Female genital schistosomiasis (FGS) is linked to serious reproductive health complications. In southwest Cameroon, girls and women living in areas endemic for urogenital schistosomiasis (UGS) face a high risk of undiagnosed FGS. This study aimed to identify probable cases of FGS by conducting syndromic screening, to administer pre-emptive treatment with praziquantel (PZQ) in accordance with World Health Organization (WHO) guidelines in the Ikange community, Tiko Health District (THD), Cameroon.
Adolescent girls and women of reproductive. (WRA) age (15–54 years) residing in Ikange were invited to take part in a community-based screening for FGS. Participants’ self-reported symptoms such as genital itching/burning sensations, abnormal vaginal discharge, pelvic pain, dyspareunia, and irregular bleeding, were recorded using a symptom checklist. A semi-structured questionnaire was also administered to collect data on water contact behaviours. Urine microscopy was performed to diagnose UGS. Individuals identified as probable FGS cases (presence of FGS-related symptoms and/or confirmed UGS) received a single dose of PZQ at 40 mg/kg and were followed up six weeks after treatment. Bivariate analysis and relative risk reduction ratios were used to assess the impact of treatment on genital tract symptoms.
All 44 girls and women (median age = 34 years (Interquartile range (IQR): 20–40 years) enrolled reported prior contact with stream. Among them, 61.4% (27/44) exhibited FGS-related symptoms. The commonly reported symptoms were genital itching/ burning sensations (47.7%; 21/44) and pelvic pain (25%; 11/44). Less frequently observed symptoms included abnormal genital discharge (13.6%; 6/44) and intermenstrual genital bleeding (4.5%; 2/44). A positive diagnosis of UGS was confirmed in 31.8% (14/44) of participants. Interestingly, a majority of symptomatic individuals (59.3%; 16/27) did not show evidence of ova excretion. Conversely, 17.6% (3/17) of asymptomatic individuals were found to have schistosome ova. Pelvic pain was significantly associated with UGS (crude odds ratio [OR] = 6.5; 95% confidence interval [CI], 1.5–28.7; p = 0.014). Additionally, 71.4% (10/14) of those diagnosed with UGS reported genital itching/burning sensations (crude OR = 4.32; 95% CI, 1.1–17.1; p = 0.033). When evaluated as potential screening indicators for FGS using urine microscopy as the reference standard, self-reported genital itching/burning and pelvic pain identified 47.6% and 63.8% of UGS cases as probable FGS, respectively. These symptoms also demonstrated strong specificity, correctly excluding probable FGS in 82.6% and 78.9% of cases, respectively. A single dose of PZQ significantly reduced the risk of genital itching/burning sensation by 93% (Relative risk reduction (RRR) = 0.93; 95% CI, 0.52–0.99) compared to pre-treatment level meanwhile only a 13% (RRR) = 0.13; 95% CI, -0.8–0.57) reduction in unresolved pelvic pain was observed, which was not significant.
The high prevalence (61.4%) of FGS-related symptoms among girls and women with a history of stream contact indicates that FGS is likely underdiagnosed in THD. The therapeutic effectiveness of PZQ in partially alleviating genital symptoms supports the implementation of community-led mass drug administration (MDA) as an effective strategy for preventing FGS in resource-limited endemic settings.
Keywords: FGS; Praziquantel treatment; Syndromic screening; Tiko; UGS.