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 study population comprised women with abnormal Pap smears who underwent large loop excision of the transformation zone (LLETZ) treatment during the five years. In total, 915 electronic clinical records of patients treated at the colposcopy clinic were reviewed. The study included women aged 18 to 65 years with available pre-treatment cytology who underwent surgical excision by LLETZ or cold knife conization of the cervix and had available histology results of the excision. Women lacking both cytology and histology results were excluded from the study. Statistical analysis Data was analyzed using SPSS version 25. A p-value <0.05 was considered statistically significant. Descriptive statistics with proportions summarized the prevalence of FGS in women with abnormal cervical Pap smears. Comparative analysis of two proportions compared the prevalence of FGS in histology samples to that in Pap smears. RESULTS BaselineparticipantcharacteristicsandFGSprevalence A total of 915 files were reviewed. Five patients were excluded due to carcinoma in situ identified on histology. The remaining 910 patients had both cytology and histology results available (Figure 1). Figure 1: Study participant selection criteria and numbers The majority of the participants were African (98.5%, n=900), followed by White (0.7%, n=6), Coloured (0.6%, n=5), and Indian (0.3%, n=4). The mean age of the participants was 38.2 years (range: 25-43). Among participants, 43.9% were HIV- positive with a mean CD4 count of 422.17. Histology samples from colposcopy showed 19 cases of FGS, yielding a prevalence of 2.09%. The mean age (SD) of FGS- confirmed participants was 33.3 (5.4) years. Among these women, 26.3% were HIV-positive. Clinical characteristics of the study participants stratified by FGS status are summarised in Table 1. Table 1: Characteristics of the studyparticipants Variables FGS Positive n (%) FGS Negative n (%) All women n (%) p-value Overall 19 (2.09) 891 (97.91) 910 (100) .00001 Mean Age (SD) 33.32 (5.42) 38.29 (9.22) 38.18 (9.19) HIV Positive 5 (26.32) 355 (39.84) 400 (43.96) Mean Parity 2.3 3.2 3.1 Mean CD4 Count 477.80 391.47 422.17 Of the women who attended the colposcopy clinic, 96.5% (n=878) had a high-grade squamous intraepithelial lesion (HSIL) on Pap smear, compared to 87.9% (n=800) on histology. Thirty (30) histology specimens showed extensive cauterisation artifacts, requiring re-biopsy. Twenty (20) histology samples showed no dysplasia (data not shown). Histologyresults and characteristics of FGS-confirmed participants Of the FGS cases, 14 (73.68%) had HSIL on both Pap smear and histology. Five cases showed no dysplasia on histology, despite four having HSIL and one having low-grade squamous intraepithelial lesions (LSIL) on initial smears (Table 2). None of the FGS cases were picked up on cytology, and all on histology, p < 0.00001. Only one sexually transmitted infection, Trichomonas vaginalis, was detected on Pap smear in the FGS- confirmed group. Table 2: Histological results for 19 FGS-confirmed study participants Pt no. Age Parity HIV status Pap Smear Histology 1 37 4 Neg HSIL CIN III, Granulomatous inflammation, male and female adult worms noted, Schistosoma Ova 2 31 2 Neg LSIL CIN III, HPV changes, Schistosoma ova 3 37 3 Neg HSIL HPV changes, focal mucosal ulceration, granulomatous ova reaction, nil dysplasia noted 4 27 1 Neg HSIL CIN II, HPV changes, Chronic cervicitis, Schistosoma Ova 5 28 2 Neg HSIL HPV changes, Chronic cervicitis, Schistosoma Ova, nil dysplasia noted 6 36 3 Pos CD4=300 HSIL Chronic cervicitis, Schistosoma Ova, no atypia noted 7 35 2 Pos CD4=550 HSIL Schistosoma Ova noted within benign endocervical polyp, nil atypia 8 28 1 Neg LSIL CIN III, Schistosoma Ova, HPV changes noted 9 43 4 Neg HSIL CIN III, HPV changes, focal ulceration, chronic cervicitis, Schistosoma Ova 10 25 1 Neg HSIL CIN III, Schistosoma Ova 11 36 2 Neg HSIL HPV changes, CIN III, Schistosoma Ova 12 36 2 Pos CD4=314 HSIL CIN III, Schistosoma Ova 13 41 3 Neg LSIL HPV changes, Schistosoma Ova, nil dysplasia noted Included n=915 Excluded (Carcinoma in Situ) n=5 Total number of patients n=915 Confirmed Schistosomiasis n=19 Pap Smear n=0 Histology n=19 Negative Schistosomiasis n=891