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. 2026 Mar 13:jiag153.
doi: 10.1093/infdis/jiag153. Online ahead of print.

Association between female genital schistosomiasis and high-risk human papillomavirus among women of reproductive age in Zambia: the Schista study

Olimpia Lamberti  1 , Rhoda Ndubani  2 , Jennifer Fitzpatrick  2 , Emily Webb  3 , Nkatya Kasese  2 , Beatrice Nyondo  2 , Barry Kosloff  2   4 , Maina Cheeba  2 , Philippe Mayaud  1 , Morgan E Lemin  1 , Pytsje T Hoekstra  5 , Govert Van Dam  5 , Paul Corstjens  6 , Lisette Van Lieshout  5 , Bonnie Webster  7 , Helen Ayles  1   2 , Isaiah Hansingo  8 , Bodo Randrianasolo  9 , Dingase Kuwemba  10 , Bellington Vwalika  11 , Paul Kamfwa  12 , Kwame Shanaube  2 , Helen Kelly  1   13 , Amaya L Bustinduy  1
Affiliations

Association between female genital schistosomiasis and high-risk human papillomavirus among women of reproductive age in Zambia: the Schista study

Olimpia Lamberti et al. J Infect Dis. .

Abstract

Background: Female genital schistosomiasis (FGS), a gynaecological disease caused by Schistosoma haematobium eggs deposition in the female genital tract, is prevalent in sub-Saharan Africa (SSA), the region with the highest cervical cancer burden globally. Persistent high risk (HR-) human papilloma virus (HPV) infection is necessary for cervical cancer development. We determined the association between FGS and HR-HPV genotypes in Zambian women.

Methods: Sexually active women aged 15-50, not menstruating or pregnant, were recruited at home and provided two cervicovaginal self-swabs, urine sample, HIV and Trichomonas vaginalis self-tests, and completed a questionnaire. In clinic, midwives collected cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODTⓇ). Swabs were analysed for 14 HR-HPV types (GeneXpertⓇ) and Schistosoma DNA (ITS-2 qPCR); urine for Schistosoma ova by microscopy and circulating anodic antigen (CAA). Visual FGS was defined as colposcopic identification of specific genital lesions, and molecular FGS as Schistosoma-positive cervicovaginal qPCR.

Results: Among 2,532 women (median age 28 [IQR:22-36]) recruited at home; 67% (1,694/2,532) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV were 35.2% [595/1,691], 6.5% [165/2,532], and 28.7% [690/2,401], respectively. Molecular FGS was weakly associated with all HR-HPV (adjusted Odds Ratio [aOR]=1.3, 95% CI 0.9-1.9). Women with molecular FGS were more likely to test positive for HR-HPV 16/18/45 (aOR=1.7, 95%CI 1.0-2.8). No association was observed between visual FGS and HR-HPV infection (95% CI 0.7-1.1).

Conclusions: This is the first study to jointly screen for FGS and HR-HPV in Zambia, reporting an association between oncogenic HR-HPV types and molecular FGS.

Keywords: High-risk human papillomavirus; Neglected tropical diseases; Zambia; cervical cancer; female genital schistosomiasis; sexual and reproductive health; sub-Saharan Africa.

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