AFJOG

ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | Prevalence of female genital schistosomiasis in women with abnormal Pap smears at King Edward VIII Hospital, KwaZulu-Natal ABSTRACT Background: Female genital schistosomiasis (FGS) is a parasitic infection affecting women's reproductive organs. Despite the common use of Pap smears, and colposcopy for cervical cancer screening, local data on FGS prevalence diagnosed on Pap smear results is limited. Objectives: To determine FGS prevalence in women referred to a colposcopy clinic and treated with large loop excision of the transformation zone (LLETZ) at King Edward VIII Hospital in Durban, South Africa. Methods: This retrospective descriptive study reviewed 915 clinical records of patients treated at the colposcopy clinic and had a LLETZ procedure at King Edward VIII Hospital from 2012 to 2016. Demographic and clinical data were extracted from patient files for analysis. Statistical analysis was performed using SPSS version 25, with p<0.05 considered significant. Results: There were 19/910 cases of FGS diagnosed on LLETZ histology, giving a prevalence of 2.09%. FGS-positive participants had a mean age (standard deviation, SD) of 33.3 (5.4) years compared to 38.3 (9.2) years for those without. Among FGS-positive women, 26.3% were living with HIV, whereas the HIV prevalence was 39.8% among women without FGS. The majority (96.5%) of women were sent to colposcopy for high-grade squamous intraepithelial lesions (HGSIL), but HGSIL was present in only 73.7% of those with FGS. All these differences were significant, p<0.0001. None of the cases of were picked up on pap smear, and all were diagnosed from LLETZ histology. Conclusion: This study of histologically diagnosed FGS in cervical tissue reveals that cervical cytology performs poorly compared to histology for FGS detection. Consequently, cytology cannot be recommended as FGS screening tool. BACKGROUND Schistosomiasis is a systemic infection caused by the Schistosoma blood fluke 1,2 . It thrives in areas with poor sanitation where humans come in contact with water contaminated by human waste1. The Schistosoma haematobium species primarily affects the urogenital system, causing significant health issues in reproductive organs, urinary bladder, and kidneys. Adult worms inhabit blood vessels around the bladder and genital tissue, laying eggs within the urogenital system 3 . Globally, FGS is estimated to affect 20 to 120 million girls and women 4 , with a prevalence of 33-75% in endemic areas 1,3 . Female genital schistosomiasis (FGS) results from schistosome eggs or worms infesting a woman's reproductive organs, affecting the epithelial lining of the urinary bladder or genital mucosa. FGS symptoms include malodorous vaginal discharge, which may be blood stained, pelvic pain or pain during sexual intercourse, while clinically one may find cervical erosions, "sandy patches," contact bleeding, and swelling 1 . While less prevalent than other genital tract infections, FGS has serious long-term consequences. FGS is associated with adverse reproductive health outcomes such as infertility, ectopic pregnancies, miscarriages, premature births, low birth weight, and maternal mortality 4,5 . It also increases the risk of developing cervical cancer and triples the risk of acquiring HIV 4 . Diagnosing FGS accurately is challenging, often resulting in misdiagnosis or non-detection. FGS is frequently misdiagnosed as sexually transmitted infections or genital cancer. Misdiagnosis can severely impact women's health and social well-being 6 . FGS diagnosis is complicated by its asymptomatic nature, typically diagnosed incidentally through Papanicolaou (Pap) smears or histology of cervical biopsy specimens in women beingmanaged for premalignant cervical lesions 7 . Colposcopy can be used to identify painful vaginal lesions, characterised by grainy and homogenous yellow sandy patches, rubbery papules, and aberrant blood vessels 4 . While colposcopy and targeted biopsies offer more precise FGS diagnosis, their high cost and impracticality in HIV-prone populations limit their use 7 . Pap smears are widely used for cervical cancer screening in resource-limited areas. However, data on the prevalence of FGS, particularly in women with abnormal Pap smears, is limited in our local setting. Determining the prevalence in this population can help estimate the disease burden and support efforts to reduce both the disease and its complications. This study aimed to determine the prevalence of genital schistosomiasis in women referred to the colposcopy clinic at King Edward VIII Hospital in Durban, South Africa from either the results of a pap smear, or from LLETZ histology. METHODS Ethics approval Ethical clearance was granted by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu- Natal (BREC ref number: BE382/19). Study setting and population This retrospective descriptive study was conducted at King Edward VIII Hospital (KEH) in Durban, South Africa. Clinical files of women treated at the Colposcopy Department from 2012 to 2016 were reviewed. Demographic data (age, race, socioeconomic status) and clinical information (HIV status, lesion grade as per cytology, and histology results) were extracted for retrospective analysis of patient outcomes. The J Musoke 1 , WP Dhlomo 1 , HM Sebitloane 1 1 Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa CORRESPONDENCE: HM Sebitloane | Email: sebitloanem@ukzn.ac.za Prevalence of female genital schistosomiasis in women with abnormal Pap smears at King Edward VIII Hospital, KwaZulu-Natal African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 17