Reproductive Tract Infections among Young Married Women in Tamil Nadu, India
Prasad, Jasmin Helen, Abraham, Sulochana, Kurz, Kathleen M., George, Valentina, Lalitha, M. K., John, Renu, Jayapaul, M. N. R., Shetty, Nandini, Joseph, Abraham, International Family Planning Perspectives
CONTEXT: Women often suffer silently with reproductive tract infections (RTIs). Studies of the prevalence of these infections in South Asia have been hindered by low participation rates, and little is known about rates among the youngest married women.
METHODS: A community-based cross-sectional study of RTIs was conducted in 1996-1997 among married women 16-22 years of age in Tamil Nadu, India. The women were questioned about symptoms, received pelvic and speculum examinations and provided samples for laboratory tests. Qualitative and quantitative data on treatment-seeking behavior were collected.
RESULTS: Fifty-three percent of women reported gynecologic symptoms, 38% had laboratory findings of RTIs and 14% had clinically diagnosed pelvic inflammatory disease or cervicitis. According to laboratory diagnoses, 15% had sexually transmitted infections and 28% had endogenous infections. Multivariate analysis found that women who worked as agricultural laborers had an elevated likelihood of having a sexually transmitted infection (odds ratio, 2.4), as did those married five or more years (2.1). Two-thirds of symptomatic women had not sought any treatment; the reasons cited were absence of a female provider in the nearby health care center, lack of privacy, distance from home, cost and a perception that their symptoms were normal.
CONCLUSIONS: Young married women in this rural Indian community have a high prevalence of RTIs but seldom seek treatment. Education and outreach are needed to reduce the stigma, embarrassment and lack of knowledge related to RTIs. The low social status of women, especially young women, appears to be a significant influence on their low rates of treatment for these conditions.
International Family Planning Perspectives, 2005, 31(2):73-82
Many women and men suffer from reproductive tract infections (RTIs), including sexually transmitted infections (STIs). An estimated 340 million new cases of curable STIs occur each year, with 151 million of them in South and Southeast Asia. (1) STIs are among the top five disease categories for which adults in developing countries seek health care, and about one-third of STIs globally occur among people younger than 25 years of age. (2)
RTIs often cause discomfort and lost economic productivity. (3) The most serious long-term sequelae arise in women: pelvic inflammatory disease (PID), cervical cancer, infertility, spontaneous abortion and ectopic pregnancy, the latter of which may lead to maternal death. (4) The presence of an STI increases the risk of acquiring and transmitting HIV infection by three to five times, (5) and bacterial vaginosis may be a cofactor for HIV transmission, especially among younger women. (6) Treatment of these infections and prevention of their sequelae are complicated by the fact that 30-50% of women with infections (up to 70-75% in the case of chlamydia), and a smaller but significant proportion of men, are asymptomatic. (7)
Young women are particularly susceptible to STIs because they have fewer antibodies to fight pathogens and greater cervical ectopy. (8) Adolescent women infected with Chlamydia trachomatis are more likely than their adult counterparts to develop cancer of the cervix or PID and, consequently, infertility. (9) Worldwide, the majority of new HIV infections occur among young people aged 15-24, and young women are about six times as likely to be infected with HIV as young men. (10)
Much of the available data on RTIs comes from hospital and clinic-based studies. Yet community-based studies, which are less commonly conducted, yield better estimates of prevalence, and several have been undertaken among women in South Asia, (11) as well as those in Egypt and Nigeria. (12) The South Asian studies had a common bias: Asymptomatic women were much less likely to participate (or were excluded in one study), and therefore a true prevalence estimate was not possible. …