Researchers urge expanded testing for neglected female genital schistosomiasis

New research from Liverpool School of Tropical Medicine (LSTM) has highlighted the need to test millions of women and girls for female genital schistosomiasis (FGS), a neglected disease that can increase the risk of chronic illness, HIV and cervical cancer.

In a new paper published in The Lancet Microbe, researchers from LSTM, the Malawi-Liverpool-Wellcome Programme (MLW), and the London School of Hygiene & Tropical Medicine (LSHTM) are calling for FGS to be urgently integrated into sexual and reproductive health services to improve diagnosis and treatment.

FGS is caused by infection with the parasitic worm Schistosoma haematobium, transmitted through contact with infested freshwater. Parasite eggs become trapped in reproductive tissues, causing inflammation, lesions, and scarring. The disease affects at least 40 million women globally, primarily in sub-Saharan Africa, yet remains largely absent from reproductive healthcare services.

The study examined how FGS interacts with other gynaecological infections and found evidence that chronic inflammation and tissue damage caused by the disease may increase vulnerability to infections including HIV and human papillomavirus (HPV), the leading cause of cervical cancer.

The researchers argue that integrating FGS screening into existing HIV, cervical cancer and sexual health programmes could improve diagnosis and care for millions of women. Proposed approaches include combined HPV and FGS testing from a single genital sample, improved healthcare worker training, and the use of new molecular and AI-supported diagnostic tools.

Female genital schistosomiasis remains one of the most neglected gynecological conditions affecting women and girls in Africa. Despite the scale of the problem, it is still routinely overlooked within both neglected tropical disease programs and wider sexual and reproductive healthcare services."

Professor Amaya Bustinduy, Professor of Global Pediatric and Adolescent Infectious Diseases at LSHTM and senior author on the paper

Professor Russell Stothard, Professor of Medical Parasitology at LSTM and co-author of the paper, said: "This paper highlights the urgent need to move beyond isolated disease-specific approaches and towards integrated care that recognizes the overlap between FGS, HIV, HPV and other reproductive health conditions."

The paper draws on findings from the Hybridisation in Urogenital Schistosomiasis (HUGS) study in Malawi, which identified high levels of co-infection between FGS and other genital infections.

The study also highlights the emerging role of zoonotic and hybrid schistosome species, including parasites usually associated with livestock, which have now been detected in genital samples from women with FGS. Researchers say these findings raise important questions about diagnosis, treatment effectiveness and disease control.

Professor Stothard added: "The emergence of zoonotic and hybrid schistosome species also reinforces the importance of One Health approaches that consider human, animal and environmental health together."

The authors warn that fragmented, disease-specific programmes are failing women living in endemic areas and say continued neglect of FGS risks undermining wider global health goals.