title: Genital schistosomiasis and its unacknowledged role on HIV transmission in the STD intervention studies.
abstract: Treatment of sexually transmitted infections (STIs) has been hypothesised to decrease HIV transmission. Although observational studies show an association between STIs and HIV, only one prospective randomised controlled trial (RCT) has confirmed this. Female genital schistosomiasis can cause genital lesions, accompanied by bloody discharge, ulcers or malodorous discharge. Genital schistosomiasis is common, starts before puberty and symptoms can be mistaken for STIs. Three observational studies have found an association between schistosomiasis and HIV. Genital lesions that develop in childhood are chronic. This paper sought to explore the possible effects of schistosomiasis on the RCTs of STI treatment for HIV prevention. In the study sites, schistosomiasis was a likely cause of genital lesions. The studies recruited women that may have had genital schistosomal lesions established in childhood. Schistosomiasis endemic areas with different prevalence levels may have influenced HIV incidence in intervention and control sites differently, and some control group interventions may have influenced the impact of schistosomiasis on the study results. Schistosomiasis is a neglected cause of genital tract disease. It may have been an independent cause of HIV incidence in the RCTs of STI treatment for HIV prevention and may have obscured the findings of these trials.
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, School of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa e.f.kjetland@medisin.uio.no.
authors.forename: Eyrun F
authors.initials: EF
authors.lastname: Kjetland
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.
authors.forename: Ingrid Ea
authors.initials: IE
authors.lastname: Hegertun
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway Laboratory of Cancer Research and Clinical Oncology, University of Antwerp, Wilrijk, Belgium.
authors.forename: Marc Fd
authors.initials: MF
authors.lastname: Baay
authors.affiliation: Department of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.affiliation: Imperial College London, Charing Cross Campus, Hammersmith, London, UK.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Ndhlovu
authors.affiliation: Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, School of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Myra
authors.initials: M
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012553:Schistosomiasis haematobia / Q000150:complications* / Q000188:drug therapy / Q000469:parasitology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000871:Anthelmintics
keywords: HIV incidence; RCT; female genital schistosomiasis; randomised controlled trial; schistosomiasis; sexually transmitted infections; treatment; women