Sexually Transmitted Diseases: Current and Future Dimensions of the Problem in the Third World

Abstract

Reproductive tract infections (RTIs) have been broadly defined to include sexually transmitted infections and infections that are nonsexually transmitted, including endogenous infections, caused by an overgrowth of organisms that are normally present in the reproductive tract (such as bacterial vaginosis and vulvovaginal candidiasis) and iatrogenic infections, caused by improperly performed procedures (such as unsafe abortion, poor delivery practices, pelvic examinations, and IUD insertions).1 Although this definition has comprehensive appeal, this discussion will center on sexually transmitted RTIs. This narrower focus is deliberately chosen because the majority of RTIs are sexually transmitted, surveillance data are usually not available for nonsexually transmitted RTIs and epidemiological forces that determine transmission are better understood for sexually transmitted than nonsexually transmitted RTIs. Among the nonsexually transmitted RTIs, incidence data are partially available on the frequency of and mortality associated with unsafe abortion.2 These data suggest that worldwide, 40–60 million abortions take place annually, and up to 200,000 maternal deaths occur because of bleeding or infection complicating unsafe abortion. Over 98 percent of these deaths occur in the developing world. Clearly, unsafe abortion is a great neglected problem of health care in developing countries and benefits by separate consideration.