Guest Blog: What about Male Genital Schistosomiasis: Developing a Research Perspective from the Shoreline of Lake Malawi

 Guest Blog by Dr Sekeleghe Kayuni (Liverpool School of Tropical Medicine PhD student)

Prof. Sally Theobald has used her personal experience to highlight the importance of reporting female genital schistosomiasis (FGS) and its long term consequences, from Lake Malawi. What about male genital schistosomiasis (MGS) and its current situation within local fishermen?

Described as “the jewel in the crown of the country’s tourist attractions”, this third largest lake in Africa is a renowned destination for tourists and water sport supporting the country’s economy.  Its beautiful fresh waters also offer local communities a place for household chores and income generation through fishing. However, the lake harbours various aquatic snail species which are intermediate hosts for the Schistosoma parasite, a causative agent of schistosomiasis in humans.

Schistosomiasis is also known as Bilharzia or snail fever and its lifecycle was elucidated some a hundred years ago. Chronic schistosomiasis is a debilitating disease causing severe damage to many internal organs and tissues and if untreated can result in death.  As the second-most prevalent parasitic disease in the world after malaria, World Health Organisation (WHO) estimates that over 700 million people are at risk of the disease globally, with 200 million infected of which 85% live in sub-Saharan Africa (SSA), and 20 million suffer severe consequences.

In Lake Malawi and surrounding water bodies, two major species of the Schistosoma parasite are present; S. haematobium which causes urogenital disease and S. mansoni which causes intestinal diseases.  The parasite’s distribution and thus risk of infection is highly focal around these water bodies, with S. haematobium common in the southern areas of Lake Malawi and Shire valley, and S. mansoni in the Central plains and Northern areas.

Part of my future PhD research based at the Liverpool School of Tropical Medicine (LSTM); is to determine the local importance of MGS. I visited Malawi in December 2016 to start planning for my fieldwork later this year and appreciate the current situation of control measures within fishing communities along southern shores of Lake Malawi, especially within Mangochi district. These communities are associated with higher prevalence of S. haematobium infection, average of 23.7%, some reaching as much as 94% and also having episodes of re-infection.

Local health services are provided by the District Health Office (DHO) and complemented by Faith-based and private clinics. Most facilities have basic Outpatient departments, laboratories and dispensaries, with limited diagnostic resources resulting in limited clinical diagnosis of diseases like schistosomiasis. Preventive services are community-directed and provided by Health Surveillance Assistants (HSAs), who are a valuable multi-tasking human resource for health, supervised by the District Environmental Health Officer (DEHO).

Much emphasis of urogenital schistosomiasis in endemic areas is on urinary pathology, with less attention on its genital consequences despite its  first description by Madden in vaginal tissue of a female Egyptian woman in 1899 and a young man’s spermatic cord in 1911. This was echoed by health centre staff and people in fishing communities in the district.

FGS is now receiving at least some much-deserved focus in research and treatment, compared to MGS. This is despite the several reports and research studies describing Schistosoma eggs in male genital organs, its impact on reproductive health and possibility of increased susceptibility to HIV infection, and transmission among infected males and females in schistosomiasis-endemic regions.

In preparation for my future PhD research with Professor Russell Stothard and Dr James LaCourse, I will be hoping to bring together a multidisciplinary study to determine and describe the prevalence and morbidity of MGS in the fishing communities of southern Lake Malawi, including assessing the co-morbidity of MGS with HIV infection. The aim is to raise the much-needed awareness and understanding of MGS, expand access to regular treatment and holistic disease control interventions, by national control programmes to entire populations. So watch this space for further reports in future.