WINGS-4-FGS

The challenge

Schistosomiasis, infection with parasitic flatworms, is one of the most common neglected tropical diseases. Schistosome infections can cause a range of symptoms, including effects on the urogenital system, as seen with Schistosoma haematobium. As well as short-term symptoms such as ulcers, female genital schistosomiasis (FGS) can have longer-term impacts on sexual and reproductive health and may increase the risk of HIV infection and cervical cancer. 

Although it affects around 50 million women globally, most of them in sub-Saharan Africa, awareness of FGS is low. It is often mistaken for a sexually transmitted infection, leading to mistreatment, stigmatisation and a reluctance to seek treatment. 

If identified, adult worm infections can be treated with praziquantel. However, genital symptoms are caused by an inflammatory response to granulomas, as schistosome eggs become trapped in the urogenital system and encased in a fibrous casing; these are not resolved by treatment with praziquantel.

The project

The WINGS-4-FGS project is carrying out a coordinated set of activities to raise awareness of FGS, improve detection, enhance treatment, and integrate FGS care into wider sexual and reproductive health services.

• Awareness: Awareness-raising and training activities are being carried out among health workers and communities in Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Ghana and Malawi.
• Diagnosis: A two-step community-based screening strategy is being piloted: initial screening for schistosome infections using microscopy or a urinary test is followed by analysis of a self-collected genital swab to check for signs of FGS.
• Treatment: Alongside praziquantel, anti-inflammatory drugs may have additional benefit by alleviating genital symptoms. A clinical trial in Côte d’Ivoire, the DRC, Ghana and Malawi will test whether widely available steroids or non-steroidal anti-inflammatory drugs, when added to praziquantel treatment, help to resolve genital lesions.
• Service integration: The project will carry out studies to identify potential barriers and enablers of the integration of FGS detection and treatment into existing sexual and reproductive health services for women.

Impact

The WINGS-4-FGS project has the potential to improve multiple aspects of care of a condition that often goes unrecognised but can have a major impact on women’s quality of life. It will:

• Ensure more health workers are aware of the symptoms of FGS and how it should be treated.
• Determine whether community-based self-sampling is a more acceptable and feasible way to detect cases.
• Show whether safe and readily available anti-inflammatory drugs can alleviate the symptoms of FGS.
• Provide insights into how improved FGS care could be integrated into existing sexual and reproductive health services.

FGS is a neglected aspect of a neglected tropical disease. Ultimately, the WINGS-4-FGS project should ensure that more women gain access to appropriate treatment and care, reducing the impact the condition has on reproductive health and quality of life.