FEMALE GENITAL SCHISTOSOMIASIS DUE TO SCHISTOSOMA-HAEMATOBIUM - CLINICAL AND PARASITOLOGICAL FINDINGS IN WOMEN IN RURAL MALAWI

A total of 51 women with urinary schistosomiasis haematobium were exam ined in order to identify diagnostic indicators for female genital sch istosomiasis (FGS). Patients were selected at random from the outpatie nt department of the Mangochi District Hospital, Malawi. The medical h istories were recorded according to a pre-designed questionnaire and t he women were subjected to a thorough gynaecological examination inclu ding colposcopy and photographic documentation of lesions. Microscopy of genital biopsies revealed that 33 of the 51 women had S. haematobiu m ova in cervix, vagina and/or vulva in addition to the presence of ov a in urine. The most sensitive diagnostic procedure was bedside micros copic examination of a wet cervix biopsy crushed between two glass sli des, which revealed 25 of the 33 genital infections. There was a signi ficant correlation between the size of genital lesions and the number of ova counted per mm(2) of crushed tissue. Women with FGS had signifi cantly more tumours in the vulva than women with schistosomiasis limit ed to the urinary tract. Most of the observed genital pathology could easily be identified by the naked eye, but colposcopic examination yie lded valuable additional information Eke the demonstration of neovascu larisation around cervical sandy patches. Few of the symptoms previous ly regarded as indicators for FGS could be linked to the presence of s chistosome ova in genital tissue. Husbands of Infertile women with FGS had children with other women significantly more often than husbands of women who only had urinary schistosomiasis. This, together with the finding that the majority of the divorced women had FGS, indicates th at the manifestation of this disease may have implications for the mar ital and sexual life of the affected women.