The burden of visually diagnosed female genital schistosomiasis among women with infertility in the Volta Region of Ghana.

Background: Female genital schistosomiasis (FGS) is the outcome of the deposition of Schistosoma haematobium egg in the ovaries, fallopian tubes, uterus or cervix of women in schistosomiasis endemic areas. Chronic and untreated FGS can result in an increased risk of human immunodeficiency virus (HIV) acquisition and infertility. This study aimed to evaluate the burden of visual FGS among women with infertility in the Volta region of Ghana.

Methods: This study was a comparative cross-sectional study involving women with infertility defined as women with inability to achieve pregnancy after 12 months or more of frequent (3-4 times a week) unprotected sexual intercourse and nursing mothers (fertile women) from selected districts in the Volta Region. Questionnaire administration was used to obtain sociodemographic information including recent and childhood contact with water bodies as well as the practice of open defecation and clinical information such as the presence of genital symptoms. Urine samples were collected for detection of eggs of S. haematobium, and the women's lower genital tracts were examined using a handheld colposcope by two gynecologists and a third to resolve discrepancies. Data were analyzed using SPSS version 23 with frequency distribution done for the sociodemographic variables and the prevalence of FGS in the women. Pearson Chi-square analysis was performed to find any significant difference between the prevalence of FGS among infertile and fertile women and any significant association between any socioeconomic and clinical variables with FGS. Logistics regression analysis was performed to investigate sociodemographic and other risk factors for FGS among women.

Results: Of the 265 sampled women 132 (49.8%) were infertile and 133 (50.2%) were nursing mothers (fertile women). More women had visual FGS (155, 58.5%) and most with FGS were fertile [96, 76.1%; infertile, 59(45.3%); p < 0.001], with infertile women having lower odds of FGS in this study (AOR, 0.29 [95% CI 0.17-0.50]; p < 0.001); adjusted for childhood and current contact with rivers and streams, availability of toilets facility, practice of open defecation and age. More women with FGS had childhood contact with rivers and streams (68.4%, p = 0.007) with lower odds of FGS seen in women without childhood contact with rivers and streams (AOR, 0.52 [95% CI 0.31-0.88]; p = 0.015).

Conclusion: In this study, infertile women unexpectedly had lower odds of FGS suggesting the need for more rigorous research on this topic to elucidate the true contribution of FGS on infertility.