Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain:a prospective population-based screening study

Background Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe.Male urogenital manifestations are often neglected.We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test.Methods We carried out a prospective,community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain.Schistosoma serology tests and microscopic urine examinations were carried out,and clinical data were obtained from an electronic medical record search and a structured questionnaire.Results We included 388 adult males,mean age 43.5 years[Standard Deviation(SD)=12.0,range:18-76].The median time since migration to the European Union was 17[Interquartile range(IQR):11-21]years.The most frequent country of origin was Senegal(N=179,46.1%).Of the 338,147(37.6%)tested positive for Schistosoma.Parasite eggs were present in the urine of only 1.3%.Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results:pelvic pain(45.2%;OR=1.57,95%CI:1.0-2.4),pain on ejaculation(14.5%;OR=1.85,95%CI:1.0-3.5),dyspareunia(12.4%;OR=2.45,95%CI:1.2-5.2),erectile dysfunction(9.5%;OR=3.10,95%CI:1.3-7.6),self-reported episodes of infertility(32.1%;OR=1.69,95%CI:1.0-2.8),haematuria(55.2%;OR=2.37,95%CI:1.5-3.6),dysuria(52.1%;OR=2.01,95%CI:1.3-3.1),undiagnosed syndromic STIs(5.4%),and orchitis(20.7%;OR=1.81,95%CI:1.0-3.1).Clinical signs tended to cluster.Conclusions Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results.Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin.Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.

A potential transition from a concentrated to a generalized HIV epidemic:the case of Madagascar

Background HIV expansion is controlled by a range of interrelated factors,including the natural history of HIV infection and socio-economical and structural factors.However,how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood.We aim to explore these mechanisms,using Madagascar as a case-study.Methods We developed a compartmental dynamic model using available data from Madagascar,a country with a contrasting concentrated epidemic,to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.Results The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022,and prevalence reaching stabilization by 2033 within 9 to 24%in the studied(10 out of 11)cities,similar to high-prevalence regions in Southern Africa.The late/slow introduction of HIV and circumcision,a widespread traditional practice in Madagascar,could have slowed down HIV propagation,but,given the key interplay between risky behaviors associated to young women and acute infections prevalence,mediated by transactional sex,the protective efect of circumcision is currently insufcient to contain the expansion of the disease in Madagascar.Conclusions These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic.This case-study model could help to understand how this HIV epidemic transition occurs.