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Review
. 2020 Sep:209:105524.
doi: 10.1016/j.actatropica.2020.105524. Epub 2020 May 13.

Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition

A S Sturt  1 , E L Webb  2 , S C Francis  2 , R J Hayes  2 , A L Bustinduy  3
Affiliations
Review

Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition

A S Sturt et al. Acta Trop. 2020 Sep.

Abstract

Female genital schistosomiasis (FGS) results from egg-deposition in the female reproductive tract primarily by the waterborne parasite Schistosoma (S.) haematobium, and less commonly by Schistosoma (S.) mansoni. FGS affects an estimated 20-56 million women worldwide, mostly in sub-Saharan Africa. There is cross-sectional evidence of increased HIV-1 prevalence in schistosomiasis-infected women, but a causal relationship between FGS and either HIV-1 acquisition or transmission has not been fully established. Beyond the pathognomonic breach in the cervicovaginal barrier caused by FGS, this narrative review explores potential mechanisms for a synergistic relationship between S. haematobium infection, FGS, and HIV-1 acquisition through vaginal inflammation and target cell recruitment.

Keywords: Schistosoma haematobium; Sexually transmitted infection; Urogenital schistosomiasis, Vaginal or cervicovaginal microbiota; Vaginal or cervicovaginal inflammation.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
FIGURE 1
Figure 1
Overlapping geographical distributions of schistosomiasis infection, HIV-1 prevalence, reported cases of FGS, and infertility. (A) Prevalence of S. haematobium infection in school-aged children in Sub-Saharan Africa from 2000 onwards (from (Lai et al., 2015)); (B) HIV prevalence in African adults (15-49) (from (UNAIDS 2018)); (C) African countries with published reports of FGS (adapted from (Christinet et al., 2016)), FGS cases have been published by countries shaded in red; (D) Secondary infertility in Sub-Saharan Africa (from (Larsen 2000)).
Figure 2
Figure 2
The anatomy of female genital and female urogenital schistosomiasis.
FIGURE 3
Figure 3
Visual findings suggestive of Female Genital Schistosomiasis, from World Health Organization (2015).
FIGURE 4
Figure 4
Conceptual pathway describing the potential contribution of FGS to vaginal inflammation and the association of FGS with sexually transmitted infection and “non-optimal” cervicovaginal microbiota (McKinnon et al., 2019).
See this image and copyright information in PMC

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