Female genital schistosomiasis (FGS) in returned travellers - A review of reported cases

Abstract

Introduction: Female genital schistosomiasis (FGS) is the manifestation of schistosomiasis in the lower and the upper reproductive organs. In endemic areas FGS is frequent with a tremendous impact on reproductive health. Anecdotal observations indicate that FGS also occurs in travellers who became infected when exposing themselves in natural water bodies in endemic areas. The objective of this study is to summarize existing knowledge on FGS in travellers with a focus on FGS-associated morbidity, diagnosis, and treatment.

Material and methods: The PubMed database was searched for reports on FGS in travellers from 1980 to 2023. Case reports of FGS in travellers were identified and reviewed.

Results: Thirty-eight case reports were identified. The most common manifestation of FGS were lesions at the vulva (n = 16), the cervix (n = 11), the ovaries and Fallopian tubes (n = 6), the vagina (n = 3) and the endometrium (n = 2). With a few exceptions the diagnosis was spurious. 15 patients with vulval schistosomiasis were treated with the anti-helminthic drug praziquantel (i.e. 40 mg/kg) in 1-3 doses. In all but one patient the lesions disappeared three to six months after treatment.

Conclusions: This study shows that FGS in travellers exhibits the same disease manifestations as in FGS patients living in endemic areas. However, correct diagnosis was established after months to years delaying treatment and cure. This precludes the inclusion of FGS in diagnostic guidelines for female travellers returning from endemic areas for schistosomiasis.

Keywords: Diagnosis; Female genital schistosomiasis; Morbidity; Schistosomiasis; Treatment.