Association of Urogenital Symptoms with History of Water Contact in Young Women in Areas Endemic for S. haematobium. A Cross-Sectional Study in Rural South Africa

Hashini Nilushika Galappaththi-Arachchige, Ingrid Elise Amlie Hegertun, Sigve Holmen, Erik Qvigstad, Elisabeth Kleppa, Motshedisi Sebitloane, Patricia Doris Ndhlovu, Birgitte Jyding Vennervald, Svein Gunnar Gundersen, Myra Taylor, Eyrun Floerecke Kjetland, Hashini Nilushika Galappaththi-Arachchige, Ingrid Elise Amlie Hegertun, Sigve Holmen, Erik Qvigstad, Elisabeth Kleppa, Motshedisi Sebitloane, Patricia Doris Ndhlovu, Birgitte Jyding Vennervald, Svein Gunnar Gundersen, Myra Taylor, Eyrun Floerecke Kjetland

Abstract

Female genital schistosomiasis is a neglected tropical disease caused by Schistosoma haematobium. Infected females may suffer from symptoms mimicking sexually transmitted infections. We explored if self-reported history of unsafe water contact could be used as a simple predictor of genital schistosomiasis. In a cross-sectional study in rural South Africa, 883 sexually active women aged 16-22 years were included. Questions were asked about urogenital symptoms and water contact history. Urine samples were tested for S. haematobium ova. A score based on self-reported water contact was calculated and the association with symptoms was explored while adjusting for other genital infections using multivariable logistic regression analyses. S. haematobium ova were detected in the urine of 30.5% of subjects. Having ova in the urine was associated with the water contact score (p < 0.001). Symptoms that were associated with water contact included burning sensation in the genitals (p = 0.005), spot bleeding (p = 0.012), abnormal discharge smell (p = 0.018), bloody discharge (p = 0.020), genital ulcer (p = 0.038), red urine (p < 0.001), stress incontinence (p = 0.001) and lower abdominal pain (p = 0.028). In S. haematobium endemic areas, self-reported water contact was strongly associated with urogenital symptoms. In low-resource settings, a simple history including risk of water contact behaviour can serve as an indicator of urogenital schistosomiasis.

Keywords: Schistosoma haematobium; female genital schistosomiasis; sexually transmitted infections; urogenital symptoms; water contact.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Prevalence of S. haematobium ova in the urine and total number of years of unsafe water contact. Error bars: 95% confidence interval (CI).
Figure 2
Figure 2
Flowchart of the participants and sample selection procedure. CVL: cervico-vaginal lavage.
Figure 3
Figure 3
Frequency whereby the participants engaged in different water contact activities in their lifetime, n = 883.
Figure 4
Figure 4
Distribution of the calculated water contact score. The score was calculated as the multiplicative product of frequency of water contact, a risk coefficient assigned to the each of seven common water contact activities and a risk coefficient assigned to the number of years exposed to unsafe water. Mean = 4.94, standard deviation = 2.424, n = 883.
Figure 5
Figure 5
Urogenital symptoms (lifetime occurrence).
Figure 6
Figure 6
The prevalence of S. haematobium ova in the urine increases with increasing water contact score. Error bars: 95% CI.

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