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SIMPLE CLINICAL MANIFESTATIONS OF GENITAL SCHISTOSOMA HAEMATOBIUM INFECTION IN RURAL ZIMBABWEAN WOMEN

Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal.

Received May 20, 2004. Accepted for publication June 21, 2004.

Acknowledgments: Technical, medical, or cultural assistance was provided by Dr. S. Charimari (Provincial Medical Director and Supervisor); the Mupfure community; the staff at Madziwa, Harare Central, and Mount Darwin Hospitals; the personnel from the Blair Research Laboratory; Drs. T. Magwali, T. Mhlanga, M. Chirara, B. Vennerwald, and I. Lyngstad-Vik; and Professors F. Jerve and L. Sandvik. We are indebted to the Medical Research Council of Zimbabwe; the staff at Mupfure Secondary School; headmistress V. Mugabe; and the following indispensable people: Sister J. Chikoore, the late Sister P. Dungare, Councillor C. Chadzimura, the village health workers, the environmental health technicians, and in particular N. Taremeredzwa, C. Mukahiwa, R. Manyaira, and T. Mushipe for prolonged hard work under very difficult circumstances.

Financial support: This study was supported by the Director’s Initiative Grant, United Nations Development Program/World Bank/ World Health Organization Special Program for Research and Training in Tropical Diseases, The Norwegian Research Council (NORAD), The Department for Infectious Diseases, Competence Centre for Imported and Tropical Diseases and Research Forum, Ullevaal University Hospital (Oslo, Norway), and the Danish Bilharziosis Laboratory.

Authors’ addresses: Eyrun Floerecke Kjetland, Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Ullevaal University Hospital, 0407 Oslo, Norway, Telephone: 47-97-00-85-79, Fax: 47-22-11-91-81, E-mail: e.f.kjetland{at}medisin.uio.no. Patricia D. Ndhlovu and Takafira Mduluza, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, E-mails: pndhlovu{at}rfc.ucl.ac.uk and mduluza{at}medic.uz.ac.zw. Exnevia Gomo, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe and Blair Research Institute, Harare, Zimbabwe, E-mail: exgomo{at}mweb.co.zw. Lovemore Gwanzura, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, E-mail: lgwanzura{at}healthnet.zw. Peter R. Mason, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe and Biomedical Research and Training Institute, Harare, Zimbabwe, E-mail: pmason{at}vet.uz.ac.zw. Edith Nyaradzai Kurewa and Nicholas Midzi, Biomedical Research and Training Institute, Harare, Zimbabwe, E-mails: enkurewa{at}hotmail.com and midzi{at}blair.co.zw. Henrik Friis, Department of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark, E-mail: h.friis{at}pubhealth.ku.dk. Svein Gunnar Gundersen Research Unit, Sorlandet Hospital/Department of Health and Sports, Agder University College, Kristiansand, Norway, E-mails: s.g.gundersen{at}medisin.uio.no and s.g.gundersen{at}vas.no.

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