A formative appraisal of Female Genital Schistosomiasis (FGS) score card results against point-of-care gynaecological and molecular parasitological information within four counties of Liberia

Liberia (West Africa) has an extensive (co)burden of urogenital and intestinalschistosomiasis; each largely restricted to more inland areas. Where urogenitalschistosomiasis is endemic, as both disease surveillance and case management are nascent,many women may unknowingly be living with Female Genital Schistosomiasis (FGS). Usinga recently developed FGS score card, we appraised FGS score card valuations with point-of-care gynaecological and molecular parasitological evaluations as undertaken within typicalprimary care settings of four Liberian counties. A total of 400 women, 100 participants fromeach of four endemic inland counties, underwent a cursory gynaecological examination usinga speculum for visible FGS lesions, undertaken by a midwife, and provided a urine samplethat was examined by centrifugation with microscopy for Schistosoma ova. Urine-sedimentsin ethanol were later analysed with a high-resolution melt (HRM) real-time (rt) PCR assay toscreen for Schistosoma genetic markers. Using a combination of clinical and parasitologicalinformation, overall prevalence of UGS and FGS was <10% and a single case of putativeFGS-associated co-infection with Schistosoma mansoni was observed. Participant interviewswith the FGS score cards provided an insight into at-risk lifestyle and environmental factors,e.g. women who fished regularly were more likely to present with FGS whereas those wholived > 15 km from a local river were less likely to present with FGS. In this resource-poorsetting of Liberia, active surveillance for FGS with either clinical or parasitological methodsremains challenging such that sole future use of the FGS score card is most pragmatic forprimary care.