title: The burden and determinants of reproductive tract infections in India: a population based study of women in Goa, India.
abstract: OBJECTIVE
  Reproductive tract infections (RTI) present major health, social, and economic problems in developing countries. Our objective was to describe the prevalence and risk factors of RTIs in a population based sample of women aged 18-45 years.
  
  
  METHODS
  2494 women of 3000 randomly selected from the population defined by a primary health centre catchment area consented to participate. Participants were interviewed regarding complaints and risk factors. Laboratory specimens were collected for the diagnosis of RTIs. Analyses of risk factors were carried out separately for the outcomes of sexually transmitted infections: chlamydia, gonorrhoea, trichomoniasis; and endogenous infections: bacterial vaginosis (BV) and candida.
  
  
  RESULTS
  Endogenous infections were relatively common (BV 17.8%; candida 8.5%), and sexually transmitted infections (STI) were infrequent (4.2%). Factors indicative of poverty and marginalisation were associated with STIs and BV. Gender disadvantage, particularly spousal violence, was associated with BV, while concern about a husband's extramarital relationships, an indicator of sexual risk, was associated with STI. Husband's discharge was strongly associated with STI, and a non-white vaginal discharge was associated with both STI and BV. Condom use and oral contraceptive use were associated with a reduced risk of BV.
  
  
  CONCLUSIONS
  Most of the population burden of RTIs is attributed to endogenous infections. Socioeconomic deprivation and gender disadvantage are associated with raised risk for BV, while the risk factors for STIs indicated that disadvantaged women were likely to be infected by their husbands.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. vikram.patel@lshtm.ac.uk
authors.forename: V
authors.initials: V
authors.lastname: Patel
authors.forename: H A
authors.initials: HA
authors.lastname: Weiss
authors.forename: D
authors.initials: D
authors.lastname: Mabey
authors.forename: B
authors.initials: B
authors.lastname: West
authors.forename: S
authors.initials: S
authors.lastname: D'Souza
authors.forename: V
authors.initials: V
authors.lastname: Patil
authors.forename: P
authors.initials: P
authors.lastname: Nevrekar
authors.forename: S
authors.initials: S
authors.lastname: Gupte
authors.forename: B R
authors.initials: BR
authors.lastname: Kirkwood
mesh_terms: D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology*; D012959:Socioeconomic Factors; D047568:Unsafe Sex