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The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

  • Hanne M. Norseth,

    Affiliations Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway, University of Oslo, Oslo, Norway

  • Patricia D. Ndhlovu,

    Affiliation Imperial College London, London, United Kingdom

  • Elisabeth Kleppa,

    Affiliations Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway, University of Oslo, Oslo, Norway

  • Bodo S. Randrianasolo,

    Affiliation Institut Pasteur de Madagascar, Antananarivo, Madagascar

  • Peter M. Jourdan,

    Affiliations Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway, University of Oslo, Oslo, Norway

  • Borghild Roald,

    Affiliation Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway

  • Sigve D. Holmen,

    Affiliations Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway, University of Oslo, Oslo, Norway

  • Svein G. Gundersen,

    Affiliations Research Department, Sorlandet Hospital HF, Kristiansand, Norway, Department for Global Development and Planning, Institute for Development Studies, University of Agder, Kristiansand, Norway

  • Jayanthilall Bagratee,

    Affiliation Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

  • Mathias Onsrud,

    Affiliation Department of Gynaecology, Oslo University Hospital Ullevaal, Oslo, Norway

  • Eyrun F. Kjetland

    e.f.kjetland@medisin.uio.no

    Affiliations Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital Ullevaal, Oslo, Norway, Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

  • Hanne M. Norseth, 
  • Patricia D. Ndhlovu, 
  • Elisabeth Kleppa, 
  • Bodo S. Randrianasolo, 
  • Peter M. Jourdan, 
  • Borghild Roald, 
  • Sigve D. Holmen, 
  • Svein G. Gundersen, 
  • Jayanthilall Bagratee, 
  • Mathias Onsrud
PLOS
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Abstract

Background

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.

Methodology/Principal findings

Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.

Significance

This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Author Summary

Female genital schistosomiasis commonly remains undiagnosed due to its unacknowledged clinical manifestations. Millions of women in endemic areas are infected, and many suffer from abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies, and an increased susceptibility to HIV. Sandy patches and rubbery papules identified by visual inspection may serve as indicators for the diagnosis of genital schistosomiasis. However, text books do not contain this information and it is not taught in medical school or to nurses serving these patients in endemic areas. The aim of this Atlas is to present the photocolposcopic manifestations of schistosomiasis in the lower female genital tract. Photocolposcopic images were captured from women between 15 and 49 years of age, between 1994 and 2012 in four different sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. This is the first atlas to present the clinical manifestations of schistosomiasis. Two types of sandy patches, abnormal blood vessels and rubbery papules are shown, as well as differential diagnoses. PloS NTDs makes it possible for all to access this information.