Female genital schistosomiasis, including zoonotic and hybrid schistosomes, and other cervicovaginal co-infections

In sub-Saharan Africa, adult women and adolescent girls face a high burden of genital tract co-infections, either by sexual or non-sexual transmission route. Distinguishing between these modes of transmission has important implications for diagnosis and treatment and is particularly relevant for community perceptions and associated stigma. Causative pathogens and parasites include a wide spectrum of organisms, including bacteria, viruses, fungi, protozoans, and helminths. Understanding shared risk factors, overlapping geographical distribution, and potential biological interactions between these infections is paramount for an integrated approach to prevention, management, and control of genital co-infections in African women. This Series paper assesses one of the most neglected and least understood genital infections, female genital schistosomiasis (FGS), mainly caused by the waterborne parasitic helminth Schistosoma haematobium. We explore current evidence on its interactions with other genital infections, including those acquired by sexual transmission (HIV and human papillomavirus) and non-sexual transmission (bacterial vaginosis and vulvovaginal candidiasis). We highlight the emerging role of zoonotic and hybrid Schistosoma species in FGS and consider their potential clinical implications. Opportunities to integrate FGS into broader sexual and reproductive health frameworks are explored within shared diagnostic tools and combined treatment strategies, with the ultimate goal of improving clinical care for affected women.