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

Kvinnelig genital schistosomiasis (Bilharzia) er en neglisjert tropesykdom forårsaket av parasitten Schistosoma haematobium. Den legger egg i genitalslimhinnene, og dette fører til lokal inflammasjon med kontaktblødning, skjøre blodkar og oppregulering av immunceller. Pasientene opplever en rekke symptomer som smerte, kløe, utflod og lukt. Videre er det funnet at kvinner med genital schistosomiasis har tre ganger mer HIV. Prosjektet drives av en forskningsgruppe med deltakere fra 8 institusjoner i 6 land. I en prospektiv studie på skolejenter og i en tverrsnittstudie på seksuelt aktive unge kvinner har vi evaluert kliniske funn, symptomer og celle-mottagelighet for HIV. Vi har funnet at selv barn har symptomer på genital schistosomiasis med illeluktende utflod, blodig utflod (før menstruasjonsalder) og de har brennende følelse i underlivet. Videre viser det seg at gjennomgått parasittbehandling fører til nedgang i antall HIV-mottagelige celler. Videre forskning trengs for å finne diagnostiske metoder som kan brukes i u-land, samt å avklare om parasittbehandling kan forebygge HIV.

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.