In sub-Saharan Africa’s endemic areas for urogenital schistosomiasis, male genital schistosomiasis (MGS) can cause significant morbidity. As part of the Hybridization in UroGenital Schistosomiasis investigation, an MGS sub-study examined a cohort of adult men over a calendar year to better ascertain general infection dynamics and putative zoonotic schistosome transmission. During follow-up, demographic, health and socio-economic data were collected through individual questionnaire interviews. Collected urine and semen were analysed using urine filtration, urine and semen microscopy and molecular DNA analyses of semen. Ten participants with reported MGS-associated symptoms had Schistosoma eggs in their urine and semen at 6-month follow-up, with seven at 12 months. Ten out of 11 participants with Schistosoma haematobium eggs on semen microscopy at baseline had persistent infection at 6-month follow-up, together with 6 new participants, giving an MGS prevalence of 84·2% (n = 19). Two also had Schistosoma mattheei eggs co-infection. Four of the 13 participants at 12-month follow-up had S. haematobium eggs in their semen which were persistent at all the time points. Using semen PCR, 14 participants (73·7%) had Schistosoma infection at 6 months, with only 2 participants being infected for first time. Upon DNA analysis, three participants also had hybrid co-infection at this time point. At 12 months, only 6 participants had Schistosoma infection with no hybrids detected. In summary, like S. haematobium and despite praziquantel treatment, both zoonotic and hybrid schistosomes can continue to cause MGS, which pose a further tangible challenge in future management and control measures.

Urogenital schistosomiasis (UGS) caused by zoonotic or hybrid schistosome infection(s) is an emerging public health concern in Malawi, and we describe a 1-year clinical sub-study with 3 inspection time points for female genital schistosomiasis (FGS) upon selecting 86 women with proven UGS. This sub-study was set within a broader 2-year longitudinal ‘Hybridization in UroGenital Schistosomiasis (HUGS)’ investigation. A detailed cervicovaginal examination with a portable colposcope was conducted, examining cervicovaginal lavage (CVL), cervical swab, cervical biopsy and urine with traditional parasitological and molecular diagnostic methods. At baseline, overt FGS by colposcopy was 72.1%, 64.3% by CVL real-time PCR and 51.2% by both colposcopy and CVL-PCR, noting urine-microscopy could often be negative. Human papillomavirus was detected in 31.0% of the cervical swabs, with 8.3% women also FGS positive by colposcopy and real-time PCR. Over the year, FGS prevalence by colposcopy increased by 32.7% during the study to 84.6%, homogenous yellow and grainy sandy patches being very common in the youngest 18–25 age group, where 51.9% were positive. FGS appears widespread locally and we discuss difficulties in its detection without invasive sampling. In addition to the presence of S. haematobium, S. mattheei was noted alongside key concurrent sexually transmitted infections. From our findings, we point out that improved prevention and management of FGS is required, foremost, better availability and regular accessibility to praziquantel treatment is needed. Furthermore, targeted health education, raised community awareness and dovetailing synergistic public health activities within Sexual and Reproductive Health services and local HIV/AIDS programmes could develop an appropriate holistic health intervention package.