The Presence of Hemoglobin in Cervicovaginal Lavage Is Not Associated With Genital Schistosomiasis in Zambian Women From the BILHIV Study

Amy S Sturt; Emily L Webb; Comfort R Phiri; Joyce Mapani; Maina Mudenda; Lisa Himschoot; Eyrun F Kjetland; Tobias Mweene; Bruno Levecke; Govert J van Dam; Paul L A M Corstjens; Helen Ayles; Richard J Hayes; Suzanna C Francis; Lisette van Lieshout; Piet Cools; Isaiah Hansingo; Amaya L Bustinduy

doi:10.1093/ofid/ofac586

The Presence of Hemoglobin in Cervicovaginal Lavage Is Not Associated With Genital Schistosomiasis in Zambian Women From the BILHIV Study

Open Forum Infect Dis. 2022 Dec 16;9(12):ofac586. doi: 10.1093/ofid/ofac586. eCollection 2022 Dec.

Authors

Amy S Sturt¹, Emily L Webb², Comfort R Phiri³, Joyce Mapani⁴, Maina Mudenda⁴, Lisa Himschoot⁵, Eyrun F Kjetland^{6

7}, Tobias Mweene³, Bruno Levecke⁸, Govert J van Dam⁹, Paul L A M Corstjens¹⁰, Helen Ayles^{3

11}, Richard J Hayes², Suzanna C Francis², Lisette van Lieshout⁹, Piet Cools^{5

8}, Isaiah Hansingo⁴, Amaya L Bustinduy¹¹

Affiliations

¹ Department of Infectious Diseases, Veterans Affairs Health Care System, Palo Alto, California, USA.
² MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ Zambart, Lusaka, Zambia.
⁴ Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia.
⁵ Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁶ Department of Infectious Diseases and Global Health, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway.
⁷ Discipline of Public Health Medicine, College of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa.
⁸ Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
⁹ Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands.
¹¹ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Abstract

Background: Female genital schistosomiasis (FGS) occurs when Schistosoma haematobium eggs are deposited in reproductive tissue. Female genital schistosomiasis in the cervical mucosa is associated with increased vascularity. If FGS is associated with the presence of hemoglobin in cervicovaginal lavage (CVL), the use of urinary reagent strips to detect hemoglobin in CVL could supplement FGS diagnosis.

Methods: Nonmenstruating, nonpregnant, sexually active women aged 18-31 participating in the HPTN 071 (PopART) Population-Cohort were invited in 2 Zambian communities. Genital self-swabs and a urine specimen were collected at a home visit, and CVL and hand-held colposcopy were performed at a midwife led clinic visit. Urinary reagent strips were used to identify hemoglobin in CVL. Eggs and circulating anodic antigen (CAA) were detected from urine. Visual-FGS was defined as the presence of sandy patches, rubbery papules, or abnormal blood vessels. Polymerase chain reaction (PCR)-FGS was defined as Schistosoma deoxyribonucleic acid detected by real-time PCR on CVL or cervical or vaginal swab.

Results: Of 209 women with home genital swabs and companion CVL specimens, 66% (138 of 209) had detectable CVL hemoglobin, 13.4% (28 of 209) had PCR-defined FGS, and 17.2% (36 of 209) had visual-FGS. Active Schistosoma infection, diagnosed by CAA or urine microscopy, was present in 21.0% (44 of 209) participants. Active Schistosoma infection (P = .4), PCR-FGS (P = 0.7), and visual-FGS (P = 0.3) were not associated with CVL hemoglobin presence. Results did not differ in subgroups with high infection burden (cycle threshold < 35 or 2-3 positive genital PCR).

Conclusions: Polymerase chain reaction-FGS, visual-FGS, and active Schistosoma infection were not associated with the presence of CVL hemoglobin. Further research is needed to establish accessible community-based FGS diagnostics.

Keywords: Schistosoma haematobium; cervicovaginal lavage; female genital schistosomiasis; hematuria; hemoglobin.

Abstract

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