clove and Genital-Diseases--Female

In this paper we summarise the parasitological, clinical and epidemiological characteristics of female genital schistosomiasis (FGS), a frequent manifestation of the infection with Schistosoma haematobium. Means to diagnose and treat lesions in the lower and upper genital tract are discussed. Based on clinical findings and available pathophysiological as well as immunological data it is conceivable that FGS of the cervix and vagina not only facilitates the infection with agents of sexually transmitted diseases, but presumably also alters the natural history of such infections. Two infectious agents are of particular concern: the Human Immunodeficiency Virus and the oncogenic Human Papilloma Viruses. Possible interactions and their consequences are discussed and research areas which should be addressed are outlined.

Topics: Africa; Animals; Female; Genital Diseases, Female; Genitalia, Female; HIV; HIV Infections; Humans; Madagascar; Papillomaviridae; Papillomavirus Infections; Prevalence; Risk Factors; Schistosoma haematobium; Schistosomiasis haematobia; Tumor Virus Infections; Uterine Cervical Neoplasms

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women.. Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes.. This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Topics: Adolescent; Adult; Africa, Southern; Animals; Colposcopy; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Madagascar; Middle Aged; Schistosoma haematobium; Schistosomiasis haematobia; Sexually Transmitted Diseases; Vagina; Young Adult

In Madagascar, as in other places in the world, infertility is associated with social stigmatism and an underlaying long-term risk for separation of the couple. A 12 months prospective study was carried out in 1999 in the Department of Gynecology, Obstetrics and Reproductive Health at the University Hospital in Mahajanga in order to collect data related to possible causes of infertility. For the women, serologic tests for Treponema pallidum (syphilis) and Chlamydia trachomatis were performed. And, in addition to sonography and hysterosalpingography, cervico-vaginal smears were obtained as part of the pelvic examination. A semen sample was obtained from each male partner. Of the 37 couples enrolled in the study 35 were classified as primary infertile (n = 9) or secondary infertile (n = 28). The mean age of the women and the men was 30.7 years (ranged 20 to 41 years) and 34.3 years (ranged 24 to 46 years), respectively. Various potential causes of infertility among the women were observed, such as hormonal disturbance (76%), tubal occlusion (76%), genital infection (70%). The figures indicate that there seems to coexist the possibility of multiply causes of infertility. Of 37 semen samples 24 (65%) were found with abnormalities, predominantly of oligospermia type. In 21 couples a possibly cause of infertility was observed in both partners.

Topics: Adult; Age Distribution; Female; Genital Diseases, Female; Hospitals, University; Humans; Hysterosalpingography; Infertility; Madagascar; Male; Middle Aged; Oligospermia; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Prospective Studies; Risk Factors; Sperm Count; Treatment Outcome; Vaginal Smears

To assess the morbidity of S. haematobium infection in women of reproductive age (15-49 years) in the western part of Madagascar, the village of Betalatala with a prevalence of urinary schistosomiasis in women of 75.6% (95% confidence limit 69.3 to 81.9%) was compared with a neighbouring village with similar socio-economic characteristics and a prevalence of 5.0% (95% confidence limit 0 to 11.75%). The women were questioned in Malagasy about obstetrical history and urogynecological symptoms. They were examined gynaecologically, parasitologically and by ultrasonography. Important STDs were excluded by appropriate diagnostics. In Betalatala significantly more women reported a history of spontaneous abortion (P < 0.01), complaints of irregular menstruation (P < 0.001), pelvic pain (<0.05), vaginal discharge (P < 0.0001), dysuria (P < 0.05) and haematuria (P < 0.01) than in the control village. Biopsies were obtained from the cervix of 36 women with macroscopical lesions, and in 12 cases S. haematobium eggs were found by histological sectioning (33.3%). In the control village no eggs were detected in the histological sections of biopsies taken from 14 women. (P < 0.05). Infections with Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis and Treponema pallidum were found in similar frequencies in both villages. In 9.8% of the women in Betalatala abnormalities of the upper reproductive tract were revealed by ultrasonography versus none in the women from the control village (P < 0.05). Echographic abnormalities of the urinary tract were present in 24% and 3% of the women in the study village and in the control village, respectively (P < 0.0001). These findings were accompanied by an elevated frequency of haematuria (55% versus 20%) and proteinuria (70.4% versus 25%) in the study population (P < 0.0001). Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract, but also frequently in the lower and upper reproductive tract.

Topics: Abortion, Spontaneous; Adolescent; Adult; Female; Genital Diseases, Female; Humans; Madagascar; Menstruation Disturbances; Middle Aged; Pregnancy; Prevalence; Rural Population; Schistosomiasis haematobia; Social Class; Surveys and Questionnaires; Ultrasonography