Schistosomiasis, an unusual cause of infertility, painful sex

 













People become infected with schistosomiasis when its larval forms released by freshwater snails– penetrate the skin during contact with infested water. Experts say that individuals affected by the disease stand a chance of developing severe anaemia and HIV, aside infertility and painful sex, reports Sade Oguntola.
Ill-health due to reproductive health problems and sexually transmitted infections (STIs) is mostly both preventable and remediable in its nature.

These illnesses, nevertheless, account for a great health burden in women in developing countries where, oftentimes, many go unrecognised.
Although, both health professionals and the public are aware of the dismal statistics for STIs, few seem to realise that there are other infectious agents such as schistosomiasis, a parasitic worm other than bacteria and virus, that can havoc and complicate reproductive health.
Schistosomiasis, also known as bilharzia, is a chronic disease caused by parasitic worms that live in certain types of freshwater snails.
People who come into contact with water that contains these snails are at risk of infection when the larval forms of the parasites (schistosome), which are released by freshwater snails, penetrate their skin of when in contact with the contaminated water while bathing, swimming, or performing daily chores, such as washing laundry, fetching water, and herding animals.
In the body, the larvae develop into adult schistosomes. Adult worms live in the blood vessels where the females release eggs. Some of the eggs are passed out of the body in the faeces or urine to continue the parasite life-cycle. Others become trapped in body tissues, causing an immune reaction and progressive damage to organs.
Schistosomiasis is considered second only to malaria as the most devastating parasitic disease in tropical countries.  There are two major forms of schistosomiasis — intestinal and urogenital — caused by five species of parasites.
Fully matured worms often travel to the intestine, liver or bladder. The symptoms of intestinal schistosomiasis can include abdominal pain, diarrhoea and blood in the stool. Liver and spleen enlargement is also common in advanced cases.
The classic sign of urogenital schistosomiasis is blood in the urine. In women, urogenital schistosomiasis can present with genital lesions, vaginal bleeding, pain during sexual intercourse and nodules on the vulva.
The incidence of schistosomiasis, however, varies from one community to another, depending on such factors as the age of the people sampled, its level of development and gender, said Dr Olufemi Popoola, a lecturer at the Department of Preventive Medicine and Primary Health Care, University of Ibadan.
According to Dr Popoola, “schistosomiasis is commoner where people wade in streams that had snails that transmit this disease or swim in such water bodies. But it is more of a disease of children and adolescents than adults.”
Ironically, “a study carried out in Adelanwa, a community in Saki West Local Government Area in Oyo State puts the incidence of schistosomiasis at 14 per cent among group of people with the age range of 15 and 19 years. This is an average of one per seven of the people in this age group having schistosomiasis.”
“In endemic communities, the incidence of schistosomiasis is as much as 70 per cent. Also in such communities, the prevalence of the disease is higher among those who wade or swim in infected waters, so accounting for why it is seen more in children since they enjoy swimming.”
Nevertheless, many people with schistosomiasis may have no symptoms early in the infection but may develop itchy skin and a rash within days.
Fever, chills, cough and muscle aches can follow and occur within one to two months after infection. Basically, symptoms of schistosomiasis are caused by the body’s reaction to the worms’ eggs, not by the worms themselves.
However, in some communities, when the boys are infected and they start to pass out blood with their urine, they see it as a passage into maturity because the period tallies with when the females would start to menstruate, said Dr Popoola.
According to World Health Organisation (WHO), in sub-Saharan Africa, more than 200,000 deaths per year are due to schistosomiasis.
Depending on the species of parasite, schistosomiasis causes kidney and bladder dysfunction or liver and intestinal disease, and it contributes to anaemia and growth retardation in children as well as infertility in both men and women.
“The reaction to the eggs of the worms can causes problem in the pelvic region, where the reproductive organs are and as such theoretically cause infertility. It has been seen in some special cases to cause infertility.
“Schistosomiasis is not one of the common causes of infertility. However, this unusual presentation of the disease had, in some instances, been reported in some cases to have contributed to infertility problem. Basically, the reaction to the eggs causes fibrosis and in that respect, could affect the reproductive organs, which are in the pelvic region, hence, resulting into infertility in both genders.
“For instance, if it causes fibrosis around the fallopian tube, then it can block this tube, causing infertility. Where the ovaries are affected, it can contribute to infertility. The same is the case with reproductive organs of man.
The case of schistosomiasis affecting the reproductive organs of women was detected for the first time, in a young Egyptian woman, more than 100 years ago. This has been associated with ectopic pregnancy, infertility, miscarriage and HIV. Due to bleeding and sores in the vulva, schistosomiasis affecting the bladder and genital tract is also a risk factor for HIV transmission, especially in women. It can also contribute to painful sex.
Studies have demonstrated that pregnant women infected with schistosomiasis develop severe anaemia, have low birth weight infants, and an increased infant and maternal mortality rate. In men, heavy infection of schistosomiasis of the male genital tract can affect the testicles, prostate and other organs.
A serious, long-term irreversible consequence of schistosomiasis can include male infertility. Rarely, eggs can be found in the brain or spinal cord and cause seizures, paralysis, or spinal cord inflammation. Children who are infected can develop anaemia, experience malnutrition and developmental setbacks as well as acquire learning disabilities.
No vaccine is available. The control of schistosomiasis is based on improving access to safe water, sanitation, hygiene education and snail control. The best way to prevent schistosomiasis is to avoid swimming or wading in infested freshwater; there is no risk in seawater.
 Infection can occur if one’s mouth or lips come in contact with contaminated water. So drinking safe water is important. Boiling water for at least one minute will normally kill any harmful parasites, bacteria or viruses present.

source: tribune.com.ng