Female genital schistosomiasis: pathological features and density infestation

Abstract

Objectives: To study the percentage distribution and Average Tissue Density (ATD) of schistosoma infestation in different parts of the Female Genital System (FGS).

Design: A retrospective explorative study of all surgical pathology cases examined from January to December of2000.

Setting: Public Health Laboratories, Parirenyatwa Hospital, Harare, Zimbabwe.

Subjects'. All archive slides cases positive for schistosoma ova were examined.

Intervention: To generate awareness of female genital schistosomiasis, often under diagnosed, despite causing dysmenorrhea, chronic pelvic pain, infertility, genital ulcer disease and mimicking cancer.

Main Outcome Measures: Female genital schistosomiasis is underdiagnosed as of all forty seven (47) cases found positive microscopically, the clinicians had not raised it in their differentials.

Results: Forty seven (47) cases of Schistosomiasis were found with an ATD of six (6) to thirty nine (39) schistosoma ova per 10 hpf. In the lower genital tract, the cervix accounted for thirty two (68%) cases. Interestingly fifteen (47%) of cases showed association with cervical dysplasia, invasive squamous cell carcinoma or human papilloma virus koliocytosis. Presentations in the lower genital tract were of ulceration, polyps or abnormal vaginal bleeding. Surprisingly of the total forty seven (47) cases three (3%) cases were in leiomyomata. Significantly tubal ectopic pregnancy was associated with 3 (50%) cases out of six (6) cases of fallopian tube.

Conclusion: Schistosomiasis needs more recognition as a cause of disease of the female genital tract. Its association with tubal ectopic pregnancies can be catastrophic. Further molecular studies towards its association with cervical cancer need to be done.