Human schistosomiasis (bilharzia) is a terminology that is utilized for a parasitic disease which is prevalent within in tropical areas of the world. [1] Even though the clinical manifestations on the urinary or gastrointestinal tracts are widely known, many clinical health-care professionals would presumably not be aware of the genital manifestations of Schistosomiasis which are often inadvertently ignored or underestimated and for this reason the diagnosis of Schistosomiasis of the genital tract system in the male could either be delayed or the diagnosis could be missed completely. Schistosoma haematobium is the main species causing genital manifestations but other species of schistosomiasis had been implicated. The number of people who suffer from genital manifestations is not known precisely. [WHO] It has been iterated that the biological plausibility of a causal association between genital schistosomiasis and Human Immunodeficiency Virus (HIV) had been documented, and it might be a pertinent factor in increasing the risk of contracting HIV within areas or communities where both infections are contemporaneously co-endemic. The clinical manifestations of genital schistosomiasis are encountered both in women and in men. With regard to men, Schistosomiasis of genital organs could be asymptomatic and the diagnosis may be made incidentally in post-mortem specimen examinations of genital organs and on other occasions Schistosomiasis of the genital symptoms may manifest non-specific symptoms that are more commonly associated with more common diseases of the genital system. Some of manifestations tend to simulate the symptoms and signs of epididymitis / epididymoorchitis, hydrocoele, testicular tumour, haematospermia, infertility, azoospermia, raised serum prostate specific antigen levels that may be suggestive of possible prostatitis and carcinoma of the prostate gland and Schistosomiasis of genital tract organs in the male could  simulate the manifestations of tuberculosis and associated funiculitis, indolence and possible fistulisation, dysuria and lower urinary tract symptoms. With regard to women, the manifestations of genital tract Schistosomiasis has tended to be non-specific due to the fact that could provoke gynaecological ailments. The most frequently observed manifestations include: lower abdominal and pelvic pain as well as loin pain presenting in forms such as dyspareunia, dysmenorrhea, leucorrhoea, menstrual disorders, post-coital bleeding or simple contact bleeding upon examination, cervicitis, endometritis and salpingitis. The disease most often manifests in a chronic manner. These genital lesions could cause complications such as early abortion, ectopic pregnancy and infertility. Genital schistosomiasis might be associated with the presence of schistosome eggs (ova) within the genitals in both men and women. Nevertheless, Schistosoma ova are not always contemporaneously present, and current laboratory methods have a low sensitivity to confirm their presence. Lesions that are associated with genital schistosomiasis may simulate host of infections and premalignant or malignant conditions. It is therefore crucial to identify alterations which are pathognomonic of Schistosomiasis. Differential diagnoses of Schistosomiasis must be undertaken systematically to screen for cancers including cancers of the vulva, vagina, cervix, endometrium, sexually transmitted infections and urogenital tuberculosis. Clinical diagnosis of female genital schistosomiasis is mainly undertaken by visual inspection and histological examination of biopsy specimens obtained from the cervix, vagina, or pelvis mass demonstrating Schistosomes. Cases of infertility may be associated with Schistosomiasis of genital organs in the male alone, female alone or both male and female. WHO has pointed out that treatment with praziquantel kills the adult worms and does provide relief and regression of inflammatory lesions. Few studies had reported that praziquantel has no effect on established grainy lesions. Nevertheless, elimination of adult worms does prevent further egg deposition within the tissues and thus prevents the development of new lesions. Early treatment, especially in childhood, is regarded as the most effective intervention to prevent the occurrence and development of complications associated with urogenital schistosomiasis.

The widespread lack of awareness of genital schistosomiasis leads to misdiagnosis and, therefore, false and ineffective therapy. As female genital schistosomiasis is rarely diagnosed correctly, knowledge about the effect of treatment is also scanty. Incorrect diagnostic of genital schistosomiasis lesions frequently leads to debilitating and irreversible operations such as oophorectomy, salpingectomy and hysterectomy. It is therefore of utmost importance to sensitize health workers and raise awareness of urogenital schistosomiasis, particularly in endemic countries. The World Health Organization (WHO) has iterated that regular therapy with praziquantel from an early age prevents schistosomiasis from progressing to genital damage and other related complications. In endemic areas, WHO recommends regular large-scale administration of preventive chemotherapy to entire communities or routinely in health facilities. Other anti-Schistosoma medicaments are available for treating Schistosomiasis. The public health advantages of anthelminthic treatment with praziquantel go beyond the simple benefits of curing schistosomiasis and preventing its related genital morbidity. Regardless of the presumptive causal association with HIV infection, urogenital schistosomiasis is a disabling disease by itself, and it should be prevented with the currently available means. The WHO recommended policy of regularly treating school-age children with praziquantel should be reinforced and extended, to involve collaborations with programmes for preventing HIV and other sexually transmitted infections. A past history of having had treatment for Schistosomiasis does help in alerting clinicians to the possibility of Schistosomiasis of the genital tract in patient who manifest with non-specific symptoms related to the genital tract in males and females as well as patients who manifest with lesions that look like testicular tumour, hydrocoele, epididymoorchitis and infertility in order to avoid the undertaking of unnecessary mutilating surgery. The ensuing article on Schistosomiasis of the scrotum, scrotal contents and prostate gland has been divided into two parts: (A) Overview which has discussed general aspects related to Schistosomiasis of the genital tract and (B) Miscellaneous Narrations and Discussions Related to Schistosomiasis of the scrotum and scrotal contents, prostate gland with a focus on the male genital tract.

Aim

To review and update the literature on Schistosomiasis of the scrotal contents and prostate gland including the scrotal skin, testis, seminal vesicle, epididymis, spermatic cord, prostate gland and infertility in men.