Gynecological manifestations, histopathological findings, and schistosoma-specific polymerase chain reaction results among women with Schistosoma haematobium infection: a cross-sectional study in Madagascar.
BACKGROUND
The pathophysiology of female genital schistosomiasis (FGS) is only partially understood. This study aims to describe the histopathological findings, polymerase chain reaction (PCR) results, and gynecological manifestations of FGS in women with different intensities of Schistosoma haematobium infection.


METHODS
Women aged 15-35 years living in an S. haematobium-endemic area in Madagascar underwent pelvic and colposcopic examinations. Small biopsy specimens were obtained from lesions and examined histopathologically. Schistosoma PCR was done on urine, biopsy, cervicovaginal lavage, and genital mucosal surface specimens.


RESULTS
Sandy patches and rubbery papules were found in 41 of 118 women (35%). Rubbery papules reflected an intense cellular immune reaction dominated by eosinophils, epithelial erosion, and viable ova. There was a significant decrease in the prevalence of rubbery papules with age, even after adjustment for urinary ova excretion. The sandy patches with grains showed moderate cellular immune reaction and ova (viable and/or calcified). They were most prevalent in cases with low-intensity urinary S. haematobium infection. Forty-two percent of women with Schistosoma-negative urine specimens had at least 1 genital specimen test positive for Schistosoma by PCR.


CONCLUSIONS
The results indicate a diversity of lesions caused by S. haematobium and a dynamic evolution of the genital lesions. Schistosoma PCR may give an indication of the diagnosis.
Helminthiasis Unit.
Bodo Sahondra
BS
Randrianasolo
Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Department of Obstetrics and Gynecology Faculty of Medicine, University of Oslo.
Peter Mark
PM
Jourdan
Helminthiasis Unit Ministry of Public Health, Antananarivo, Madagascar.
Pascaline
P
Ravoniarimbinina
Department of Epidemiology, Institut Pasteur de Madagascar.
Charles Emile
CE
Ramarokoto
Department of Epidemiology, Institut Pasteur de Madagascar.
Fanjasoa
F
Rakotomanana
Helminthiasis Unit.
Vololomboahangy Elisabeth
VE
Ravaoalimalala
Research Unit, Sorlandet Hospital HF Department of Development Studies, University of Agder, Kristiansand, Norway.
Svein Gunnar
SG
Gundersen
Institute of Microbiology and Hygiene, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany.
Hermann
H
Feldmeier
Section for Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen.
Birgitte Jyding
BJ
Vennervald
Department of Parasitology, Leiden University Medical Center, The Netherlands.
Lisette
L
van Lieshout
Department of Obstetrics and Gynecology Centre for Pediatric and Pregnancy-Related Pathology, Department of Pathology, Oslo University Hospital Ullevaal.
Borghild
B
Roald
Department of Infectious Diseases, Aarhus University Hospital, Denmark.
Peter
P
Leutscher
Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Discipline of Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Eyrun Floerecke
EF
Kjetland
D000293:Adolescent; D000328:Adult; D000818:Animals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008270:Madagascar; D025202:Molecular Diagnostic Techniques; D016133:Polymerase Chain Reaction; D012548:Schistosoma haematobium / Q000235:genetics*; D012553:Schistosomiasis haematobia / Q000469:parasitology* / Q000473:pathology; D014591:Uterine Diseases / Q000469:parasitology*; D055815:Young Adult
Madagascar; Schistosoma haematobium; female genital schistosomiasis (FGS); histopathology; polymerase chain reaction (PCR); reproductive health