Female genital schistosomiasis and reproductive tract infections. A cross-sectional study in rural adolescents in South Africa

Background and objectives The aim of the current study was to establish the relative prevalences of Female Genital Schistosomiasis (FGS) and sexually transmitted infections (STIs). We hypothesised that due to the use of syndromic management for STIs it is possible that FGS is being misdiagnosed and mismanaged as an STI. We therefore wanted to examine the relationship between FGS and the individual STIs in schistosomiasis endemic areas. Methods Between 2011 and 2013, a cross-sectional study was performed in 32 randomly selected secondary schools in rural KwaZulu-Natal, South Africa, where each school had at least 300 pupils. In a research clinic, FGS diagnosis, STI testing, and face-to-face interviews were performed in sexually active, young women aged 16 – 22 years. Results FGS was the second most prevalent current genital infection (23%). There were significantly more women who had presented FGS among those who had detectable urinary schistosomiasis (35%), compared to those without (19%, p< 0.001). In the FGS positive group 35% were positive for HPV infection, compared to 24 % in the FGS negative group (p=0.010). In the FGS positive group 37% were sero-positive for HSV infection, compared to 30% in the FGS negative group (p=0.079). There were significantly fewer chlamydia infections amongst women with FGS (20%, p=0.018) compared with those who did not have FGS (28%). Conclusions FGS was the second most common genital infection after HSV but the two were not significantly associated. HPV infection was significantly associated with FGS. Surprisingly Chlamydia infection were negatively associated with FGS. The results show the importance of the inclusion of FGS in the management protocols for genital infections in areas endemic for urinary schistosomiasis, and highlight the importance for more research on suitable differential diagnostic tools and disease management. Key messages box ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial - ### Funding Statement We are grateful for funding for research leading to these results from the South-Eastern Regional Health Authority, Norway (2012032, 2014065), European Research Council under the European Union's Seventh Framework Programme, ERC Grant (PIRSES-GA-2010-269245), University of Copenhagen with the support from the Bill and Melinda Gates Foundation (OPPGH5344), Norwegian Research Council (213702/H10), and Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital. ### Author Declarations All relevant ethical guidelines have been followed and any necessary IRB and/or ethics committee approvals have been obtained. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes Any clinical trials involved have been registered with an ICMJE-approved registry such as ClinicalTrials.gov and the trial ID is included in the manuscript. Yes I have followed all appropriate research reporting guidelines and uploaded the relevant Equator, ICMJE or other checklist(s) as supplementary files, if applicable. Yes Data will be available, however it is still undergoing publication and facts are being used by other authors.