A neglected tropical disease is silently hitting 40 million women

Introduction: the silence surrounding an infection affecting millions of women

A disease known for decades, yet still ignored

Researchers at the Liverpool School of Tropical Medicine have just issued a clear call to action: screening must be expanded for female genital schistosomiasis (FGS), a neglected tropical infection affecting at least 40 million women worldwide, primarily in sub-Saharan Africa. Some estimates, notably from the WHO and UNAIDS, put the figure as high as 56 million women and girls affected.

This disease, caused by the parasite Schistosoma haematobium transmitted through contact with infested fresh water, remains largely absent from reproductive health services despite its scale. The parasite's eggs lodge in reproductive tissue, causing inflammation, lesions, and scarring, often without the patient ever knowing what is actually affecting her.

An infection too often mistaken for something else

The central problem, according to the study published in The Lancet Microbe, is that FGS is frequently misdiagnosed. A woman presenting with symptoms such as vaginal discharge, contact bleeding, or pelvic pain will first be tested for sexually transmitted infections or ordinary urinary infections, never for this specific parasite, for lack of adequate training among medical staff.

Yet it must be stated plainly: female genital schistosomiasis is NOT a sexually transmitted infection, even though its name invites confusion. It is contracted through contact with contaminated water, often in childhood, during activities as ordinary as doing laundry or bathing in a river.

A troubling link to HIV and cervical cancer

Lesions that open the door to other infections

The study, led by the team of Professor Amaya Bustinduy, a specialist in pediatric and adolescent infectious diseases at the Liverpool School of Tropical Medicine, examined how FGS interacts with other gynecological infections. The results show that chronic inflammation and tissue damage caused by the disease can increase women's vulnerability to HIV and human papillomavirus (HPV), the leading cause of cervical cancer.

Several earlier studies conducted in Mozambique, Tanzania, and Zimbabwe had already established that adult women with FGS faced a three to four times higher risk of contracting HIV than uninfected women, according to data compiled by UNAIDS.

A biological explanation that is now better understood

Two mechanisms would explain this heightened vulnerability: first, a higher number of HIV receptor cells present in lesions caused by FGS; second, the physical damage inflicted on vaginal and cervical mucosa, which facilitates viral transmission through contact bleeding during intercourse.

Among adolescent girls, this reality is even more troubling: FGS often occurs before girls ever become sexually active in regions where the parasite is endemic, meaning these young girls are already left vulnerable to HIV before being exposed to a first partner.

Toward combined screening, without promising miracles

A concrete approach: testing for several infections at once

Researchers propose a pragmatic rather than revolutionary approach: integrating FGS screening into existing programs targeting HIV, cervical cancer, and sexual health. In practice, this means using a single genital sample to test for both HPV and FGS, a method that would avoid multiplying medical visits for women who often live far from health centers.

More modern diagnostic tools, supported by artificial intelligence and molecular testing, are also being studied to make field detection easier, in areas where traditional colposcopy remains hard to access across rural sub-Saharan Africa.

Staying cautious amid scientific enthusiasm

That said, the enthusiasm needs to be tempered: these proposals remain at the recommendation stage. No large-scale rollout timeline has been confirmed, and funding for these integrated programs will depend heavily on the political will of the governments involved and international donors, at a time when global health budgets are already under strain.

Professor Bustinduy herself acknowledges that FGS remains one of the most neglected gynecological conditions affecting women and girls in Africa, despite the scale of the problem, which illustrates the gap between scientific knowledge and action on the ground.

An invisible burden on local health systems

A glaring shortage of diagnostic tools on the ground

Standard diagnosis of FGS requires a colposcopy and a histopathological examination, procedures that demand well-equipped facilities rarely available in endemic regions of sub-Saharan Africa. According to data compiled by the Bulletin of the World Health Organization, only a few tens of thousands of women have ever been formally examined out of the tens of millions potentially affected, a staggering gap between the scale of the problem and actual screening capacity.

This shortage of diagnostic tools is not merely a technical issue: it reflects decades of chronic underfunding of neglected tropical diseases, a category of illness that mainly affects poor, rural populations, far removed from the research priorities of major Western pharmaceutical powers.

Low-cost solutions are starting to emerge

Researchers in Zambia are currently testing home self-sampling methods, an approach that could democratize screening without requiring the systematic presence of a colposcope or a trained specialist. These studies, such as the Zipime-Weka-Schista project, rely on community acceptance to reach women who would otherwise never have access to gynecological screening.

Early results from these initiatives show high participant uptake, an encouraging sign suggesting that the main obstacle is not the willingness of the women involved, but rather the absence of structured, funded programs to reach them.

The ambiguous role of major international institutions

Commitments that exist but remain insufficient

The WHO has already distributed hundreds of millions of praziquantel tablets, the standard treatment for schistosomiasis, through school-based deworming programs in endemic countries. This drug, administered early, can prevent the onset of chronic lesions linked to FGS, making it a simple and inexpensive prevention tool.

However, these programs mainly target school-age children and often neglect adult women, a blind spot that leaves a significant share of the at-risk population without regular access to treatment, particularly in isolated rural areas where school coverage itself remains incomplete.

The weight of competing priorities in global health

In a context where global health budgets are being pulled simultaneously by the fight against HIV, tuberculosis, malaria, and now the lingering effects of the COVID-19 pandemic, female genital schistosomiasis struggles to secure a priority spot on the agendas of major international donors, despite its demonstrated links to several of those same diseases.

It is precisely this lack of prioritization that is now pushing researchers like Professor Bustinduy to multiply publications and public appeals, in the hope of shifting budget lines before more women develop preventable complications.

What this study concretely changes for affected women

A recognition that could open doors

The publication of this study in a journal as respected as The Lancet Microbe constitutes in itself a form of institutional recognition that could facilitate future funding. Major scientific journals play a meaningful role in how donors prioritize their investments, and increased coverage of FGS in the medical literature could gradually change the equation.

For women living with this infection unknowingly, this scientific recognition changes nothing about their immediate situation, but it lays the groundwork for medium-term change, provided the recommendations translate into concrete, funded programs on the ground.

The importance of community awareness

Beyond the purely medical aspects, researchers stress the need for greater community awareness, particularly among frontline health workers who are often the first, if not the only, medical point of contact for women in rural areas. Better training for this staff could, on its own, considerably reduce diagnostic delays.

This human dimension of the story is a reminder that science, however solid, is never enough on its own: it also takes functioning health systems, trained personnel, and sustained political will to turn a discovery into a real improvement in the lives of affected women.

The potential impact on the global fight against HIV

A missed opportunity for cross-prevention

Major global HIV prevention campaigns, led notably by UNAIDS, traditionally focus on condoms, preventive treatments like PrEP, and regular testing. These campaigns rarely factor in parasitic diseases as a driver of heightened vulnerability, which, according to researchers, represents a missed opportunity for cross-prevention that is particularly relevant in sub-Saharan Africa.

Integrating FGS screening into HIV programs would, according to several specialists, cost only a small fraction on top of the budget already allocated to these existing programs, since the basic infrastructure, clinics, staff, monitoring systems, is already in place for HIV in most affected regions.

A measurable potential to reduce new infections

If the studies conducted in Zambia, Mozambique, and Zimbabwe are any indication, early screening and treatment of FGS could help reduce new HIV infections among women and adolescent girls in the hardest-hit areas, even though no large-scale study has yet precisely quantified this potential impact.

This scientific caution is healthy: it would be irresponsible to promise a measured drop in HIV infections before rigorous clinical trials confirm it, but the underlying biological logic remains solid enough to justify additional pilot investments.

Lessons to draw from other neglected tropical diseases

Encouraging precedents in the fight against other parasites

Recent global health history offers examples of neglected tropical diseases that eventually secured the attention and funding needed, such as dracunculiasis, also known as Guinea worm disease, whose cases dropped from several hundred thousand in the 1980s to just a few dozen today thanks to targeted campaigns and sustained funding over several decades.

This precedent shows that coherent international mobilization, even for a disease that does not directly affect wealthy countries, can produce concrete, measurable results when political will and funding are sustained over time.

Why FGS has not yet benefited from the same momentum

Unlikedracunculiasis, whose eradication was a simple, measurable goal, female genital schistosomiasis suffers from a visibility problem: its symptoms affect intimate organs rarely discussed publicly, a cultural taboo layered on top of the technical and financial obstacles already mentioned.

Breaking this taboo has now become an integral part of researchers' strategy, as they multiply accessible academic publications and simplified press releases to pull FGS out of the media shadow where it has remained confined for decades.

Conclusion: a neglect that must end

A call to action that deserves to be heard

This appeal from researchers at the Liverpool School of Tropical Medicine comes at a time when global health inequalities remain glaring. Millions of women live with an infection that increases their vulnerability to HIV and cancer, without even knowing they carry it, for lack of adequate screening in their local health systems.

What to watch in the coming months

The question that will determine the real impact of this study is not scientific, but political: will governments in sub-Saharan Africa, supported by organizations such as the WHO and UNAIDS, actually integrate this screening into their public health programs, or will this appeal remain, like so many before it, an academic recommendation with no budgetary follow-through.

By Maxime Marquette, columnist

Columnist's transparency note

Who I am and my acknowledged biases

I am neither a physician nor a tropical disease researcher. I am a columnist who translates peer-reviewed scientific studies for a general audience, drawing on releases from the institutions involved and specialized journalistic coverage. My acknowledged bias: I believe neglected tropical diseases deserve far more media attention, because they affect populations that have historically had little voice in public debate.

What I don't know and my method

I cannot guarantee the implementation timeline for the recommendations put forward by researchers, nor predict whether international donors will actually fund this expanded screening. My method: I rely on publications from the Liverpool School of Tropical Medicine, on data from UNAIDS and the WHO, and on coverage from specialized health media, systematically cross-checking figures before citing them.

Sources

Primary sources

World Health Organization, newsroom — accessed July 2026

Researchers call for increased screening for parasitic disease linked to HIV and cervical cancer risk, Medical Xpress — July 2, 2026

Liverpool School of Tropical Medicine, official press release — July 2026

Secondary sources

Researchers urge expanded testing for neglected female genital schistosomiasis, News-Medical — July 2, 2026

Lancet series highlights schistosomiasis in women and girls, Stanford Global Health — 2026

No more neglect — Female genital schistosomiasis and HIV, UNAIDS