The Journal of infectious diseases · 2026
Association Between Female Genital Schistosomiasis and High-Risk Human Papillomavirus Among Women of Reproductive Age in Zambia: The Schista Study.
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Lamberti Olimpia, Ndubani Rhoda, Fitzpatrick Jennifer, Webb Emily, Kasese Nkatya, Nyondo Beatrice, Kosloff Barry, Cheeba Maina, Mayaud Philippe, Lemin Morgan E, Hoekstra Pytsje T, Van Dam Govert, Corstjens Paul, Van Lieshout Lisette, Webster Bonnie, Ayles Helen, Hansingo Isaiah, Randrianasolo Bodo, Kuwemba Dingase, Vwalika Bellington, Kamfwa Paul, Shanaube Kwame, Kelly Helen, Bustinduy Amaya L
Аннотация
BACKGROUND: Female genital schistosomiasis (FGS), a gynecological disease caused by Schistosoma haematobium egg deposition in the female genital tract, is prevalent in sub-Saharan Africa, the region with the highest cervical cancer burden globally. Persistent high-risk human papillomavirus (HR-HPV) infection is necessary for cervical cancer development. We determined the association between FGS and HR-HPV genotypes in Zambian women.
METHODS: Sexually active women aged 15-50 years, not menstruating or pregnant, were recruited at home and provided 2 cervicovaginal self-swabs, urine sample, and HIV and Trichomonas vaginalis self-tests, and completed a questionnaire. In clinic, midwives collected cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODT). Swabs were analyzed for 14 HR-HPV types (GeneXpert) and Schistosoma DNA (ITS-2 real-time polymerase chain reaction [qPCR]); urine was analyzed for Schistosoma ova by microscopy and circulating anodic antigen. Visual FGS was defined as colposcopic identification of specific genital lesions, and molecular FGS as Schistosoma-positive cervicovaginal qPCR.
RESULTS: Among 2532 women (median age, 28 [interquartile range, 22-36] years) recruited at home, 1694 (67%) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV was 35.2% (595/1691), 6.5% (165/2532), and 28.7% (690/2401), respectively. Molecular FGS was weakly associated with all HR-HPV (adjusted odds ratio [aOR], 1.3 [95% confidence interval {CI}, .9-1.9]). Women with molecular FGS were more likely to test positive for HR-HPV types 16/18/45 (aOR, 1.7 [95% CI, 1.0-2.8]). No association was observed between visual FGS and HR-HPV infection (95% CI, .7-1.1).
CONCLUSIONS: This is the first study to jointly screen for FGS and HR-HPV in Zambia, reporting an association between oncogenic HR-HPV types and molecular FGS.
METHODS: Sexually active women aged 15-50 years, not menstruating or pregnant, were recruited at home and provided 2 cervicovaginal self-swabs, urine sample, and HIV and Trichomonas vaginalis self-tests, and completed a questionnaire. In clinic, midwives collected cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODT). Swabs were analyzed for 14 HR-HPV types (GeneXpert) and Schistosoma DNA (ITS-2 real-time polymerase chain reaction [qPCR]); urine was analyzed for Schistosoma ova by microscopy and circulating anodic antigen. Visual FGS was defined as colposcopic identification of specific genital lesions, and molecular FGS as Schistosoma-positive cervicovaginal qPCR.
RESULTS: Among 2532 women (median age, 28 [interquartile range, 22-36] years) recruited at home, 1694 (67%) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV was 35.2% (595/1691), 6.5% (165/2532), and 28.7% (690/2401), respectively. Molecular FGS was weakly associated with all HR-HPV (adjusted odds ratio [aOR], 1.3 [95% confidence interval {CI}, .9-1.9]). Women with molecular FGS were more likely to test positive for HR-HPV types 16/18/45 (aOR, 1.7 [95% CI, 1.0-2.8]). No association was observed between visual FGS and HR-HPV infection (95% CI, .7-1.1).
CONCLUSIONS: This is the first study to jointly screen for FGS and HR-HPV in Zambia, reporting an association between oncogenic HR-HPV types and molecular FGS.