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PubMedDate not supplied

Reproductive tract infection: an experience in rural West Bengal.

A community based cross-sectional study was conducted in the villages of Singur block, Hooghly district, West Bengal during September 2000 to February 2001. The objectives of the study were to find out the magnitude of Reproductive Tract Infections (RTI) among reproductive age group women, their knowledge about RTI and utilization of service available locally. Out of an estimated 896 women of reproductive age group in the study area, 186 women were selected by multistage random sampling technique. The study revealed that 66.1% respondents experienced one or more symptoms of RTI in four weeks recall period of this study. There was significant association (p < 0.01) between literacy status and their experiences of reproductive illness. 57% had knowledge about RTI. This increased gradually with increase of their ages (p < 0.01); literacy status (p < 0.01) and their socio-economic condition (p < 0.05). 27.6% of RTI patient did not receive any treatment, and majority of those received treatment (41.5%) sought advice from private practitioners.

Adolescent↗

PubMed2002

Reproductive tract infections among women attending primary health care facilities in Moshi, Tanzania.

OBJECTIVES: To determine the prevalence and risk factors for reproductive tract infections (RTIs), the frequency of asymptomatic genital tract infections, the frequency of genitourinary symptoms and signs and to assess their associations with vaginal and cervical infections. DESIGN: A cross sectional study carried out between September and December 1999. SETTING: Three primary health care centres in Moshi, Tanzania. SUBJECTS: A total of 382 consenting women attending Maternal Child Health (MCH) and Family planning clinics (FP). INTERVENTIONS: Women were interviewed and then pelvic examination was performed. Blood and genital specimens were collected for laboratory diagnosis of RTIs. RESULTS: Of the 382 women, 64% had-at least one RTI (33.9% bacterial vaginosis, 27% C. albicans, 21.2% T. vaginalis, 5% C. trachomatis, 4% syphilis and 0.5% N. gonorrhoea) and 26% had at least one STI. Nearly 43% of laboratory diagnosed RTIs were asymptomatic. Although none of the women had reported abnormal urogenital symptoms during routine clinical consultation, 64% revealed such symptoms on direct questioning. Reported genital symptoms and signs were significantly associated with vaginal, but not cervical infection. CONCLUSIONS: Curable RTIs are prevalent among women attending the MCH and FP clinics. Symptomatic infections were frequently not recognised or reported. We recommend introduction of routine RTI screening and treatment service in the MCH and FP clinics. Strategies to improve women's awareness and knowledge of urogenital symptoms should be instituted.

Adolescent↗

PubMed2004

Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru.

OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy.

Adolescent↗

PubMed1999

Reproductive tract infections among rural women in Meerut.

The present study was done among 500 women of reproductive age group. Study revealed overall prevalence rate of RTI of 44.8%. Excessive vaginal discharge was the most common presenting symptom (42.0%). Inspite of such an high prevalence of reproductive tract infections, only 22.8% of the women sought treatment for their problem. The study suggests to improve the awareness about RTI and its treatment facility among women and also recommends to develop a strategy to train and reorient the health personnel.

Adolescent↗

PubMed2002

[Utilization of health service in women with reproductive tract infections in urban and rural areas].

OBJECTIVE: To provide insight on psychosocial factors underlying utilization of health services of women whom perceived reproductive tract infection (RTI) symptoms. METHODS: A cross-sectional study, adopted Aday and Andersen's Social Behaviour Model was conducted in 1998 - 1999 in China. Hebei province and Beijing were purposely chosen as the research sites. All eligible married women aged 21 to 60, 864 subjects, were interviewed in person. RESULTS: Findings showed that the percentage of self-reported symptoms of RTIs was 35.6 in urban compared to 46.8 in the rural areas. The proportion of women with RTIs who utilized health services was 27.5 versus 26.7 percent among the two groups. Urban women, mostly 'white collar' class, with free medical service, satisfied with health providers, receiving information from health provider and having severe current experience RTIs, were more likely to use health services. Rural women, however, having both severe prior experience and current experience of RTIs, high family income, having much knowledge about self-medication, perceiving less social stigma of getting RTIs, and perceiving severity of RTIs, were more likely to use health services. CONCLUSION: These findings showed that there was a great need on providing culturally acceptable reproductive health education at different places so as to improve women's ability of self-care. Regular medical check-up for women is also important for improving the quality of health service. Reform on health insurance seemed necessary. Factors as social stigma related to RTIs, giving women social and moral support also need to be taken into account.

Adult↗

PubMed2005

Prevalence of and factors associated with reproductive tract infections among pregnant women in ten communes in Nghe An Province, Vietnam.

BACKGROUND: A community-based survey was conducted to investigate reproductive tract infections (RTIs) among pregnant women in Vietnam, where epidemiologic data on these infections are scarce. METHODS: The focus of the study were: candidiasis, bacterial vaginosis, group B streptococcal infection,trichomoniasis, gonorrhea, syphilis, and hepatitis B. In addition to their prevalence, a generalized estimating equation was used to analyze infection-associated factors and diagnostic test analysis to examine the accuracy of currently performed presumptive clinical diagnoses. RESULTS: Among 505 pregnant women in 10 communes, 182 (36%) had at least one infection with a wide regional variation in prevalence. The most prevalent infection was candidiasis (17%); sexually transmitted infections were rare except hepatitis B (10%); and the prevalence of bacterial vaginosis and group B streptococcal infections was 7% and 4%, respectively. Two factors were associated with the decreased risk of endogenous infections: a higher household assets score (odds ratio [OR] = 0.67) and condom use (OR = 0.15). Not living with a husband (OR = 1.55) was associated with an increased risk. For hepatitis B, three factors were associated with a decreased risk: employment by the government (OR = 0.26), higher education (OR = 0.18), and being older at the time of first sexual intercourse (OR = 0.58). Women's self-reported symptoms and clinical findings had low positive predictive values. Only clinical findings from the vaginal wall showed both a sensitivity and specificity over 50%. CONCLUSIONS: Suggested recommendations are: extensive application of microscopic diagnosis, prevention of hepatitis B transmission, and addressing the issues of regional differences in the prevalence of RTI and of less wealthy people.

Adult↗

PubMed2002

Health service needs of women with reproductive tract infections in selected areas of China.

OBJECTIVE: To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms. METHODS: A cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. RESULTS: The percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. CONCLUSION: The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

Adult↗

PubMed2001

Virulence factors of Escherichia coli isolated from female reproductive tract infections and neonatal sepsis.

OBJECTIVE: The presence of enterobacteria such as Escherichia coli in the vagina of normal women is not synonymous with infection. However, vaginal E. coli may also cause symptomatic infections. We examined bacterial virulence properties that may promote symptomatic female reproductive tract infections (RTI) and neonatal sepsis. METHODS: E. coli isolated as the causative agent from cases of vaginitis (n = 50), tubo-ovarian abscess (n = 45) and neonatal sepsis (n = 45) was examined for selected phenotypic and genetic virulence properties. Results were compared with the frequency of the same properties among fecal E. coli not associated with disease. RESULTS: A significantly greater proportion of infection E. coli exhibited D-mannose resistant hemagglutination compared with fecal E. coli (p < 0.01). This adherence phenotype was associated with the presence of P fimbriae (pap) genes which were also significantly more prevalent among isolates from all three infection sites (p < 0.01). The majority of pap+ isolates contained the papG3 allele (Class II) regardless of infection type. Increased frequency of Type IC genes among vaginitis and abscess isolates was also noted. No significant differences in frequency of other bacterial adherence genes, fim, sfa, uca (gaf or dra were observed. E. coli associated with vaginitis was significantly more likely to be hemolytic (Hly+) than were fecal isolates (p < 0.05). The Hly+ phenotype was also more prevalent among tubo-ovarian abscess and neonatal sepsis isolates (p < 0.08). CONCLUSIONS: E. coli isolated from female RTI and neonatal sepses possess unique properties that may enhance their virulence. These properties are similar to those associated with other E. coli extra-intestinal infections, indicating that strategies such as vaccination or bacterial interference that may be developed against urinary tract infections (UTI) and other E. coli extra-intestinal infections may also prevent selected female RTI.

Bacterial Adhesion↗

PubMed1998

Sexually transmitted diseases and reproductive tract infections among contraceptive users.

OBJECTIVE: To establish the association between the use of contraceptives and the prevalence of sexually transmitted diseases (STD) and other reproductive tract infections (RTI). METHODS: 840 women who used contraception and who attended the Fundação Nossa Senhora do Bom Sucesso's Family Planning Clinic (FNSBS-FPC) over a 2-year period (1993-1994) were studied. All women answered a standard epidemiological survey and underwent a clinical laboratory assessment. The Chi-square test and a logistic regression model were used for statistical analysis. RESULTS: The majority of women were young (58.7%); low educational achievers (59.0%); middle or working class (85.0%); had a fixed partner (79.8%), and were of non-African origin (95.6%). Of the 627 women who responded, 4.1% stated that their sexual behavior was of high risk. The prevalence of any infection and particularly of bacterial vaginosis (BV), was highest among users of the intra-uterine device (IUD). Use of an IUD (P = 0.001) and high risk behavior (P = 0.04) were the variables associated to presence of a STD/RTI in multiple regression analysis. CONCLUSION: Results suggest that STD/RTIs basically occur due to high risk behavior and that, with the exception of an association between use of IUD and BV, the method of contraception does not affect the incidence of these infections.

Adult↗

PubMed1997

Reproductive tract infections--and associated difficulties.

In addition to financial constraints there are significant social, educational, moral and religious barriers to the prevention and treatment of reproductive tract infections in rural India. A pilot project aimed at achieving progress in this field is reported below.

Adult↗

PubMed2002

Reproductive tract infections and the risk of HIV among women in Moshi, Tanzania.

OBJECTIVES: The objectives of the study were to determine the prevalence of HIV and reproductive tract infections (RTIs); to compare the occurrence of RTIs among HIV-infected and non-infected women; and to assess the association of HIV with RTIs and behavioral factors among women aged 15-49 years. METHODS: A cross-sectional study was conducted in late 1999 among 382 consenting women attending three primary healthcare clinics. They were interviewed and screened for HIV-1 and RTIs. RESULTS: The prevalence of HIV-1 was 11.5%. Sixty-four percent of the women had one ongoing treatable RTI. Endogenous and sexually transmitted RTIs were higher in HIV-positive than negative women and 84% of the HIV seropositive women were co-infected with one treatable RTI. HIV was significantly associated with cervicitis (chlamydial or gonococcal) [OR = 3.2 (CI 1.1-13.2)], HSV-2 [OR = 2.6 (CI 1.3-5.1)], bacterial vaginosis [OR = 1.9 (CI 1.1-4.1)], genital warts [OR = 4.8 (CI 1.1-22.2)], and presence of vaginal discharge [OR = 2.7 (CI 1.3-5.2)]. Having more than one lifetime sexual partner, a history of infant mortality or a partner who had other wives or resided away from home > 6 months, were risk factors for HIV infection. CONCLUSION: HIV-1 and RTIs are a major public health problem among women in this population. Integration of routine screening and treatment of RTIs in the reproductive health clinics will be an important strategy to combat HIV in the area. Further, innovative behavior interventions targeting both men and women, preferably as couples are needed.

Adolescent↗

PubMed1991

Phospholipase C activity in microorganisms associated with reproductive tract infection.

Phospholipase C (lecithinase or phosphatidylcholine phosphorylase) catalyzes the hydrolysis of lecithin into phosphorylcholine and 1,2-diglyceride. Bacterial production of phospholipase C may damage reproductive tract tissues by both direct and indirect mechanisms. Use of the synthetic substrate p-nitrophenylphosphorylcholine phospholipase C activity was determined in 204 isolates representative of those found in female genital tract. Multiple aerobic (28%) and anaerobic (28%) reproductive tract microorganisms showed phospholipase C activity. Phospholipase C-producing isolates included strains of Bacteroides fragilis, B. bivius, B. thetaiotaomicron, Gardnerella vaginalis, and group B streptococcus. Phospholipase C activity was heterogenous; not all isolates that belong to a particular species showed activity. Phospholipase C production may be a possible virulence factor produced by a number of microflora commonly implicated in various reproductive tract infections or conditions, as well as in some instances of preterm birth.

Bacteria, Aerobic↗

PubMed2004

Self-reported symptoms of reproductive tract infections among rural women in Hainan, China: prevalence rates and risk factors.

OBJECTIVES AND GOAL: The goal of this study was to examine risk of reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic practices, attitudes, and behaviors related to premarital and extramarital sex, and abortion. STUDY: During 2000, a stratified cluster sample of 606 rural married women in Hainan province completed an interviewer-administered standardized questionnaire. RESULTS: Overall, 39% of participants reported at least 1 RTI symptom in their lifetime and 20% during the past 6 months. Having had premarital sex, having sex during menstruation, belonging to an ethnic minority, being knowledgeable about RTIs, and living in a village at medium economic level were all related to having RTI symptoms. CONCLUSION: Among married women in rural China, the prevalence of RTI symptoms was high, indicating the need for health education, particularly targeting women from ethnic minorities and resource-poor areas.

Adolescent↗

PubMed2001

HIV seroprevalence and its associations with the other reproductive tract infections in asymptomatic women in Harare, Zimbabwe.

The objective was to determine the magnitude of HIV as well as the associations between HIV seropositivity with reproductive tract infections (RTIs) among healthy women in Harare, Zimbabwe. In a cross-sectional study, 393 informed consenting women aged 15--49 years, attending 2 primary healthcare clinics, were interviewed and screened for HIV and RTIs. HIV seroprevalence was 29.3%. Seropositivity was significantly associated with bacterial vaginosis, syphilis, gonorrhoea and/or Chlamydia trachomatis infection, warts and genital ulcers. Risk factors for HIV were absence of lactobacilli in vaginal fluid, vaginal pH >4.5, age >20 years, being unmarried, having had more than one lifetime sexual partner, having used a condom at least once in their lifetime, having experienced an infant mortality, and a partner who was non-monogamous or a frequent traveller. In view of the very high seroprevalence and concomitant RTIs in this population, we recommend promotion of women-controlled prevention methods along with proactive detection and treatment of RTIs.

Adolescent↗

PubMed2007

Prioritizing health problems in women in developing countries: comparing the financial burden of reproductive tract infections, anaemia and depressive disorders in a community survey in India.

OBJECTIVES: To compare the health care and opportunity costs of three common health problems [depressive disorders, reproductive tract infections (RTIs) and anaemia] affecting women and their associated risks of catastrophic health expenditure (defined a priori as out-of-pocket expenditure on health care exceeding 10% of the total monthly household income). METHODS: Cross-sectional survey of 2494 women who consented to participate, from a randomly selected sample of 3000 women aged 18-50, living in the catchment area of a primary health centre in Goa, India. Depressive disorders were diagnosed with the Revised Clinical Interview Schedule; anaemia on the basis of a fingerprick sample of blood using the Haemocue system; and RTI using PCR, culture and microscopy with vaginal or urine specimens. Economic consequences were measured using the Costs of Illness Schedule and the WHO Disability Assessment Schedule. Health provision costs were calculated using previously derived unit costs for services for the main types of health care provider. RESULTS: Catastrophic health expenditure, defined a priori as >10% of total household income spent out of pocket on health in the previous month, was reported by 138 women (5.5%; CI: 4.7-6.5%); they were more likely to report economic difficulties, such as having gone hungry in the past 3 months because of lack of money (OR 1.99, CI 1.1-3.6, P = 0.02). Only depressive disorder was associated with significantly higher health care costs, lost time costs and risk of catastrophic health expenditure (OR 2.66, CI 1.6-4.4, P < 0.001, after adjustment for possible sociodemographic confounders and other physical health problems). There was a linear association between the psychological morbidity score (arranged into quintile groups) and the risk of catastrophic health expenditure (adjusted). CONCLUSIONS: If economic arguments were considered a key driver for global health policy, then depressive disorder should be considered a major health priority for women in developing countries.

Adolescent↗

PubMed1998

Reproductive tract infections in primary healthcare, family planning, and dermatovenereology clinics: evaluation of syndromic management in Morocco.

OBJECTIVE: To determine where and with what symptoms women seek care for reproductive tract infections (RTI) in Morocco and to guide allocation of resources for training and treatment for RTIs. METHODS: A primary healthcare centre (PHC), a family planning centre (FPC), and a specialty dermatovenereology clinic (SC) were selected in each of three urban areas. Women with symptoms of vaginal discharge, lower abdominal or pelvic pain, or genital lesions (genital ulcer or warts) underwent interviews, physical examinations, serological testing for human immunodeficiency virus (HIV) and syphilis, and collection of vaginal fluid for microscopic examination, and urine for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) by ligase chain reaction (LCR). RESULTS: Over 8 months, 1238 women enrolled, including 61.8% at PHCs, 34.8% at FPCs, and 3.4% at SCs. Overall, 54% complained of vaginal discharge, of whom 8.8% had GC or CT infection and 30.1% had trichomoniasis (TV) or bacterial vaginosis (BV); 24.9% complained of lower abdominal pain with or without vaginal discharge, of whom 7.3% had GC or CT and 22.6% had TV or BV. GC or CT infections were found in 10.1% of PHC and 5.4% of FPC patients; while TV and/or BV infections were found in 28.7% and 22.8%, respectively. GC or CT infection was associated with perceived risk behaviours of the male partner (for example, belief partner is unfaithful) more often than with reported risk behaviours of the women themselves. For vaginal infections, a modified World Health Organisation (WHO) test algorithm for vaginal discharge involving risk assessment plus speculum and bimanual examination was 98.0% sensitive at PHCs and 90.8% at FPCs, with positive predictive value (PPV) of 33.4% at PHCs and 26.8% at FPCs. For GC or CT infections this algorithm was 60.6% sensitive at PHCs and 85.7% sensitive at FPCs; but PPV was only 9.9% and 9.0% respectively, little higher than the background prevalence of these infections. An RTI algorithm (Morocco specific) had comparable sensitivity and PPV for vaginal infection, and for cervical infection was less sensitive but had much higher PPV (26.9% for PHCs and 26.7% for FPCs). CONCLUSION: Women with complaints of vaginal discharge and/or lower abdominal pain presented to PHC and FP clinics, not to SCs. PHCs and FPCs should therefore receive resources for management of vaginal discharge. Both the test algorithm and the new RTI algorithm were useful in allocating treatment for vaginal infection, but only the RTI algorithm discriminated in selecting women with cervical infection. Even with the RTI algorithm, which limited treatment for cervical infection to risk assessment positive patients with signs of cervical infection or PID, the PPV for cervical infection was low, potentially resulting in frequent overtreatment and problems of partner notification.

Adolescent↗

PubMed1997

[The study on the epidemiological features and risk factor of Chlamydia trachomatis reproductive tract infection (CTRTI) among 664 married women at reproductive age in rural areas].

The infection rate and risk factors of CTRTI among 664 married women at reporductive age in rural areas in Chengjiang county, Yunnan province were investigated. Specimens of cervical swab were detected for CT antigen using Chlamydia EIA(Syva co., USA). The selection of major risk factors was through Logistic regression and chi 2-test. The results showed that the overall infection rate of CTRTI was 5.0%, with 60.6% of these cases asymptomatic. The major risk factors include: spouse who has symptoms of RTIs; history of others vaginitis; divorce; habit of washing face, feet and vulva with the same wash basin; age of menarche; amenorrhoea during lactation; low education and living in poverty.

Adult↗

PubMedDate not supplied

Physician-patient communication in the prevention of female reproductive tract infections: some limitations.

The objective of this study was to describe the information that women with tubal infertility recalled having received from physicians when they consulted for a reproductive tract infection (RTI) and the information physicians reported having provided to women consulting for RTIs. Interviews were conducted with 16 women presenting primary tubal infertility selected on the basis of purposeful sampling criteria. Also, 15 physicians working in the public health network in the city of Campinas, Brazil, were selected at random and interviewed. Analysis of the women's statements concerning previous RTI-related medical consultations showed that they did not recall having received any information on either prevention or the impact of RTI on their reproductive future. Analysis of interviews with physicians showed that the information they provided to women consulting for RTIs was incomplete and unclear. The information women recalled having received and that which physicians remembered having provided at the time of treating a patient with RTI was similar. In conclusion, these women lacked adequate or complete information and that it was probably not possible for them to adopt measures to avoid repetition of RTI and minimize risk of tubal infertility.

Adult↗