The cause of the most common gynecological problem in sub-Saharan Africa isn’t hormones, puberty, or menopause — it’s parasitic worms.
Female genital schistosomiasis (FGS) is a variation of schistosomiasis, also known as snail fever or bilharzia — a neglected tropical disease (NTD) that stems from parasitic worms. They make their way into the human body through skin that has been in contact with infected freshwater.
It is estimated that nearly 56 million women in sub-Saharan Africa suffer from FGS, according to the World Health Organization (WHO), making it possibly the most common gynecological condition in schistosomiasis-endemic areas.
Take Action: Email South Africa’s Minister of Health Urging Him to Invest in Ending Neglected Tropical Diseases
The damaging effects range from genital itching and painful sex to infertility and even increased risk of HIV — and yet, it’s a condition that’s completely preventable.
Children are often at risk from swimming or treading barefoot in infected water, but women are also at high risk from doing domestic chores, such as laundry, in infested rivers, lakes, and lagoons.
In the common forms of schistosomiasis, worms live in the blood vessels of the body, where the female worms also produce eggs. Sometimes the eggs travel to the bladder or intestine and are passed through urine or stool (thus, starting a new cycle of infection for people who come in contact with infected water). But in FGS, eggs travel to the cervix or vaginal wall.
Research in Zimbabwe, Tanzania, South Africa, and Mozambique have shown that women with FGS are three times more likely to be infected with HIV, according to a study published in the Lancet.
Researchers noted the lesions FGS inflict on the vulva, vagina, cervix, and uterus are irreversible, which creates a lasting entry point for HIV. Other studies have shown that FGS compromises the vaginal mucosal barrier tissue, which weakens immune systems and exacerbates co-infection with HIV and other infections, while weakening the efficacy of antiretroviral therapy.
Still, despite its incredibly damaging effects, FGS often goes undiagnosed.
#Schistosomiasis can lead to female genital schistosomiasis in women, which can drastically increase their risk from #HIV. The drugs have already been donated, we just need to get them to those who need them. https://t.co/9YYsZ8b1W4#beatNTDs#DayOfTheGirlpic.twitter.com/zDYR4V64f9
— UnitingtoCombatNTDs (@CombatNTDs) October 11, 2018
“Doctors know bilharzia, but very few know the damage it can do to female genitals,” Professor Eyrun Kjetland, an honorary senior lecturer at University of KwaZulu-Natal in Durban, South Africa, told Zimbabwe News. “The early stages are difficult to see with the naked eye, especially before training. During gynaecological exams on women with bilharzia, it’s often misconceived as cancer or an STI.”
Because FGS is not very well known among clinicians, it is often mistaken for STIs or other infections. In order to identify FGS, clinicians need to inspect the cervix and vaginal walls for its characteristic lesions. This requires a digital camera or an instrument called a colposcope, which is a resource that some health care facilities lack.
FGS is not reversible, but treatment can end the cycle of infection and prevent future illnesses — so detection is key.
In 2015, the WHO compiled a booklet, titled the Pocket Atlas, that contains real-life examples of FGS to help clinicians recognize the disease.
Currently, the only treatment is a simple and affordable one: a single dose of praziquantel, an anti-worm drug which prevents worms from growing or multiplying in the body. It’s estimated to cost about USD $0.13 per person, but many endemic countries can receive it for free from the WHO.
For just over a dime per person, there is no question it is worth stopping the spread of a preventable, incredibly harmful disease. The more we talk about FGS, the more healthcare professionals will recognize it and stop future infection of a preventable disease.