A neglected tropical disease that mimics sexually transmitted infections is slipping through clinical nets in sub-Saharan Africa—not because diagnostic tools are unavailable, but because the clinicians tasked with using them have rarely encountered formal training on the condition. That gap has measurable consequences for thousands of women living near major river systems in Ghana.
A cross-sectional survey of 237 healthcare workers drawn from 19 facilities near the Black and White Volta rivers in Ghana's Central Gonja District found that knowledge of urogenital schistosomiasis was strikingly low across the workforce. Only 30% of respondents demonstrated adequate understanding of schistosomiasis in general, and the figure dropped sharply to just 16.9% when assessed specifically on Female Genital Schistosomiasis (FGS)—its gynaecological presentation. Facilities were evaluated for the presence of functional screening equipment, and demographic variables including sex, cadre, and years of practice were cross-tabulated against knowledge scores using Pearson's chi-square analyses to identify which worker characteristics predicted competence.
FGS is caused by Schistosoma haematobium eggs lodging in vaginal and cervical tissue, producing sandy patches, contact bleeding, and lesions that are visually and symptomatically similar to sexually transmitted infections including HPV and chlamydia. This diagnostic overlap has long been flagged by the WHO as a barrier to appropriate case management. What this Ghanaian survey adds is granular, facility-level evidence of how deep the knowledge deficit runs in a high-endemicity setting. The findings are consistent with earlier work in sub-Saharan regions—Tanzania, Zimbabwe, Malawi—suggesting the problem is regional rather than country-specific. Crucially, misdiagnosis carries downstream harms: women with FGS treated repeatedly for STIs receive ineffective therapy and may face stigma, delayed praziquantel access, and elevated HIV susceptibility due to mucosal disruption. The study is observational and self-reported, limiting causal inference, but its programmatic implication is clear: praziquantel mass drug administration programs operating without parallel clinical training components are likely leaving the gynaecological burden of schistosomiasis largely unaddressed.