Schistosomiasis is the second most common socio-economically devastating 
parasitic disease after malaria, affecting about 240 million residents of 
developing countries. In Africa, it predominantly manifests as urogenital 
disease, and the main infective agent is Schistosoma hematobium. Endemicity is 
propagated by poor socio-economic status and environmental degradation due to 
rapid urbanization. Recreational swimming is a potent medium for the spread of 
disease in children and adolescents. Most affected individuals are asymptomatic. 
The male and female worms are equipped with an extraordinary capacity for immune 
evasion and are able to co-habit for several decades within the pelvic venous 
plexus. Eggs deposited in the bladder wall resist elimination by type 1 T 
lymphocytes. Instead, they are sustained by pro-fibrogenic encapsulation (as 
modulated by type 2 helper cells). Progressive bladder disease results in 
obstructive uropathy and predisposes to (mostly) squamous cell carcinoma. 
Schistosomal glomerulopathy manifests as a clinical spectrum of asymptomatic 
proteinuria, nephrosis and/or nephritic syndrome. Findings on renal biopsy may 
be influenced by co-morbidity with Salmonella bacteria, amyloidosis and 
hepatitis C infection. Potentially fatal Katayama fever and spinal radiculopathy 
may ensue in tourists visiting an endemic zone. Early detection by urine 
microscopy is hampered by low urinary excretion rates of the parasite eggs. 
Although useful in travelers with newly acquired disease, the results of the 
serological antibody assay may be false positive in residents of an endemic 
zone. Cystoscopy, however, may be invaluable. Due to its safety, effectiveness 
and once-daily dosing, praziquantel is the drug of choice. An integrated 
approach that includes mass chemotherapy, environmental health programs and 
public health education is the most cost-effective preventive strategy.