Figure 2. Hand-held colposcopic image with FGS areas highlighted (left). Histopathology section of one of the FGS lesions showing S.haematobium eggs (right).

女性生殖血吸虫病（FGS）是一种由卵被沉积引起的残疾和被忽视的妇科疾病血吸虫血吸虫病生殖道中的寄生虫。作为中间宿主，淡水蜗牛促进了传播，当一个人与受污染的淡水接触时会发生。FGS是一种显着的炎症性疾病。随着人体试图包含感染的进展，捕获的卵在生殖道中捕获的卵产生炎症细胞和细胞因子的募集。临床后果是这种炎症过程的直接结果，并表现出阴道分泌物，在月经期之间性行为和性爱期间性行为和出血期间的腹部疼痛，疼痛和不适。未经治疗的感染可能导致不孕症，生殖器溃疡，流产，异位妊娠，后毛发后出血以及增加HIV和可能是宫颈癌的风险增加。研究落后，迫切需要增加知识和选择来诊断这种残疾疾病。

In my own practice as a specialist Gynaecologist, working atQueen Elizabeth central hospital在马拉维的Blantyre市，我看到妇女从初级和中学医疗机构中转诊出了异常的阴道分泌物。这些妇女通常有多次注射抗生素，但没有太大改善。有时会被转介，因为它们在生殖道中怀疑癌症。在多次使用生殖道的组织样品以确认宫颈癌或其他疾病的临床诊断。有趣的是，一些活检结果已显示Schistosomaeggs with or without cancer findings, but even in the presence of FGS, the clinical importance is placed heavily on the alternative diagnosis, minimizing the contribution of this parasitic disease on sexual and reproductive health.

在这篇文章中，我将分享我在FGS项目中工作的个人经验，病态FGS研究，在马拉维的卫生中心，农业，发展研究咨询中心（CHAD），伦敦卫生与热带医学学院以及英国的SCISOSOMISIS CONTERITIVE INTIATIVE FOUNTION（SCIF）之间的多方合作。该研究的主要目的是量化马拉维两个地区FGS疾病的负担，一种患病率很高，血吸虫病患病率很高（NSANJE），一种患病率较低（Chikwawa）。该研究包括从15岁到59岁的生殖年龄，性活跃和怀孕的妇女。2020年11月，我们开始从正在进行的大型研究中招募妇女（病态)旨在找到不同勒之间的关联vels of schistosomiasis endemicity and clinical morbidity. Eligible women were given a questionnaire and were asked about symptoms pertaining to their reproductive tract and invited to come for a clinical review. At the clinic, nurses performed a genital examination of the women, examining the vulva, vagina and cervix, first with the naked eye and then with a hand-held阴道镜to magnify any abnormalities. Swabs and lavage samples were obtained from the lower genital tract and processed forSchistosomaDNA检测。

在招募的最初几周，在Nsanje区，一个患病率很高的地区，我们的团队遇到了一个15岁的年轻女孩，他们居住在Nsanje的一部分，称为Fatima。她社区日常活动的主要水源是夏尔河。它也是农业活动（例如农业和钓鱼）的枢纽。获得清洁的便携式水和卫生设施有限。淡水是蜗牛充当血吸虫中间宿主的好栖息地。

Just like other girls, she had been invited to participate in the病态FGSstudy. She was about to start secondary school and her growth was what was expected at this age. She had an otherwise non-remarkable gynaecological or history. Upon undergoing visual screening with a colposcope for female genital schistosomiasis, a suspicious mass with contact bleeding was discovered on her vaginal wall. Exercising caution, I took a biopsy to rule out a possible choriocarcinoma (a malignant tumor of the uterus). The histopathological results of the biopsy revealed that the mass was a collection ofS. haematobiumeggs. She was treated with , the only available drug to treat all types of schistosomiasis. If this girl hadn’t been part of this study, she would have likely been treated for sexually transmitted infections since the symptoms are indistinguishable, and her FGS would have remained untreated with potential dire impact to her sexual and reproductive life.

The images obtained by colposcopy allowed us to see the effects of schistosomiasis only in the lower genital tract as it is unable to image deeper genital organs like the uterus, fallopian tubes or ovaries. Therefore, it is difficult to quantify the extent of the clinical disease just by imaging the cervix and vagina. In addition to the clinical diagnostic limitations, many women go undiagnosed due to a lack of awareness of FGS by health care workers. Another limiting factor is the lack of access safe water and sanitation.

由于马拉维和其他地方的大多数医疗机构缺乏普拉齐特尔，妇女也无法得到适当的治疗。PZQ被视为一种“控制”药物，仅在卫生系统中偶尔使用来治疗尿液或粪便确认的血吸虫病。

只要不充分解决这些问题ed, schistosomes will remain a threat to women’s sexual and reproductive health. I have now learned to identify FGS and I have also realized that many of my colleagues continue to practice without thinking about it. I would like to increase awareness in the medical education in Malawi by teaching nurses, doctors and gynecologists about my experience. I continue to be part of the FGS research efforts in Africa as an expert reviewer in both Malawi and Zambia.