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Recent years have witnessed a growing concern about the reproductive tract infections (RTI), especially those that are sexually transmitted. The serious threat of AIDS has further drawn attention to the importance of RTI/sexually transmitted diseases (STD),1 especially in developing countries like India where RTI diagnosis and treatment facilities are extremely limited. Women with RTI are asymptomatic, which if undetected or untreated can lead to complications in the index woman. It is, therefore, worthwhile screening of all women of reproductive age for various RTI so that appropriate interventions can be planned and initiated.
We analysed a total of 2526 women attending the antenatal outpatient department of obstetrics and gynaecology of Nehru Hospital attached to Post Graduate Institute of Medical Education and Research, Chandigarh, for screening of RTI during a 3 year period. This project was approved by the institute’s ethics committee. The women were divided into six groups based on clinical histories and various signs and symptoms: group I, pregnant women (n = 600); group II, contraceptive advice seekers (n = 378); group III, contraceptive users (n = 525); group IV, women with infertility (n = 464); group V, women with leucorrhoea (n = 288); group VI, women with a diagnosis of pelvic inflammatory disease (n = 271). Endocervical swabs were collected from all patients and were sent to the microbiology laboratory for Gram stain and culture of Neisseria gonorrhoeae (New York city medium). ELISA was also carried out for antigen detection of N gonorrhoeae (Abbott laboratories) and Chlamydia trachomatis (Chlamydia CELISA, Cellabs Pvt, Ltd, Brookvale, Australia). Venous blood was collected from all women, sera were separated and stored at −20°C till further use. Sera were subjected to the standard Venereal Disease Research Laboratory (VDRL) test and Treponema pallidum haemagglutination (TPHA) test (Serodia-TPHA, Fujirebio Inc, Tokyo, Japan) for syphilis, enzyme linked immunosorbent assay (ELISA) for HbsAg (Auszyme Monoclonal, Abbott Laboratories, USA), and HIV (HIV-1/HIV-2 third generation plus EIA, Abbott Laboratories, USA). Western blot was done if ELISA for HIV was positive.
The mean age of the women in the study group was 30.6 years and the parity ranged from 1 to 6. Overall, seroprevalence of RTI in various groups was 1.82% (n = 46/2526). Each of syphilis and hepatitis B infection were found in 17 women (0.67%), followed by C trachomatis in 11 (0.43%) and HIV seropositivity in one (0.02%) (table 1). Though figures of RTI were quite low, all the infections were more common in the pregnant group compared to the other groups. However, surprisingly, N gonorrhoeae was not found in any of the women.
Our study reveals that the prevalence of RTI, especially those that are sexually transmitted, is low. Similarly low prevalence of RTI has been reported from Thailand2 and Bangladesh.3 Moreover, a very low prevalence of HIV has earlier been reported from Chandigarh.4 This is in contrast with studies from the developing world, where prevalence rates ranging from 30–40% have been reported.5–7 Even the low risk populations have a prevalence ranging between 15–20%.8 The low prevalence in this region is attributed to the better personal hygiene, environmental conditions, healthy sexual behaviour and good socioeconomic status of the patients residing in this area. However, ours is a tertiary care centre and most cases had been treated before they were referred to this hospital. However, even at such a low prevalence, there are still likely to be cost effective interventions for RTI prevention and care—for example, screening of pregnant women for syphilis may be cost effective when prevalence is 1% in this population.