Reproductive tract infections, gynaecological morbidity and HIV seroprevalence among women in Mumbai, India

Abstract

Reported are the prevalence of reproductive tract infections and their contribution to pelvic inflammatory disease (PID), as well as the seroprevalence of human immunodeficiency virus (HIV), among women living in three inner city wards of Mumbai, India. Women aged < or = 35 years were recruited and screened as cases if they had been admitted to hospital for gynaecological investigation for suspected PID (n = 151) or infertility (n = 295); controls were healthy fertile women attending for laparoscopic tubal ligation (n = 2433). The women were mainly of low socioeconomic status. A total of 59.4% were migrants and 14.9% of these came to Mumbai to seek treatment. Cases reported a history of adverse pregnancy outcomes significantly more often than controls, and 30.5% of suspected PID cases had previously undergone laparoscopic tubal ligation. At examination 24.2% of cases and 8.4% of controls had a vaginal discharge. Pelvic infection was confirmed in 42.0% of suspected PID cases and 14.6% of infertile cases for whom diagnostic laparoscopy was performed. The prevalence of sexually transmitted diseases was low: Chlamydia trachomatis was found in 0.2%; and Neisseria gonorrhoeae was cultured from the cervix in only four cases. Neither of these infections was detected in laparoscopic aspirates. The prevalence of HIV1/2 infections in unlinked samples was 1.9%. Sexually transmitted diseases were not major factors leading to gynaecological morbidity. Heterosexual spread of HIV infection to this population of married women is still relatively low but needs to be carefully monitored. The gynaecological morbidity detected may be a consequence of widespread use of invasive methods of fertility regulation.

PIP: A case-control study conducted in 1993-95 among women 35 years of age and younger living in three inner-city wards of Mumbai, India, investigated the prevalence of reproductive tract infections and their contribution to pelvic infection. Enrolled as cases were 151 women admitted to the hospital with suspected pelvic inflammatory disease (PID) and 295 infertile women; 2433 healthy fertile women undergoing laparoscopic tubal ligation served as controls. Adverse pregnancy outcomes were reported significantly more often by cases than controls. 31.8% of suspected PID cases, 9.1% of infertile women, and 53.1% of tubal ligation patients reported ever-use of a contraceptive method, primarily a copper IUD. At examination, 24.2% of cases and 8.4% of controls had a vaginal discharge. Pelvic infection was confirmed in 42.0% of suspected PID cases and in 14.6% of infertile women in whom diagnostic laparoscopy was performed. HIV prevalence was 1.9% in unlinked samples. The prevalence of other sexually transmitted diseases (STDs) was under 1%. The gynecologic morbidity recorded in this study is presumed to be a result of widespread use of invasive methods of fertility regulation, not STDs.