{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:36:42Z","timestamp":1789151802400,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011798","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000}}],"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024216","name":"College of Health Sciences, University of KwaZulu-Natal","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024216","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011199","name":"FP7 Ideas: European Research Council","doi-asserted-by":"publisher","award":["PIRSES-GA-2010-269245"],"award-info":[{"award-number":["PIRSES-GA-2010-269245"]}],"id":[{"id":"10.13039\/100011199","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPPGH5344"],"award-info":[{"award-number":["OPPGH5344"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020560","name":"South East Regional Health Authority","doi-asserted-by":"publisher","award":["2016055"],"award-info":[{"award-number":["2016055"]}],"id":[{"id":"10.13039\/501100020560","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Female Genital Schistosomiasis (FGS) causes intravaginal lesions and symptoms that could be mistaken for sexually transmitted diseases or cancer. In adults, FGS lesions [grainy sandy patches (GSP), homogenous yellow patches (HYP), abnormal blood vessels and rubbery papules] are refractory to treatment. The effect of treatment has never been explored in young women; it is unclear if gynaecological investigation will be possible in this young age group (16\u201323 years). We explored the predictors for accepting anti-schistosomal treatment and\/or gynaecological reinvestigation in young women, and the effects of anti-schistosomal mass-treatment (praziquantel) on the clinical manifestations of FGS at an adolescent age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The study was conducted between 2011 and 2013 in randomly selected, rural, high schools in Ilembe, uThungulu and Ugu Districts, KwaZulu-Natal Province, East Coast of South Africa. At baseline, gynaecological investigations were conducted in female learners in grades 8 to 12, aged 16\u201323 years (n = 2293). Mass-treatment was offered in the low-transmission season between May and August (a few in September, n = 48), in accordance with WHO recommendations. Reinvestigation was offered after a median of 9 months (range 5\u201314 months). Univariate, multivariable and logistic regression analysis were used to measure the association between variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prevalence: Of the 2293 learners who came for baseline gynaecological investigations, 1045 (46%) had FGS lesions and\/or schistosomiasis, 209\/1045 (20%) had GSP; 208\/1045 (20%) HYP; 772\/1045 (74%) had abnormal blood vessels; and 404\/1045 (39%) were urine positive.<\/jats:p>\n                    <jats:p>Overall participation rate for mass treatment and gynaecological investigation: Only 26% (587\/2293) learners participated in the mass treatment and 17% (401\/2293) participated in the follow up gynaecological reinvestigations.<\/jats:p>\n                    <jats:p>Loss to follow-up among those with FGS: More than 70% of learners with FGS lesions at baseline were lost to follow-up for gynaecological investigations: 156\/209 (75%) GSP; 154\/208 (74%) HYP; 539\/722 (75%) abnormal blood vessels; 238\/404 (59%) urine positive. The grade 12 pupil had left school and did not participate in the reinvestigations (n = 375; 16%).<\/jats:p>\n                    <jats:p>\n                      Follow-up findings: Amongst those with lesions who came for both treatment and reinvestigation, 12\/19 still had GSP, 8\/28 had HYP, and 54\/90 had abnormal blood vessels. Only 3\/55 remained positive for\n                      <jats:italic>S<\/jats:italic>\n                      .\n                      <jats:italic>haematobium<\/jats:italic>\n                      ova.\n                    <\/jats:p>\n                    <jats:p>Factors influencing treatment and follow-up gynaecological investigation: HIV, current water contact, water contact as a toddler and urinary schistosomiasis influenced participation in mass treatment. Grainy sandy patches, abnormal blood vessels, HYP, previous pregnancy, current water contact, water contact as a toddler and father present in the family were strongly associated with coming back for follow-up gynaecological investigation.<\/jats:p>\n                    <jats:p>Challenges in sample size for follow-up analysis of the effect of treatment: The low mass treatment uptake and loss to follow up among those who had baseline FGS reduced the chances of a larger sample size at follow up investigation. However, multivariable analysis showed that treatment had effect on the abnormal blood vessels (adjusted odds ratio = 2.1, 95% CI 1.1\u20133.9 and p = 0.018).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compliance to treatment and gynaecological reinvestigation was very low. There is need to embark on large scale awareness and advocacy in schools and communities before implementing mass-treatment and investigation studies. Despite challenges in sample size and significant loss to follow-up, limiting the ability to fully understand the treatment\u2019s effect, multivariable analysis demonstrated a significant treatment effect on abnormal blood vessels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0011798","type":"journal-article","created":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T13:59:07Z","timestamp":1711547947000},"page":"e0011798","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors for participation in mass-treatment and female genital schistosomiasis re-investigation, and the effect of praziquantel treatment in South African adolescents"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4912-1570","authenticated-orcid":true,"given":"Takalani Girly","family":"Nemungadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Kleppa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashini Nilushika","family":"Galappaththi-Arachchige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavitra","family":"Pillay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svein Gunnar","family":"Gundersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitte Jyding","family":"Vennervald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Doris","family":"Ndhlovu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saloshni","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyrun Floerecke","family":"Kjetland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,27]]},"reference":[{"issue":"3","key":"pntd.0011798.ref001","doi-asserted-by":"crossref","first-page":"e2104","DOI":"10.1371\/journal.pntd.0002104","article-title":"S. haematobium as a common cause of genital morbidity in girls: A cross-sectional study of children in South Africa","volume":"7","author":"IEA Hegertun","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0011798.ref002","unstructured":"UNAIDS, World Health Organization. No more neglect. Female genital schistosomiasis and HIV. Integrating reproductive health interventions to improve women\u2019s lives [Internet]. Geneva, Switzerland; 2019 [cited 2020 Mar 12]. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/female_genital_schistosomiasis_and_hiv_en.pdf"},{"key":"pntd.0011798.ref003","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ijgo.2014.07.014","article-title":"Classification of the lesions observed in female genital schistosomiasis.","volume":"127","author":"EF Kjetland","year":"2014","journal-title":"Int J Gynaecol Obstet [Internet]."},{"issue":"3","key":"pntd.0011798.ref004","doi-asserted-by":"crossref","first-page":"311","DOI":"10.4269\/ajtmh.2005.72.311","article-title":"Simple clinical manifestations of genital Schistosoma haematobium infection in rural Zimbabwean women","volume":"72","author":"EF Kjetland","year":"2005","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pntd.0011798.ref005","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.ijpara.2016.02.006","article-title":"Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease.","volume":"46","author":"V Christinet","year":"2016","journal-title":"Int J Parasitol"},{"key":"pntd.0011798.ref006","volume-title":"World Health Organisation. 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