Abstract
Female genital schistosomiasis (FGS) remains a neglected sexual and reproductive health (SRH) condition, predominantly affecting women and girls in sub-Saharan Africa. Infection with Schistosoma haematobium, resulting in trapped parasite eggs in the genital tract, causes lesions that mimic sexually transmitted infections and cervical neoplasia, often leading to misdiagnosis, stigma and delayed treatment. This review summarises current developments on FGS burden, prevention, diagnostics, integration, policy, community engagement and identifies critical threats to progress. Ongoing surveys show promise in ensuring robust burden estimates and age-related risk data. Diagnostic advances include portable colposcopy, digital image analysis techniques and molecular assays, although limitations persist in resource-limited settings. Praziquantel remains the cornerstone of treatment, yet single-dose regimens inadequately reverse established lesions; repeated dosing shows improved parasite clearance but limited lesion regression, highlighting the necessity for early, life-course preventive chemotherapy including access to paediatric praziquantel. Successful programmatic pilots have developed training curricula, minimum service packages, community engagement tools and have integrated FGS care into SRH platforms. Policy momentum is building through World Health Organization taskforces and national strategies, yet sustainable financing remains a challenge. Key threats include bilateral aid reductions, climate change, emerging infections, rising healthcare costs and persistent gender inequities. To address these challenges, we propose seven priority actions, encompassing all health system building blocks, for the global community. Nationally coordinated, multisectoral efforts are urgently required to embed FGS prevention, diagnosis and management within broader health systems, thereby improving outcomes for affected women and girls.