Approximately 200 million persons are infected with schistosomes. Of those infected, a small proportion develop serious chronic disease, usually after years of intensive exposure and infection. Schistosoma mansoni and Schistosoma japonicum reside in the mesenteric veins and produce liver fibrosis, which results in portal hypertension and bleeding esophageal varices but little hepatocellular dysfunction. Schistosoma haematobium resides primarily in the pelvic veins and produces mass lesions in the bladder and ureters, which lead to hydroureter and hydronephrosis. The intensity of infection is a major factor determining development of disease, but differences in worm strain and host response may also be important. In acute schistosomiasis there is an intense response to the parasite, which is suppressed as the infection becomes chronic. The marked inflammatory response seen in early and acute schistosomiasis becomes less intense and fibrotic lesions predominate. The recent advent of safe, effective, and easily administered chemotherapeutic reagents will aid in the control of schistosomiasis.