Diagnosis of genital cervical schistosomiasis: comparison of cytological, histopathological and parasitological examination.

Granulomatous inflammation of the cervix uteri is a common manifestation of infection with Schistosoma haematobium. In women the cervix is the most common site of infection by S. haematobium. Three methods were used to assess the performance of three different ways of detecting schistosome eggs in cervical tissue: cytological examination of a cervical smear, histological examination of a cervical biopsy, and direct examination of cervical tissue obtained by forceps biopsy (quantitative compressed biopsy technique [QCBT]). Of 228 women studied who lived in an S. haematobium endemic area in Tanzania, 112 (49%) had schistosome eggs detected in the cervix using QCBT. Histological examination detected eggs in 40 of 228 (18%). The cytological examination of cervical smears yielded only 6 positive results (3%). The median egg load in the cervical tissue of cases correctly diagnosed by histology was significantly higher than the egg load in the misclassified cases, indicating that the sensitivity of histological sectioning increases with egg density. We conclude that the QCBT is the diagnostic test of choice for schistosomiasis of the genital cervix.