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Abstract：
BACKGROUND: Female genital schistosomiasis (FGS), caused by the parasite Schistosoma haematobium (Sh), is prevalent in Sub-Saharan Africa. FGS is associated with sexual dysfunction and reproductive morbidity, and increased prevalence of HIV and cervical precancerous lesions. Lack of approved guidelines for FGS screening and diagnosis hinder accurate disease burden estimation. This study evaluated FGS burden in two Sh-endemic areas in Southern Malawi by visual and molecular diagnostic methods.
RESULTS: Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. \'Visual-FGS\' was defined as specific genital lesions. \'Molecular-FGS\' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). \'Molecular-FGS\' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high \'molecular-FGS\' prevalence, despite <10% prevalence of urinary Sh among school-age children.
CONCLUSIONS: Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.
RESULTS: Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. \'Visual-FGS\' was defined as specific genital lesions. \'Molecular-FGS\' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). \'Molecular-FGS\' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high \'molecular-FGS\' prevalence, despite <10% prevalence of urinary Sh among school-age children.
CONCLUSIONS: Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.
摘要：
背景：女性生殖器血吸虫病（FGS），由寄生虫血吸虫（Sh）引起，在撒哈拉以南非洲很普遍。FGS与性功能障碍和生殖发病率有关，HIV和宫颈癌前病变的患病率增加。缺乏经批准的FGS筛查和诊断指南阻碍了准确的疾病负担估计。这项研究通过视觉和分子诊断方法评估了马拉维南部两个Sh流行地区的FGS负担。
结果：15-65岁女性，性活跃，不是来月经,或怀孕,从MORBID研究中招募。一名助产士填写了一份问卷，获得宫颈阴道拭子和灌洗，并使用手持式阴道镜评估FGS相关生殖器病变。“Visual-FGS”定义为特定的生殖器病变。“分子FGS”定义为通过实时PCR从拭子中检测到的ShDNA。显微镜检查检测到尿Sh卵专利感染。总的来说,950名妇女完成了问卷（平均年龄27岁，[IQR]20-38）。视觉和分子FGS患病率分别为26·9%(260/967)和8·2%(78/942)，分别。6·5％的生殖器和尿液样本的女性（38/584）患有卵孔Sh感染。分子-和视觉-FGS之间存在正相关（AOR=2·9，95CI1·7-5·0）。“分子FGS”与卵专利Sh感染相关(AOR=7·5，95%CI3·27-17·2)。一些村庄的分子FGS患病率很高，尽管学龄儿童的尿Sh患病率<10％。
结论：马拉维南部的FGS负担不足。在不符合血吸虫病控制策略条件的村庄可以检测到FGS，根据世卫组织现行准则，可能会导致女孩和妇女得不到治疗。对于新的控制策略，可以考虑经过验证的现场可部署方法。
结果：15-65岁女性，性活跃，不是来月经,或怀孕,从MORBID研究中招募。一名助产士填写了一份问卷，获得宫颈阴道拭子和灌洗，并使用手持式阴道镜评估FGS相关生殖器病变。“Visual-FGS”定义为特定的生殖器病变。“分子FGS”定义为通过实时PCR从拭子中检测到的ShDNA。显微镜检查检测到尿Sh卵专利感染。总的来说,950名妇女完成了问卷（平均年龄27岁，[IQR]20-38）。视觉和分子FGS患病率分别为26·9%(260/967)和8·2%(78/942)，分别。6·5％的生殖器和尿液样本的女性（38/584）患有卵孔Sh感染。分子-和视觉-FGS之间存在正相关（AOR=2·9，95CI1·7-5·0）。“分子FGS”与卵专利Sh感染相关(AOR=7·5，95%CI3·27-17·2)。一些村庄的分子FGS患病率很高，尽管学龄儿童的尿Sh患病率<10％。
结论：马拉维南部的FGS负担不足。在不符合血吸虫病控制策略条件的村庄可以检测到FGS，根据世卫组织现行准则，可能会导致女孩和妇女得不到治疗。对于新的控制策略，可以考虑经过验证的现场可部署方法。
