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Female Genital Schistosomiasis in Malawi

49:57 recording · AUTO · 3 speakers

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Brief overview

Female genital schistosomiasis is massively under-diagnosed because urine testing misses it; colposcopy finds it.

  1. Urine testing alone misses most casesFGS can be present with no urinary schistosomiasis, so urine and stool microscopy misses the majority of affected women.
  2. Colposcopy was by far the most sensitive methodVisual examination found FGS in 78.6% of women in Nsanje and 69% in Mangochi at baseline, well above the other techniques.
  3. It is not a sexually transmitted infectionInfection comes from cercariae in fresh water, so even young girls who are not sexually active are affected, yet the stigma delays care.
Executive Summary AI
  • On TWIP 271, recorded december 12, 2025, Vincent Racaniello, Daniel Griffin and Christina Naula discuss a paper by Dingase Kumwenda and Jenalisa Musaya on female genital schistosomiasis and associated genital infections in southern Malawi.2:39
  • Christina Naula recaps the Schistosoma haematobium life cycle: cercariae penetrate skin on leaving fresh water, paired adults settle in the bladder venous plexus, and the female lays about 3,000 eggs a day, only half of which are excreted.4:31
  • The retained eggs lodge in the bladder, ureters and genital tract, causing inflammation, fibrosis, sandy patches and nodules, with symptoms including bloody discharge, pain during intercourse, infertility and raised risk of HIV and HPV.11:54
  • Daniel Griffin sets the scale at an estimated 56 million women, stresses that FGS is not sexually transmitted and can occur with no eggs in the urine at all, and notes some cases here are caused by the zoonotic cattle parasite Schistosoma mattheei.19:47
  • Table three shows visual diagnosis by colposcopy detecting FGS in 78.6% of women in Nsanje and 69% in Mangochi at baseline, far above urine microscopy, so the authors advocate multiple diagnostic techniques, and the hosts argue mass drug administration aimed only at school-age children leaves these women untreated.31:34
Key Quote
“They find each other delightful.”
— Daniel Griffin9:00
Key Quote
“we also really should mention this is most definitely not a sexually transmitted infection”
— Christina Naula14:52
Key Quote
“And so this really is a disease that is debilitating.”
— Daniel Griffin19:08