title: Coexistence of urogenital schistosomiasis and sexually transmitted infection in women and men living in an area where Schistosoma haematobium is endemic.
abstract: BACKGROUND
  In settings in which adequate laboratory service is lacking, the coexistence of urogenital schistosomiasis and sexually transmitted infections (STIs) poses a diagnostic challenge for health care providers in the management of patients with urogenital complaints.
  
  
  METHODS
  Symptoms were recorded with use of a semistructured questionnaire at baseline and in follow-up surveys after STI and Schistosoma haematobium infection had been assessed and systematically treated as part of a community-based study of 253 women and 236 men, aged 15-49 years, living in an area of Madagascar where S. haematobium is endemic.
  
  
  RESULTS
  Of those infected with S. haematobium, 35% of the women had concordant STI (e.g., infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and/or Trichomonas vaginalis), compared with 17% of the men. Both S. haematobium infection and STI were significantly more common among younger individuals, aged 15-24 years, than among older individuals. A broad spectrum of urogenital symptoms was reported. However, one-half of the women and men who had positive test results for an STI or for S. haematobium infection were asymptomatic. Gross hematuria and dysuria were, in multivariate analysis, associated with S. haematobium infection, as were genitopelvic discomfort in women and ejaculation pain in men. The association became stronger with higher intensity of infection. In bivariate analysis but not in the multiregression model, STI was associated with vaginal discharge and genitopelvic discomfort in women and was associated with urethral discharge in men.
  
  
  CONCLUSIONS
  The rationale for empirical antischistosoma treatment of adolescents and younger adults in areas where S. haematobium is endemic, with praziquantel alone or in combination with existing anti-STI regimens, is discussed.
authors.affiliation: Institut Pasteur de Madagascar, Antananarivo, Madagascar. apd@sks.aaa.dk
authors.forename: Peter Derek Christian
authors.initials: PD
authors.lastname: Leutscher
authors.forename: Charles-Emile
authors.initials: CE
authors.lastname: Ramarokoto
authors.forename: S
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Jørgen S
authors.initials: JS
authors.lastname: Jensen
authors.forename: V
authors.initials: V
authors.lastname: Ramaniraka
authors.forename: B
authors.initials: B
authors.lastname: Randrianasolo
authors.forename: C
authors.initials: C
authors.lastname: Raharisolo
authors.forename: R
authors.initials: R
authors.lastname: Migliani
authors.forename: N
authors.initials: N
authors.lastname: Christensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002690:Chlamydia Infections / Q000150:complications; D002692:Chlamydia trachomatis; D005260:Female; D006801:Humans; D008270:Madagascar; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000150:complications; D045704:Mycoplasma genitalium; D012548:Schistosoma haematobium; D012553:Schistosomiasis haematobia / Q000150:complications*; D015231:Sexually Transmitted Diseases, Bacterial / Q000150:complications*; D014247:Trichomonas Vaginitis / Q000150:complications; D014246:Trichomonas vaginalis; D055815:Young Adult