Housewives not immune to STDs

JAKARTA (JP): Women with reproductive tract infections are often suspected of being sex workers, who are at a high-risk of contracting sexually transmitted diseases (STDs). Many housewives, however, believe they have nothing to worry about getting similar infections.

The newly revealed truth is that although housewives are in the low-risk category, "good" housewives are vulnerable to sexually transmitted diseases and reproductive tract infections -- which are being increasingly recognized as a serious global health problem with impact for individual women and men, their families and communities.

The infections can have severe consequences, including infertility, abnormal pregnancy, chronic pelvic pain, miscarriages and increased risk of HIV transmission.

The conclusion was drawn during a recent media discussion forum, the third such discussion, on reproductive tract infections in low-risk women.

A recent study on the issue in North Jakarta by Population Council -- an international nongovernmental research organization that seeks to improve the reproductive health and wellbeing of current and future generations -- which was presented at the discussion, confirmed the conclusion.

Laboratory tests of 486 women with comprehensive data (mainly housewives) visiting two family planning clinics in the area showed 38.9 percent, or 189 women, had one or more reproductive tract infections and 14.4 percent, or 70 people, had one or more sexually transmitted infections.

"This number is worrying, since reproductive tract infections can cause many adverse pregnancy implications, including spontaneous abortion, premature rupture of membranes, premature delivery and consequent low birth weight and still births," said Sjaiful Fahmi Daili of the sexually transmitted diseases study group.

According to the study, the majority, or 75 percent of the total 628 participants (housewives), experienced adverse reproductive tract symptoms within the past three months, such as abnormal vaginal discharge, ulcers or sores, pain when urinating, lower abdominal pain and bleeding after intercourse, while 5.7 percent of the total number of housewives reported symptoms in their partners.

"Some sexually transmitted infections cause no symptoms at all, and some can easily be cured. Others result in severe long- term consequences and cannot be cured," Sjaiful said.

The study was conducted by Population Council for 28 weeks in the low-income neighborhood at Koja District Hospital, with the other at Cilincing Community Health Center with support from the Ministry of Health HIV/AIDS Prevention Project under USAID funding. The main authors of the report were Meiwita Budiharsana, Jane H. Patten, Siti Nurul Qomariyah, Catherine Vickers and Subadra Indrawati Molyneaux, with support from experts, including Sjaiful.

The study also discovered that 79.4 percent of the women with sexually transmitted infections returned for and received treatment according to their final diagnosis, while 75.5 percent of the husbands of women with sexually transmitted infections received treatment.

"In the second stage of our data collection, 25 partners of women with confirmed sexually transmitted infections came in for counseling. The partners who came in were asked if they had recently had intercourse with someone other than their wives. Seventeen of 25 admitted that they had another partner," Nurul said.

The study concluded that the low number of partners coming to the clinic might be a result of the participants' fear of informing their partners about the infections.

"Gender inequality in informing partners is an obstacle to being free from sexually transmitted diseases. In fact, the impacts of these chronic diseases are more harsh for women than men," the report said, urging men to improve awareness and attention in preventing reproductive tract infections or sexually transmitted infections while improving available medical treatments for positively infected people.

Global

Worldwide, the World Health Organization estimates that each year, there are over 333 million new cases of curable sexually transmitted infections. In addition, UNAIDS calculates that in 1997 alone, 5.8 million people became infected with HIV. Reproductive tract infections that are not sexually transmitted are considered even commoner.

Reproductive tract infections result in numerous serious consequences, particularly in women. Pregnancy-related complications, as well as congenital infections, can result from these infections. Pelvic inflammatory disease can develop and can cause infertility, ectopic pregnancy and chronic pain.

According to Population Council's fact sheets, reproductive tract infections, which can affect the external genital region and the reproductive organs, refer to three different types of infections which affect the reproductive tract.

Endogenous infections -- resulting from an overgrowth of organisms normally present in the vagina -- are probably the most common infections. Common symptoms include vulvo-vaginitis (itching and pain in the external genital region and vagina), painful or uncomfortable sexual intercourse and the presence of an abnormal discharge. Endogenous infections, which include bacterial vaginosis and candidiasis, can easily be treated and cured. If they are not treated, they can cause problems ranging from localized irritation to more serious consequences, such as pelvic inflammatory disease.

Iatrogenic infections occur when the cause of infection (a bacterium or other microorganism) is introduced into the reproductive tract through a medical procedure such as menstrual regulation, induced abortion, the insertion of an IUD or during childbirth. This can happen if surgical instruments used during the procedure have not been properly sterilized, or if an infection that was already present in the lower reproductive tract is pushed through the cervix into the upper reproductive tract.

Sexually transmitted infections are caused by viruses, bacteria or parasitic microorganisms that are transmitted through sexual activity with an infected partner. About 30 different sexually transmitted infections have been identified, some of which are easily treatable, many of which are not. HIV, the virus that causes AIDS, is perhaps the most serious sexually transmitted infection as it eventually leads to death. Sexually transmitted infections affect both men and women, and can also be transmitted from mothers to children during pregnancy and childbirth.

The organization recommends several behavioral changes, such as reducing the number of partners, being in a mutually monogamous relationship, substituting nonpenetrative sex for intercourse, use of barrier contraception, such as male or female condoms, delaying marriage/first intercourse, treating the infections in individuals and partners and prompt and appropriate care. (ste)