Urogenital schistosomiasis has 2 gender-specific manifestations, male genital schistosomiasis (MGS) and female genital schistosomiasis (FGS). The burdens of MGS and FGS are multifaceted, encompassing financial hardship, emotional and mental health problems and sometimes social stigmatization. Given the pernicious nature of sequelae in the genitalia, managing these chronic health conditions is expensive, difficult and problematic in resource poor settings. Key challenges include lack of epidemiological data on the burden of MGS and FGS, inadequate knowledge among primary and auxiliary health care workers, leading to misdiagnosis, incorrect treatment administration, e.g. overuse of antibiotics, and a lack of appropriate point-of-care diagnostic equipment. Prevention of MGS and FGS is therefore more preferable, however, current preventive programmes and chemotherapy campaigns offering praziquantel are becoming more resource constrained and in most endemic areas are not reaching at-risk adults (and adolescents), sufficiently. Furthermore, there are limited prospects for adequate access to treatment in pre-school children where infections can be first acquired. Therefore, we propose 3 key recommendations guiding movement towards elimination of schistosomiasis as a public health problem: scaling-up praziquantel treatment for other at-risk groups; developing a targeted One Health approach to reduce environmental transmission in both humans and animals; Multi-stakeholder collaboration and community engagement for effective implementation of Water Sanitation and Hygiene components of disease control. Whilst maintaining a school-based approach is still foundational, targeted and sustainable expansion of preventive chemotherapy to other at-risk groups within communities is needed to secure real prospects in elimination of genital schistosomiasis as a public health problem in Africa.

The Liolopidae (Diplostomoidea) are a small family of digeneans that parasitize reptiles and amphibians as adults. Knowledge of intermediate hosts in this family remains scarce, leaving a major gap in the understanding of liolopid biology. To date, the only fully elucidated life cycle is that of Liolope copulans Cohn 1902, a species infecting Asian salamanders, with no other cercarial or metacercarial stages known. This study aimed to identify potential intermediate hosts for Paraharmotrema karinganiense, found in several chelonian species from southeastern Mozambique and South Africa. African apple snails of the genus Lanistes and Nothobranchius killifish were sampled from temporary pools in Karingani Game Reserve, southern Mozambique. Snails were screened over 9 months for cercarial shedding, and encapsulated metacercariae recovered from the spotted killifish (N. orthonotus, Peters) (Cyprinodontiformes: Nothobranchiidae) were excysted for morphological and molecular analyses. Fork-tailed cercariae from Lanistes sp. and 1 metacercaria found in the spotted killifish were genetically identical to the adult of P. karinganiense. This study provides the second documented life cycle of a liolopid trematode and presents the first life cycle for the family based on natural infections, being the first completely documented life cycle for freshwater trematodes from southern Africa. This linkage of larval and adult specimens signifies the importance of Nothobranchius killifish as intermediate hosts as well providing insight in parasite transmission dynamics within temporary aquatic ecosystems.