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Urogenital Schistosomiasis - An Overview

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Schistosoma haematobium drains the veins of the pelvic organs, bladder, uterus, and cervix. Read this article below to know more about it.

Written byDr. Kavya

Medically reviewed byDr. Samer Sameer Juma Ali Altawil

Published At October 17, 2022
Reviewed AtSeptember 11, 2024

Introduction:

Schistosomiasis infections are seen in most parts of the world, contributing to morbidity and mortality. It is common in African countries, and the disease with Schistosoma haematobium causes squamous cell carcinoma and urothelial carcinoma of the urinary bladder. It is also responsible for female genital schistosomiasis, which causes infertility, and the patient is prone to acquiring the human immunodeficiency virus (HIV). However, there is less evidence on the pathogenesis of the virus and how it causes cancer. Studies conducted have discussed the possible reasons. Therefore, treatment mainly focuses on a preventive form that involves preventive chemotherapy.

What Is the Mode of Transmission of Schistosoma Haematobium?

Infection occurs when the skin comes in contact with an infected water source and when the freshwater snails release larval forms of the parasite. Transmission occurs when an infected person contaminates a freshwater body through excreta or urine, which contains parasite eggs. These eggs hatch and penetrate the human body through the skin. The larvae develop inside the body to form adult schistosomes, the adult worms thrive in the blood vessels, and the females lay their eggs there. The parasite's life cycle continues by passing down a few eggs or worms through urine or feces. The trapped eggs create an immune reaction inside the body, leading to organ damage.

What Are the Symptoms of Urogenital Schistosomiasis?

The symptoms are caused by the body's immune reaction due to parasite eggs leading to inflammation, parenchymal tissue destruction, and granulomata. The typical symptom of urogenital schistosomiasis is hematuria (blood in urine) caused due to bladder damage by the worms. The worms may also be visible in the urine. Fibrosis (a condition with thickening or scarring of the tissues) and fibrotic nodules called sandy patches are seen in the bladder and ureter. Advanced cases lead to kidney damage. Women experience vaginal bleeding, pain during sexual intercourse, genital lesions, and nodules in the vulva. In men, there may be long-term irreversible consequences, including infertility. Pathological changes may be seen in the prostate, seminal vesicles, and other organs.

What Is the Diagnosis of Urogenital Schistosomiasis?

The diagnosis of urogenital schistosomiasis is as follows:

  • Stool and Urine Tests: The common investigation involves stool and urine tests, where they are examined for larvae or eggs of Schistosoma haematobium. The urine and stool samples are also examined for antibodies or antigens, which is a sign of active infection.

  • Filtering Technique: The standard diagnostic tests involve a filtering technique that uses nylon, polycarbonate, or paper filters. In addition, chemical reagent strips are used in children who are infected by Schistosoma haematobium, which helps in the detection of microscopic blood in their urine.

  • Serological and Immunological Tests: Serological and immunological tests may be used in low transmission or non-endemic areas to help with exposure, treatment, and follow-up.

What Is the Relationship Between Urogenital Schistosomiasis and Bladder Cancer?

The bladder undergoes morphological and molecular level changes when infected by Schistosoma haematobium. The females produce around three thousand eggs, and the remaining eggs cause lesions that lead to inflammation of the ureters and bladder. More than 50 percent of cases show hematuria, organ deformities like narrowing down of ureters, hydronephrosis (swelling of one or both kidneys due to blockage), urinary tract and renal infections, and renal failure. Out of these, bladder cancer is a frequent complication in chronic urogenital schistosomiasis.

Studies have shown that different levels of host proteins, such as COX2, iNOS, EGFR, and TGFα, are markers for bladder cancer. The incidence is higher in the younger age group, which presents as well-differentiated squamous cell carcinoma and has a poor prognosis. The frequency and severity of chronic urogenital schistosomiasis depend on the duration and intensity of the infection. Carcinomas associated with urogenital schistosomiasis show cytological changes, genetic alterations, and chromosomal aberrations, and nitroso compounds have been used as etiologic agents.

Biomarkers Candidates for Bladder Cancer:

Biomarkers help in the early detection of malignancy and can help in providing a good prognosis. Promising candidates include estrogen-like and 8-oxodG-related metabolites. The malignant lesions found were related to both squamous cell carcinoma and urothelial cell carcinoma. Studies have shown that urogenital schistosomiasis is a risk factor for squamous cell carcinoma but not urothelial cell carcinoma. There were estrogen-like metabolites and DNA adducts in urogenital schistosomiasis-associated bladder cancer.

Urine Proteome in Urogenital Schistosomiasis:

Purified urine proteins analyzed by GeLC-MS/MS (mass spectrometric), which is separated by sodium dodecyl sulfate precast polyacrylamide gel electrophoresis, showed Th-2 type immune response in urogenital schistosomiasis samples. Proteins involved in inflammation and negative regulation of endopeptidase activity were seen in urogenital schistosomiasis-related bladder cancer. Proteins were seen in association with tumor growth, metastasis, metabolisms, cell adhesion, and immune response in cases of the bladder without infection.

What Is the Treatment of Urogenital Schistosomiasis?

Praziquantel is used for the treatment of urogenital schistosomiasis. It is safe and cost-effective. There are chances of reinfection, but the severity is comparatively low and does not lead to complications. The disease can be easily treated and reversed. The principle is to reduce morbidity and mortality, and periodic treatments will cure mild, undetectable symptoms and prevent previously infected people from developing severe complications.

How Can Urogenital Schistosomiasis Be Prevented and Controlled?

Based mainly on:

  • Large-scale treatment of population at risk.

  • Snail control.

  • Access to clean water.

  • Improved sanitation.

  • Education on hygiene.

The World Health Organization (WHO) has provided a strategy for the large-scale population through preventive chemotherapy. Preventive chemotherapy involves the administration of the drug Praziquantel through periodic and targeted treatment of the affected populations.

Groups to be focused on:

  • The age group of children attending preschool.

  • School-going children in endemic areas.

  • Adults in contact with risk factors such as fishermen, farmers, irrigation workers, or any other work that involves coming in contact with the infested water.

  • Communities living close to endemic areas.

In areas with high transmission, frequent monitoring is essential, and preventive therapy may have to be repeated yearly. The frequency of infection in school-going children depends on the prevalence.

Conclusion:

Urogenital schistosomiasis is caused by Schistosoma haematobium, which drains the pelvic organs, bladder, uterus, and cervix veins. It is common in African countries, and the infection with Schistosoma haematobium causes squamous cell carcinoma and urothelial carcinoma of the urinary bladder. The standard diagnostic tests involve a filtering technique that uses nylon, polycarbonate, or paper filters. In addition, Praziquantel is used for the treatment of urogenital schistosomiasis.

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Frequently Asked Questions

Schistosomiasis, also called Bilharzia, is a condition caused by parasitic worms. People worldwide are sick of this infectious disease. It is most common in African countries, even though the worms that cause schistosomiasis are not prevalent in the United States. This illness stands secondary to malaria as the most lethal parasite disease
 
Schistosoma haematobium is a medically significant parasite. It belongs to the Trematodes genus, also called blood flukes. They are parasitic flatworms that cause serious infections in humans, known as schistosomiasis. Schistosomiasis is ranked by the World Health Organization as the second parasitic disease with the greatest socioeconomic impact (after malaria), with hundreds of millions of cases globally.
The two forms of schistosomiasis are urogenital and intestinal, which are caused by five species of the blood fluke (schistosomiasis). Intestinal schistosomiasis is caused by Schistosoma mansoni, Schistosoma japonicum, Schistosoma mekongi, Schistosoma guineensis, and related S. intercalatum. And urogenital schistosomiasis is caused by Schistosoma haematobium.
1. Eggs are disposed of via feces or urine during the life cycle of Schistosoma. 
2. When the eggs hatch, they release miracidia.
3. They swim and pierce certain snail intermediate hosts.
4. The snail goes through two generations of sporocysts.
5. It produces cercariae (the larval form of the parasite Trematodes).
Schistosomiasis is a severe and long-lasting infection caused by parasitic worms. People become sick when engaging in routine residential, professional, recreational, and agricultural activities that expose them to contaminated water. School-aged children are especially prone to illness due to poor hygiene and specific play activities like swimming or fishing in contaminated water.
Schistosomiasis is not caused by viruses but is caused by parasites. These worms infect humans when they come into contact with water contaminated by these parasites. Also, not maintaining hygiene after engaging in playful activities in outdoor contaminated water causes this.
 
Praziquantel is the recommended medication for treating all kinds of schistosomes. After a single dose of Praziquantel, cure rates of 65 to 90 % have been reported. The medication reduces egg excretion by 90 % in those not healed. This medication needs to be taken for 1 to 2 days.
Schistosomiasis is transmitted through contaminated water. It is not a sexually transmitted disease. However, female genital schistosomiasis is a sexually transmitted disease. At least 40 million girls and women worldwide, predominantly in sub-Saharan Africa, are affected with female genital schistosomiasis. It is caused by the parasite Schistosoma haematobium.
Schistosomiasis lives for around 3 to 10 years inside humans. But in some instances, they survive for around 40 years. So, if a person is infected with Schistosomiasis, it is best to get medical attention, as the worm can survive for a longer time.
Since these worms tend to linger in the body for a longer time, they cause symptoms like fever, chills, muscle and body pain, and stomach p[pain. It also leads to blood in urine, stools, difficulty while passing urine, and miscarriage. The most devastating factor is that it can cause bladder cancer if it stays in the body for a long time.
Schistosomes are not hermaphrodites (an organism that has both reproductive organs); they have separate sexes, in contrast to all other pathologically significant trematodes. The adult worms have a cylindrical body that is between one and two centimeters long and has two terminal suckers, a sophisticated tegument, a blind digestive tract, and reproductive organs.
Several factors, including hormonal imbalance, testicular tissue destruction, and genital ductal system obstruction, may contribute to schistosomiasis-induced male infertility. In addition, it also leads to diminished libido and erectile dysfunction due to related hormonal imbalance and prostatic infestation.
The main pelvic organs, such as the bladder, uterus, and cervix, are supplied by veins that are home to egg-laying S. haematobium worms, which cause urogenital schistosomiasis. The infectious stage of the parasite, larvae cercariae, emerges from freshwater snails and infects people by directly penetrating their skin.
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Dr. Samer Sameer Juma Ali Altawil from iCliniq
Dr. Samer Sameer Juma Ali Altawil

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