title: The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa.
abstract: BACKGROUND
  Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.
  
  
  RESULTS
  Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.
  
  
  CONCLUSIONS
  This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Hanne M
authors.initials: HM
authors.lastname: Norseth
authors.affiliation: Imperial College London, London, United Kingdom.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Ndhlovu
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kleppa
authors.affiliation: Institut Pasteur de Madagascar, Antananarivo, Madagascar.
authors.forename: Bodo S
authors.initials: BS
authors.lastname: Randrianasolo
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jourdan
authors.affiliation: Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway.
authors.forename: Borghild
authors.initials: B
authors.lastname: Roald
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway; University of Oslo, Oslo, Norway.
authors.forename: Sigve D
authors.initials: SD
authors.lastname: Holmen
authors.affiliation: Research Department, Sorlandet Hospital HF, Kristiansand, Norway; Department for Global Development and Planning, Institute for Development Studies, University of Agder, Kristiansand, Norway.
authors.forename: Svein G
authors.initials: SG
authors.lastname: Gundersen
authors.affiliation: Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jayanthilall
authors.initials: J
authors.lastname: Bagratee
authors.affiliation: Department of Gynaecology, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway; Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Eyrun F
authors.initials: EF
authors.lastname: Kjetland
mesh_terms: D000293:Adolescent; D000328:Adult; D000353:Africa, Southern / Q000453:epidemiology; D000818:Animals; D003127:Colposcopy; D003937:Diagnosis, Differential; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008875:Middle Aged; D012548:Schistosoma haematobium / Q000276:immunology* / Q000502:physiology; D012553:Schistosomiasis haematobia / Q000453:epidemiology / Q000473:pathology*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D014621:Vagina / Q000469:parasitology / Q000473:pathology*; D055815:Young Adult