Isothermal recombinase polymerase amplification based diagnostics for female genital schistosomiasis and human papillomavirus: a review of combined molecular diagnostic opportunities

Women in sub-Saharan Africa face complex, multifaceted challenges to their health, including a high burden of infectious diseases aggravated by socioeconomic factors. Parasitic and sexually transmitted infections both cause significant morbidity and mortality. Co-infections compound these effects, leading to high rates of chronic illness and making diagnosis and treatment challenging. There are no integrated approaches for the detection of female genital schistosomiasis (FGS), a gynaecological condition caused by <i>Schistosoma haematobium</i>, and high-risk human papillomavirus (HR-HPV), responsible for over 90% of all cervical cancer cases worldwide. FGS is a chronic condition with health outcomes such as infertility and abortion and remains severely under-reported. HR-HPV infection is the main aetiological agent of cervical cancer, the leading cause of cancer death in women in sub-Saharan Africa. Both can be disabling and stigmatizing to the sufferer. A key to disease management at patient and community levels is accurate and available diagnostics. Due to both FGS and HPV diagnostics utilising cervicovaginal samples, they are ideal candidates for a multiplex molecular diagnostic. The standard molecular diagnostics (namely PCR), through the detection of pathogen DNA, are constrained in low resource settings by requirement of a highly reliable source of energy, reliance on a cold-chain, and prohibitive costs. Isothermal molecular diagnostics are an alternative method to PCR that are more suited to basic settings. This review explores current isothermal diagnostics, with a focus on RPA/RAA, a very simple isothermal technology, for FGS and HPV and proposes the development of a multiplex isothermal diagnostic test to enable integrated screening.