Female genital schistosomiasis (FGS) is a neglected manifestation of Schistosoma haematobium infection, affecting an estimated 56 million women in sub-Saharan Africa. It is characterized by lesions in the genital tract, leading to symptoms like pain, infertility and an increased risk of HIV transmission. Despite its prevalence, FGS remains underdiagnosed and underreported due to limited awareness and diagnostic capabilities. Current knowledge emphasizes the need for integrated approaches combining diagnosis, treatment with praziquantel and education. There are ongoing efforts to integrate FGS services into women’s sexual and reproductive services, yet to date many African countries lack programmatic guidance to achieve this. More comprehensive integration and mainstreaming of FGS prevention, control and treatment across various sectors is needed to ensure intersectoral collaboration and financing of programmes. This review examines the various intervention tools currently available to achieve FGS integration in health systems. These include water, sanitation and hygiene improvements, environmental management, health education and inclusion of preschool-aged children in national schistosomiasis control programmes. Highlighted are also the required diagnostic and therapeutic tools, preventive interventions, effective policy and sustainable funding, all integral to achieving comprehensive FGS mainstreaming.

Female genital schistosomiasis (FGS) is a chronically disabling gynaecological condition, impacting up to 56 million women and girls, mostly in sub-Saharan Africa. In lieu of a gold standard laboratory test, it is possible to diagnose FGS visually. Visual diagnosis is performed through inspection of the cervix and surrounding tissue to identify signs of Schistosoma egg deposition, associated inflammation and granuloma formation. The change related to egg deposition can be very subtle and heterogeneous and is often seen in the context of other altered cervical morphology. Visual diagnostics for FGS are therefore currently highly subjective and lack specificity, with low consistency of grading between trained expert reviewers. Computer vision, driven by artificial intelligence, is an enticing prospect to overcome these issues due to the potential to accurately detect and classify the subtle changes and patterns that are indiscernible to human graders. Computer vision also offers the opportunity to support resource-constrained regions with few staff trained on visual diagnostics. However, several challenges stand in the way of progressing and successfully implementing computer vision tools for FGS. These challenges are particularly related to the variation in the appearance of the cervix (with or without disease) and FGS lesions, as well as the difficulty with accurately labelling cervical images. Exploring alternative annotation methods and model architectures is likely to improve the performance of FGS computer vision tools. This paper will explore the challenges of FGS computer vision and provide suggestions on how to overcome these barriers to enhance visual diagnostics for FGS.

We analysed the early results of a screening and management protocol of imported female genital schistosomiasis (FGS) among migrant women from endemic countries. In total we screened 136 women, from which 39 had suspicion of FGS (serology-positive test and clinical signs and symptoms compatible). Median age was of 42.7 years [interquartile range (IQR 35–45)], median time living in the Europe (EU) was of 14 years (IQR 10–19) and all of them were coming from a West African country, mainly Senegal (17 out of 39; 43.6%). All of them had 1 or more clinical genitourinary findings [median 5 (IQR 2–6)], being the most prevalent pelvic pain, vaginal discharge and menstrual disorders. According to the protocol, colposcopy and cytology examination was performed in 11 participants, from whom 7 had findings compatible with FGS and 5 had low-grade cervical dysplasia with human papillomavirus (HPV)-negative results. After specific treatment with praziquantel (PZQ), we observed a high rate of resolution of clinical signs and symptoms, serology clearance at the 12th month of follow-up. Colposcopy lesions of 3 women assessed at the end of follow-up were fully resolved. Our findings and previous research support the implementation of management protocols of FGS in non-endemic countries, in spite of the knowledge gaps that still remain. Clinical trials need further assessment to determine the efficacy of PZQ, new diagnostic tools and the interaction between FGS, HPV and cervical cancer.

The Nigerian national control programme (NCP) for schistosomiasis does not have a specific action plan for female genital schistosomiasis (FGS), mainly due to gaps in epidemiological and clinical surveillance. To address this, we conducted a pilot investigation for FGS in girls (>5 and ≤15 years) and adult women (≥16 years) in four rural communities near Abeokuta, Ogun State. Urine samples were collected from 317 participants [children (n = 187), adults (n = 130)] and examined for ova of S chistosoma haematobium by microscopy. A total of 149 participants (47·0%) had egg-patent urogenital schistosomiasis [children (64·7%), adults (21·6%)], reported blood in urine was common (44·5%) as well as sign-post symptoms of FGS. To verify FGS directly, 20 adult women each underwent a gynaecological investigation by colposcopy with observed lesions classified according to the WHO FGS pocket atlas. Fourteen (70·0%) women presented with FGS as grainy-sandy patches (n = 10), homogenous yellow sandy patches (n = 6), nabothian cysts and rubbery papules (n = 1). Our study confirms FGS in Ogun State and calls for further appraisals of this disease in other areas where urogenital schistosomiasis is endemic. The Nigerian NCP should be encouraged to develop an appropriate response to FGS not only to detect it, but also to prevent it.