Abstract:
Background: Female genital schistosomiasis (FGS) is a neglected inflammatory condition caused by the deposition of Schistosoma haematobium eggs in the female genital tract, affecting an estimated 50 million women globally. In endemic regions such as Nigeria, FGS remains underdiagnosed and frequently confused with sexually transmitted infections (STIs), contributing to reproductive health morbidity. This study investigated the burden of FGS and its co-occurrence with Trichomonas vaginalis using complementary diagnostic approaches in a schistosomiasis-endemic population.
Methods: This is a cross-sectional study carried out between 2024 and 2025 in schistosomiasis-endemic communities in the Atiba Local Government Area, Oyo State, Nigeria. Clinical symptoms were documented, and women of reproductive age underwent gynaecological examination. Urine samples were analysed for urogenital schistosomiasis (UGS) using microscopy. FGS was assessed using both visual colposcopy and quantitative polymerase chain reaction (qPCR) targeting Schistosoma DNA in cervicovaginal samples. Trichomonas vaginalis infection was detected by direct wet mount microscopy and qPCR. All participants received praziquantel (40 mg/kg).
Results: Awareness of FGS was extremely low (4%), and no participants reported adequate knowledge. The UGS prevalence was 68.0% by microscopy. FGS prevalence was 28.0% by colposcopy and 44.0% by qPCR, indicating that infection was under-detected by visual examination alone. WHO-defined FGS lesions, such as grainy sandy patches, homogenous yellow sandy patches, and abnormal blood vessels, were identified using colposcopy. Vaginal itching was significantly associated with colposcopyconfirmed FGS and emerged as a key clinical predictor.
Age-related differences were observed; molecular FGS was highest among women aged 38–57 years (70.0%), while no visual lesions were detected in women aged 18–27 years. Co-infection with FGS and T. vaginalis was higher by qPCR (32.0%) than by microscopy (8.0%), demonstrating the enhanced sensitivity of molecular diagnostics in detecting hidden co-morbidity.
Conclusions: FGS is highly prevalent in Atiba LGA, Oyo State, Nigeria, with molecular diagnostics revealing a hidden greater burden than colposcopy alone. The divergence between visual and molecular detection across age groups reflects different stages of disease progression, with colposcopy identifying established lesions and qPCR detecting early or subclinical infection. Real-time PCR was confirmed to be a valuable tool for detecting Schistosoma DNA in genital samples, thereby indicating FGS in schistosomiasis-endemic areas. The high burden of UGS and frequent co-detection of T. vaginalis are indications of reproductive health morbidity in this population. Integrating molecular diagnostics with colposcopy could substantially improve detection, surveillance, and control strategies for FGS in endemic populations.
Keywords: female genital schistosomiasis; Schistosoma haematobium; qPCR; colposcopy; urogenital schistosomiasis; Trichomonas vaginalis; neglected tropical diseases, Nigeria
Biography:
Christianah Oki is a PhD student in Parasitology at the Department of Zoology, University of Ibadan, Nigeria. Her research focuses on the epidemiological investigation and molecular characterisation of urogenital schistosomiasis and female genital schistosomiasis in endemic Nigerian communities. She holds an M.Sc in Zoology (Parasitology) from the University of Ibadan and a B.Sc in Biology from Ekiti State University. She has also contributed to One Health initiatives through her work with the One Health and Development Initiative, where she engaged in projects on global health, antimicrobial resistance, and zoonotic diseases in Nigeria.
