Giving Compass' Take:

• Clarissa Prazeres da Costa explains that female genital schistosomiasis has been neglected by the international community and needs more attention. 

• Are you prepared to step up and fill in the funding, research, or access gaps for this neglected disease? 

• Learn more about female genital schistosomiasis in Sub-Saharan Africa

More than 220 million people worldwide suffer from schistosomiasis, and the infection is well known in the global health community. But a subset of infected people – women who carry schisto in their genital organs – get little attention. Female genital schistosomiasis can bring a slew of serious problems including pain, bloody discharges, infertility, incontinence, ulcers, pregnancy problems and tumors.

You’ve been doing clinical work as an infectious disease physician and studying the flatworms that cause schistosomiasis for 15 years. What have you learned in the lab?

My work started by investigating how in mice, schistosomes use certain kinds of suppressor cells of the immune system to enhance their own survival. Then we did a lot of work investigating how parasites could be part of the so-called hygiene hypothesis—weand other researchers have shown experimentally that chronic infections can alleviate many symptoms of allergic airway inflammation. Indeed, humans who are chronically exposed to schistosomes also show fewer allergic reactions.

In the lab, we’ve studied what happens to the immune systems of infected mice during pregnancy. And we’ve found that the offspring of infected mice have an altered immune system that prevents the development of allergies later in life.

A study on schistosome-infected pregnant women in Uganda demonstrated that the children suffered from eczema (an allergic skin disease) to a greater extent if their mothers were treated during pregnancy with an anti-helminth drug, indicating that in humans, schistosomiasis during pregnancy could have an allergy-suppressive effect in offspring, just as in the mouse model. We are currently investigating possible underlying mechanisms behind this intriguing feto-maternal crosstalk in a study in Gabon.

In nominating FGS as a neglected disease, you said you were inspired by an article by Peter Hotez calling FGS one of the most common gynecological conditions afflicting women living in poverty in Africa, and an important cofactor in HIV. And he berated HIV research leaders for not paying attention. How did you feel when you read that?

Being a woman, I thought this cannot be. I felt angry—women’s access to health in general is definitely less supported than men’s access. I also felt inspired. It was always my dream to move to fieldwork after having established a firm knowledge of lab-based science. I said to myself, wait a moment, you have this project (on schistosomiasis in pregnancy in Gabon). Why not take this project and really do something about it?

There’s so much to learn. We don’t even know how prevalent FGS is yet; only a very few studies are currently investigating. In January 2019 we had a kick-off meeting of a new study funded by the German Research Foundation. We will prospectively investigate women with schistosomiasis and their children. We want to learn as much as possible at this stage, and at the same time teach the midwives and gynecologists to diagnose and treat FGS.

Read the full article about female genital schistosomiasis by Clarissa Prazeres da Costa at Global Health NOW.