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Background  Female genital schistosomiasis (FGS) is a neglected tropical gynaecological disease that affects millions of women in sub-Saharan Africa (SSA). FGS is caused by  Schistosoma haematobium , a parasitic carcinogen involved in the pathogenesis of squamous cell carcinoma of the bladder. Cervical cancer incidence and mortality are highest in SSA, where pre-cancerous cervical dysplasia is often detected on screening with visual inspection with acetic acid (VIA). There are no studies evaluating the association between VIA positivity and FGS diagnosed by genital PCR.    Methods  Women were recruited from the Bilharzia and HIV (BILHIV) study in Zambia a community-based study comparing genital self-sampling to provider obtained cervicovaginal-lavage for the diagnosis of FGS in women aged 18–31. FGS was defined as positive  Schistosoma  DNA from any genital PCR. Urogenital schistosomiasis diagnostics included urine circulating anodic antigen, urine microscopy and portable colposcopy. Participants were offered cervical cancer screening using VIA at Livingstone Central Hospital. Associations of PCR confirmed FGS and other diagnostics with VIA positivity were assessed using multivariable logistic regression.    Results  VIA results were available from 237 BILHIV participants. A positive  Schistosoma  PCR in any genital specimen was detected in 14 women (5.9%), 28.6% (4/14) of these women had positive VIA compared to 9.0% without PCR evidence of schistosome infection (20/223).  Schistosoma  PCR positivity in any genital specimen was strongly associated with VIA positivity (OR: 6.08, 95% CI: 1.58–23.37,  P  = 0.02).    Conclusions  This is the first study to find an association between FGS and positive VIA, a relationship that may be causal. Further longitudinal studies are needed.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12879-021-06380-5.

Association between cervical dysplasia and female genital schistosomiasis diagnosed by genital PCR in Zambian women