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.


RESULTS
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.


CONCLUSIONS
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.
García
Patricia J
PJ
Center for AIDS and STDs, University of Washington, Harborview Medical Center Box 359931, Seattle, WA 98104, USA.
Chavez
Susana
S
Feringa
Barbara
B
Chiappe
Marina
M
Li
Weili
W
Jansen
Kathrin U
KU
Cárcamo
César
C
Holmes
King K
KK
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007239:Infections / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology; D011795:Surveys and Questionnaires