Clinical manifestations, diagnosis, HIV and effect of treatment on genital schistosomiasis in young women: VIBE-FGS- a school based study

Female Genital Bilharzia (Schistosomiasis) seems to be co-factor in HIV transmission. It causes breaches in the vaginal surfaces in the same manner as has been reported for sexually transmitted infections. Unexpectedly, and to our concern, we have found that standard treatment of adult women does not heal these damages. Female Genital Bilharzia remains unchanged even after several rounds of treatment. We hypothesise that early treatment will cure the morbidity and prevent HV transmission. A two- pronged study has taken place in KwaZulu-Natal, South Africa to study school girls and sexually active women who wish to do a gynaecological examination. We have found that symptoms are common in children and that treatment may decrease the number of HIV receptive cells in the genital tract.

Women who do not have access to safe water, such as the inhabitants in rural Africa may have genital lesions caused by the parasite Schistosoma haematobium (Bilharzia). There is increasing evidence that schistosomiasis is a co-factor in HIV-transmission, similar to the sexually transmitted diseases. In a recent study in Zimbabwe we found a 3-fold higher prevalence of HIV in women with genital schistosomiasis. It is aimed in the Millennium Development Goals to control schistosomiasis effectively by 2015, and mass treatment for this waterborne disease is a WHO recommended policy. It is known that treatment prevents and cures long-term urinary morbidity. Moreover mass treatment is feasible and has been implemented on a large scale in some African countries . However unexpectedly, in Zimbabwe in adult women, genital lesions were calcified and standard treatment was inefficient. We hypothesize that treatment in the young will cure genital lesions, contact bleeding and symptoms; and that such standard treatm ent can prevent HIV-transmission in young women. Substantiation of the link between HIV and schistosomiasis and the biological mechanisms behind it would provide a novel intervention point against HIV transmission through implementation of the recommended mass treatment. In KwaZulu-Natal we are doing a cross sectional study following high school girls as part of a larger cluster randomized clinical trial. The partners have worked on this largely neglected disease the last decades. The Norwegian group ha s researched issues such as control, prevention of morbidity, clinical manifestations and effect of treatment on an international level. Partners from 8 institutions in 6 countries form a strong international research network collaborating in this interve ntion study.