A woman treated for HIV but never tested for FGS remains incompletely protected
Across sub-Saharan Africa and beyond, at least 40 million women and girls carry a parasitic infection in their reproductive tissue that most health systems have never thought to look for. Female genital schistosomiasis, caused by a waterborne parasite, quietly amplifies vulnerability to HIV and cervical cancer through chronic inflammation and scarring — yet it remains absent from the very clinics designed to protect women's health. Researchers publishing in The Lancet Microbe now argue that the infrastructure to change this already exists, and that integrating FGS screening into sexual and reproductive health services is not a distant aspiration but an immediate, practical possibility. The deeper question this raises is why 40 million lives have remained invisible for so long within systems that were built, in principle, to see them.
- A parasitic worm lodging in reproductive tissue affects 40 million women globally, yet it is almost never tested for in the clinics those women actually visit.
- The inflammation and scarring FGS causes appear to open biological pathways for HIV and HPV, meaning an undetected infection is quietly compounding risk across multiple diseases at once.
- Data from the HUGS study in Malawi documented high rates of co-infection, revealing that fragmented disease programs — HIV here, cervical cancer there — are leaving women only partially diagnosed and partially protected.
- Researchers propose that a single genital sample could be tested simultaneously for FGS and HPV, requiring no new infrastructure, only the institutional will to add the disease to existing screening conversations.
- An unsettling new finding — zoonotic and hybrid schistosome species detected in women's genital samples — raises urgent questions about treatment effectiveness and signals that a One Health framework connecting human, animal, and environmental disease may now be necessary.
A parasitic infection affecting at least 40 million women and girls worldwide remains almost entirely invisible within the health systems meant to care for them. Female genital schistosomiasis, or FGS, is caused by a waterborne parasite that can lodge in reproductive tissue after contact with infested freshwater, triggering inflammation, open sores, and scarring that persist for years. Despite its scale, the disease is routinely absent from sexual and reproductive health services across sub-Saharan Africa, where the burden is heaviest.
Researchers at Liverpool School of Tropical Medicine, collaborating with colleagues in Malawi and London, have published findings in The Lancet Microbe making a direct case for change. Their work reveals that FGS does not exist in isolation: the chronic tissue damage it causes appears to create pathways for HIV and human papillomavirus to take hold, compounding risk across multiple fronts simultaneously. Data from the HUGS study in Malawi documented high rates of co-infection, suggesting that a woman treated for HIV or screened for cervical cancer but never tested for FGS remains incompletely diagnosed.
The proposed solution is deliberately practical. A single genital sample could be tested for both HPV and FGS at once, and improved training alongside molecular and AI-assisted diagnostic tools could make detection faster and more reliable. No entirely new system is required — the clinics and programs already exist. What is missing is the institutional recognition that FGS belongs within the conversation about women's reproductive health.
An unexpected finding has sharpened the urgency. Zoonotic and hybrid schistosome species — parasites normally associated with livestock — were detected in genital samples from infected women, raising questions about transmission routes, treatment effectiveness, and the need for One Health approaches that treat human, animal, and environmental health as a single interconnected system. For 40 million women and girls, the researchers warn, continued neglect risks undermining broader global goals around maternal health, cancer prevention, and HIV control.
A parasitic infection that affects at least 40 million women and girls worldwide remains almost entirely invisible within the health systems designed to care for them. Female genital schistosomiasis, or FGS, is caused by a parasitic worm that lives in contaminated freshwater. When a woman or girl comes into contact with infested water, the parasite can lodge itself in reproductive tissue, where its eggs trigger inflammation, open sores, and scarring that can persist for years. Yet despite its scale and consequences, the disease is routinely absent from sexual and reproductive health services, particularly across sub-Saharan Africa where the burden is heaviest.
Researchers at Liverpool School of Tropical Medicine, working alongside colleagues at the Malawi-Liverpool-Wellcome Programme and the London School of Hygiene & Tropical Medicine, have published new findings in The Lancet Microbe that make a direct case for change. The work reveals something critical: FGS does not exist in isolation. The chronic inflammation and tissue damage it causes appear to create a pathway for other serious infections to take hold. Women with FGS show higher vulnerability to HIV and to human papillomavirus, the virus responsible for most cervical cancers. The disease, in other words, compounds risk across multiple fronts.
The research draws on data from the HUGS study conducted in Malawi, which documented high rates of co-infection—women and girls carrying FGS alongside other genital infections simultaneously. This overlap is not accidental. The scarring and inflammation created by the parasite seem to weaken the body's local defenses, making tissue more susceptible to other pathogens. The implication is stark: a woman treated for HIV or screened for cervical cancer but never tested for FGS remains incompletely diagnosed and incompletely protected.
The researchers propose a straightforward solution: integrate FGS screening into existing sexual and reproductive health programs. A single genital sample could be tested for both HPV and FGS simultaneously, reducing the burden on patients and healthcare systems alike. Better training for healthcare workers, combined with new molecular and AI-assisted diagnostic tools, could make detection faster and more reliable. The approach recognizes that women's health is not neatly divided into separate diseases but exists as an interconnected whole.
One unexpected finding has added urgency to the call. Researchers detected zoonotic and hybrid schistosome species—parasites normally associated with livestock—in genital samples from infected women. This discovery raises troubling questions about how women are becoming infected, whether current treatments remain effective against these variants, and how disease control efforts should evolve. It also points toward a broader framework: what researchers call One Health approaches, which consider human, animal, and environmental health as a single system rather than separate domains.
Professor Russell Stothard, a medical parasitologist at LSTM, emphasized the need to move beyond treating diseases in isolation. The current fragmented approach, where HIV programs operate separately from cervical cancer screening, which operates separately from tropical disease control, is failing women in endemic areas. Continued neglect of FGS, the researchers warn, risks undermining broader global health goals around maternal health, cancer prevention, and HIV control.
What makes this call for integration particularly compelling is its practicality. The infrastructure already exists. Sexual health clinics, cervical cancer screening programs, and HIV services are already reaching women in affected regions. Adding FGS testing requires no entirely new system—only the will to recognize that the disease exists, that it matters, and that it belongs within the conversation about women's reproductive health. For 40 million women and girls, that recognition could mean the difference between a diagnosis that addresses only part of their risk and one that addresses it whole.
Notable Quotes
This paper highlights the urgent need to move beyond isolated disease-specific approaches and towards integrated care that recognizes the overlap between FGS, HIV, HPV and other reproductive health conditions.— Professor Russell Stothard, Professor of Medical Parasitology at LSTM
Female genital schistosomiasis remains one of the most neglected gynecological conditions affecting women and girls in Africa, routinely overlooked within both neglected tropical disease programs and wider sexual and reproductive healthcare services.— Professor Amaya Bustinduy, LSHTM
The Hearth Conversation Another angle on the story
Why has this disease been overlooked for so long if it affects so many people?
Partly because it's concentrated in regions with fewer resources to study and treat it, and partly because it doesn't fit neatly into existing disease categories. It's not acute enough to grab headlines, not well-known enough to drive funding, and it affects women—whose health concerns have historically received less attention.
The connection to HIV and cervical cancer seems like the real news here. How does tissue damage from one infection make you more vulnerable to another?
The parasite creates chronic inflammation and scarring in reproductive tissue. That damaged tissue is less able to mount a defense against other pathogens. It's like a wall with cracks—the barrier function breaks down, and other infections find an easier entry point.
If you can test for both FGS and HPV from a single sample, why hasn't that become standard practice?
Because FGS has been treated as a tropical disease problem, separate from reproductive health. The systems don't talk to each other. A cervical cancer screening program doesn't think to test for parasites. A tropical disease program doesn't think about cancer risk. Integration requires someone to say these things are connected—and to fund it.
What about those zoonotic parasites they found? What does that change?
It suggests women might be getting infected through animal contact or contaminated water in ways we didn't fully understand. It also means some infections might not respond to standard treatments. It's a reminder that you can't control a disease if you don't understand how it spreads.
Is this a problem that can actually be solved, or is it too entrenched?
It can be solved. The tools exist. The infrastructure exists. What's missing is the decision to treat FGS as part of women's health rather than as a separate tropical disease. That's a policy choice, not a technical barrier.