methodology: In a cross-sectional study of 18 randomly chosen primary schools, we included 1057 schoolgirls between the age of 10 and 12 years. We interviewed assenting girls, whose parents had consented to their participation and examined three urines from each of them for schistosome ova.

Principal findings: One third of the girls reported to have a history of genital symptoms. Prior schistosomal infection was reported by 22% (226/1020), this was associated with current genital symptoms (p<0.001). In regression analysis the genital symptoms were significantly associated both with urinary schistosomiasis (p<0.001) and water contact (p<0.001).

Conclusions: Even before sexually active age, a relatively large proportion of the participating girls had similar genital symptoms to those reported for adult genital schistosomiasis previously. Anti-schistosomal treatment should be considered at a young age in order to prevent chronic genital damage and secondary infections such as HIV, sexually transmitted diseases and other super-infections.

Figure 1. Map of Ugu district in South Africa.

The coastal areas are inhabited by the more affluent and the schools here were excluded.

Figure 2. Genital and urinary symptoms in girls of two S. haematobium positive groups and three negative risk groups.

^aLikelihood ratio. ^bThree urines investigated for S. haematobium ova, all were negative. ^cMore than 50 S. haematobium ova per 10 ml urine. ^d1–49 ova per 10 ml urine. ^eThese girls have water body contact (e.g. river, dam or lake). ^fThese girls deny water body contact.