Sex-Based Differences in Imported Schistosomiasis among Sub-Saharan African Migrants in Spain

Schistosomiasis remains a significant but frequently underrecognized parasitic infection among migrants from endemic regions living in Europe. A retrospective cross-sectional study of sub-Saharan African migrants diagnosed with schistosomiasis was conducted at a referral center in northern Spain between 2012 and 2023. Cases were primarily defined by positive serological results, with parasitological confirmation available only in a minority of patients. The aim was to describe demographic, clinical, and diagnostic characteristics, with particular attention to sex-based differences. Among 538 screened individuals (52.8% men), 121 (22.5%) were diagnosed with schistosomiasis, including 59 women (48.7%). The mean age was 33 ± 14 years. Women had a longer duration of residence in Spain before diagnosis compared with men (39 ± 59 versus 30 ± 37 months; P = 0.037). Most patients were asymptomatic (62.7% of women and 58% of men). Hematuria was observed exclusively in men (P = 0.001), with bladder abnormalities confirmed in two cases. Among 33 women with available gynecological history, 60.6% reported reproductive tract morbidity, including recurrent miscarriage and infertility. These findings highlight the substantial burden of imported schistosomiasis among migrants from sub-Saharan Africa and reveal clinically relevant sex-related differences in presentation and associated conditions. The study results support the need for targeted screening strategies in nonendemic settings and emphasize the importance of incorporating reproductive health assessment into the evaluation of women with suspected schistosomiasis.