Beyond Human papillomavirus (HPV): why female genital schistosomiasis must be addressed in Africa's cervical cancer prevention agenda

Cervical cancer remains a leading cause of cancer-related mortality among women in Sub-Saharan Africa, despite the expansion of Human papillomavirus (HPV) vaccination and screening programmes. While HPV is a necessary cause of cervical cancer, prevention strategies that focus exclusively on HPV risk overlooking female genital schistosomiasis (FGS), a neglected tropical disease affecting millions of women and girls in schistosomiasis-endemic regions. FGS causes chronic genital inflammation and mucosal damage that may increase susceptibility to HPV infection, complicate cervical cancer screening, and contribute to diagnostic misclassification, yet female genital schistosomiasis is rarely considered in cervical cancer prevention policies or clinical algorithms. In this Comment, we argue that integrating FGS diagnosis and prevention into HPV-based cervical cancer strategies is essential for achieving equitable progress towards the World Health Organization cervical cancer elimination targets in Africa. Addressing FGS represents a pragmatic, gender-responsive, and context-specific opportunity to strengthen cervical cancer prevention across endemic settings.