Female Genital Schistosomiasis, a Neglected Differential of Cervical Precancerous and Cancerous Lesion: a Wakeup Call for on-Job Training for Healthcare Workers in Endemic Areas

Case Report

Austin J Clin Case Rep. 2022; 9(1): 1241.

Female Genital Schistosomiasis, a Neglected Differential of Cervical Precancerous and Cancerous Lesion: a Wakeup Call for on-Job Training for Healthcare Workers in Endemic Areas

Kaizilege GK¹, Kiritta R¹*, Chuma C¹, Ndaboine E¹, Ottoman O², Elias E², Zinga MM³ and Mazigo HD³

¹Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Healthy and Allied Sciences, Mwanza, Tanzania

²Department of Pathology, Weill Bugando School of Medicine, Catholic University of Healthy and Allied Sciences, Mwanza, Tanzania

³Department of Parasitology, Weill Bugando School of Medicine, Catholic University of Healthy and Allied Sciences, Mwanza, Tanzania

*Corresponding author: Richard Kiritta, Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Healthy and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania

Received: February 01, 2022; Accepted: February 25, 2022; Published: March 04, 2022

Abstract

Background: Female genital schistosomiasis is a gynecological disease caused by Schistosoma haematobium. The uterine cervix appears to be the most affected area with most cases found in sub-Saharan Africa. Though both males and females can be affected, the consequences of genital schistosomiasis are more pronounced in females with reported increased risk of HIV transmission and malignancy of female genitalia. Female genital schistosomiasis of the cervix shares similarities in presentation to those of cervical intraepithelial neoplasm and sexual transmitted infections, making diagnosis challenging and requiring high degree of suspicion.

Case Presentation: We report three cases of African women referred to our facility with a presumptive diagnosis of cervical precancerous/cancerous lesion. Initial workout at our facility was in keeping with early stages of cervical precancerous/cancerous lesion that necessitated excision as per standardized protocol. Histopathological analysis of excised tissue revealed schistosomiasis of the cervix.

Conclusion: Schistosomiasis of the cervix shares similarities with cervical precancerous/cancerous lesions and should be suspected in women presenting with chronic inflammatory conditions of the cervix or features suggestive of precancerous/cancerous cervical lesions. Screening for female genital schistosomiasis should be incorporated in an already existing screening protocol for cervical cancer and sexual transmitted diseases.

Keywords: Genital schistosomiasis; Cervical cancer; Schistosoma; Vaginal discharge

Introduction

Schistosomiasis is an acute and chronic neglected tropical disease caused by parasitic flatworms belonging to the genus Schistosoma. In the year 2019, it was estimated that approximately 240 million people were affected with the disease globally [1] and around 659 million people were vulnerable to contract the disease. It is highly prevalent in tropical and subtropical regions with 95% of the disease burden occur in sub-Saharan Africa [2]. Contact with infested water bodies during daily activities such agriculture, fishing, swimming and washing clothes/utensil predisposes individuals to Schistosoma infection. Inadequate hygiene and contact with infected water make children especially vulnerable to infection [1].

Approximately 56 million African women and young girls are infected with schistosomiasis [3]. The disease especially caused by S. haematobium does not only affect the urinary tract but also invade the female reproductive tract leading into detrimental effects to the organs, this is referred to as female genital schistosomiasis [2,4]. Despite the fact that schistosomiasis can invade the entire female reproductive tract, the uterine cervix is the most common affected site [5,6].

Clinical presentation of cervical schistosomiasis shares similarities to that of precancerous/cancerous cervical lesions and sexual transmitted infections, making the diagnosis challenging in the absence of a high degree of suspicion for this neglected tropical disease. Three cases of FGS with prior presumptive diagnosis of cervical precancerous/cancerous lesions are hereby discussed.

Case Presentation

Case 1

37 years old female referred from a peripheral regional hospital suspected to have cervical cancer, presented at our facility with longstanding lower abdominal pain, abnormal vaginal bleeding mostly post-coital and copious vaginal discharge. She is Para 9, known patient with HIV on ART for 11 years now. She suffered from schistosomiasis (urinating blood) at the age 8 years in 1992 which resolved after using herbal medication. Her review of other system, obstetrics and gynecology history was uneventful.

Gynecological examination for cervical cancer screening was done and revealed normal vulva and vaginal walls. There was non-foul smelling copious vaginal discharge, cervix had a normal morphology but hyperemic on the whole ectocervix. Visual inspection by application of acetic acid produced aceto-white reaction on the cervix and an impression of precancerous cervical lesion was reached which necessitated loop electrosurgical excision procedure (LEEP) as an option of treating precancerous cervical lesion. The excised tissue samples were taken for histopathological analysis which revealed multiple eggs of Schistosoma haematobium associated with mixed inflammatory cells, mainly eosinophils as shown in Figure 1 below.