Female genital schistosomiasis presenting with nonspecific symptoms: diagnostic challenges of vulvar schistosomiasis in a resource-limited setting—a case report

Schistosomiasis is a neglected tropical disease caused by trematode parasites of the genus Schistosoma. Female genital schistosomiasis (FGS), most often due to S. haematobium, is underdiagnosed and rarely involves the vulva. Its nonspecific manifestations frequently cause misdiagnosis in resource-limited settings. We report a 27-year-old multiparous Somali woman with an 11-month history of recurrent vulvar itching, persistent lesions, dyspareunia, and vaginal discharge. She was initially misdiagnosed with vaginal candidiasis without improvement. Examination revealed a firm vulvar lesion with localized edema. Laboratory tests showed eosinophilia, hematuria, leukocyturia, and pyuria. Histopathology of a vulvar biopsy confirmed S. haematobium ova with granulomatous inflammation. The patient was treated with praziquantel (40 mg/kg), achieving full symptom resolution and normalization of tissue architecture on follow-up biopsy. Vulvar schistosomiasis is an uncommon FGS manifestation. This first documented Somali case underscores the importance of considering FGS in persistent vulvar lesions in endemic regions.