Reproductive Health Morbidity Research Articles

Women's health and rights in the twenty-first century.

In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.

SAT374 Indirect and Intangible Burden of PCOS: A Patient Advocacy Organization Study

Abstract Disclosure: L. Thai: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. O. Delau: None. S. Yadav: None. R.P. Buyalos: Employee; Self; Fertility & Surgical Associates of California. S. Ottey: Employee; Self; Executive Director at PCOS Challenge: The National Polycystic Ovary Syndrome. Other; Self; Received honoraria from Institute for Family Centeredness, Travel support for attendance at Women's Health Innovation Summit. W. Patterson: Employee; Self; PCOS Challenge: The National Polycystic Ovary Syndrome. R. Azziz: Advisory Board Member; Self; Arora Forge. Consulting Fee; Self; Rani Therapeutics, Fortress Biotech, Spruce Biosciences, Core Access Surgical Technologies. Grant Recipient; Self; Foundation for Research and Education Excellence, Ferring Pharmaceuticals. Stock Owner; Self; Martin Imaging. Background: Polycystic Ovary Syndrome (PCOS) is a complex genetic trait, and the most common endocrine disorder of women, clinically evident in between 10% to 20% of all reproductive-aged women. PCOS is associated with reproductive, cardio-metabolic, dermatologic, maternal health and mental health morbidities, with an estimated healthcare-associated economic burden exceeding $15 billion yearly for the U.S. alone. However, the extent of indirect (lost wages due to disability or death related to the disease) and intangible (related to pain, suffering, and reduced QOL) costs of PCOS are unknown. Objective: To determine the extent of the indirect and intangible burden of PCOS. Materials and methods: We performed a prospective survey among members of an international patient advocacy organization using the Work Productivity and Activity Impairment Questionnaire: General Health v2.0 (WPAI:GH), the European QOL (EQ-5D), and the Willing-to-Pay (WTP) assessment instruments. Results: A total of 426 women responded to the study. The WPAI:GH indicated that 77.9% (332/426) were employed and had worked in the past 7 days, with 71.1% working ≥31 hrs. Of all respondents, 20.4% (70/344) reported missing ≥6 hrs for health problems. Health problems significantly (Likert score 8-10) affected the ability to do regular daily activities in 18.3% and productivity while working in 9.0%. Of the total hours worked, 9.97% (1162/11654) were reported as missed due to health problems. The EQ-5D survey indicated that 51.6% and 35.8% of respondents suffered moderate to extreme anxiety/depression and pain/discomfort, resp; and 11.5%, 6.0%, and 18.9% reported moderate to significant difficulty in walking, self-care (washing and dressing), and usual activities (e.g., housework, etc.), resp. When assessing how good or bad their health was on the day of the survey, 40.6%, 50.1%, and 9.2% described it as the ‘best/near best’, ‘moderate’, or ‘worse/near worse’ that they could imagine, resp. When queried regarding the maximum amount they were WTP as a one-time payment within their economic means for a hypothetical cure of PCOS, 61.0%, 24.9%, and 12.7% of respondents stated they were willing to spend $0-$5000, $5001-$25,000, and >$25,000, resp, although many noted they were willing to pay well beyond what they could afford. Conclusions: Regarding indirect burden, due to health problems, 10% of total hours worked were reported missed, and 20% of respondents reported missing ≥6 hrs.; in 9% of respondents, health problems significantly affected work productivity. Regarding intangible burden, >50% of respondents reported significant anxiety/depression and 20% moderate to significant difficulty in their usual activities; 10% reported their health as the worse/near worse they could imagine. Overall, the economic burden of PCOS far exceeds its direct medical costs, and indirect and intangible costs need to be considered. Presentation Date: Saturday, June 17, 2023

Disparities in the Incidence of Ectopic Pregnancy in a Large Health Care System in California, 2010-2019.

IntroductionEctopic pregnancy leads to reproductive health morbidity, including greater risk of another ectopic pregnancy, infertility, and, in rare cases, mortality. Information on trends in the incidence of ectopic pregnancy in the last decade is limited. MethodsA population-based cross-sectional study of women aged 15-44 years enrolled at Kaiser Permanente Northern and Southern California 2010-2019 was conducted. Electronic health records were used to identify ectopic pregnancies. The crude ectopic pregnancy incidence per 1000 pregnancies (live births, induced abortions, and ectopic pregnancies) and 95% confidence interval (CI) was estimated per study year, overall, and stratified by age group. The age-adjusted incidence and 95% CI was estimated per study year, overall, and stratified by race/ethnicity. Temporal trend was assessed using Poisson regression. ResultsThere were 15,537 ectopic pregnancies among 979,027 pregnancies. The overall age-adjusted ectopic pregnancy incidence was 15.8 per 1000 pregnancies, 95% CI: 15.6, 16.1. The annual incidence increased from 15.2, 95% CI: 14.4, 16.1, in 2010 to 16.4, 95% CI: 15.6, 17.2, in 2019 (p < 0.001). The overall incidence was highest among women aged 40-44 years (24.2, 95% CI: 22.7, 25.6) and non-Hispanic Black women (21.9, 95% CI: 21.0, 22.8); compared to 30-34-year-old (16.2, 95% CI: 15.7, 16.6) and non-Hispanic White (14.6, 95% CI: 14.1, 15.0) women, respectively. DiscussionThe increase in ectopic pregnancy incidence during the studied period was largely driven by increasing incidence in younger women. However, disparities in the incidence by age and race/ethnicity persisted. ConclusionEctopic pregnancy remains a significant source of reproductive health morbidity, especially for older ( >40 years) and non-Hispanic Black women.

Effect of physical health, dietary behaviour and personal hygiene on body mass index of school-going adolescents near Patna, Bihar: A cross-sectional study.

Body mass index (BMI) is the most frequently used method to determine the nutritional status in adolescents. School-going population in developing countries like India are susceptible to undernutrition due to several socioeconomic, demographic, and nutritional factors. Poor dietary habits, sedentary lifestyles and improper hygiene can have a deleterious effect on their BMI. The aim of the study was to determine any association of BMI with physical health, nutrition, and personal hygiene among the school-going adolescents near Patna, Bihar. Analytical cross-sectional study was conducted among 160 school-going adolescents, chosen by stratified random sampling. They were given Indian Adolescent Health Questionnaire which had close-ended questions about physical activity, nutritional, and hygienic practices. BMI was calculated from self-reported height and weight. Pearson's correlation, independent t test, ANOVA, and Chi-Square test of proportions were done. Significance level was set at P < 0.05. Only 39.4% adolescents had normal BMI, and almost half were underweight. Pearson's correlation of BMI with age showed a weak positive correlation (r = 0.124, P = 0.118). Participants perceiving themselves overweight, did physical exercise to lose weight (P < 0.001), whereas who stated that they rarely consumed cooked vegetables, had the self-perception of being underweight (P = 0.009). This self-perception of their weight, physical activity, handwashing after using toilet/latrine and weekly frequency of brushing teeth significantly predicted the BMI in these adolescents (F = 10.895, df (4,155), P < 0.001, R2 = 21.9%, Adj. R2 = 19.9%). Malnutrition can lead to infection, impaired reproductive health, anaemia and other long-term morbidities into adulthood. Hence there is need of more objective nutritional assessment in adolescence for prevention of disease burden in the community.

Prevalence of Stress Urinary Incontinence after Vaginal Hysterectomy in Eastern Nepal

Introduction: Pelvic organ prolapse is reproductive health morbidity in our country and vaginal hysterectomy is one of the most commonly performed surgery. Urinary incontinence is a common problem after hysterectomy.&#x0D; Objective: This study assesses the prevalence of stress urinary incontinence after vaginal hysterectomy and the factors associated for stress urinary incontinence after hysterectomy.&#x0D; Methodology: This is ahospital based descriptive prospective study conducted for a period of 1-year from January 2019 toJanuary 2020. All patients who underwent vaginal hysterectomy for pelvic organ prolapse were included in the study. Datawas recorded in Performa, and patients were followed up with telecommunication after a month of post-operative period regarding occurrence of stress urinary incontinence. Data were statistically analysed for mean, frequency and fisher’s exact test were done to find the association betweenstress urinary incontinence and risk factors.&#x0D; Results: A total of 100 patients were included in the study. Twenty-one (21%) patients complained of post-operative stress urinary incontinence. Stress urinary incontinence was not found to be significantly associated with vaginal hysterectomy, smoking habit, type of work or stage of pelvic organ prolapse. However, it was significantly associated with advancing age.&#x0D; Conclusion: Stress urinary incontinence was significantly associated with advancing age but the association with smoking habit, type of work, stage of pelvic organ prolapse was not statistically significant.

Prevalence and Factors Associated with Uterine Prolapse among Gynecologic Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction: Uterine prolapse is one of the most common cause of reproductive health morbidity, particularly among adults and old women in developing countries. There is limited information on the magnitude and associated risk factors of uterine prolapse in Ethiopia. Therefore, the aim of this study was to identify the factors of uterine prolapse. Materials and methods: Hospital based retrospective study was conducted at University of Gondar comprehensive specialized hospital, Northwest, Ethiopia from July 1, 2014, to June 30, 2019. Computer based simple random sampling technique was used to select patient‘s cards. Bivariable and multivariable logistic regression analyses were performed. Statistical differences were considered at P<0.05. Results: The overall prevalence of uterine prolapse during the study period was 91(22.3%). Age (COR=5.12; 95% CI: 2.05, 12.78), residence (COR=5.83; 95% CI:2.66, 12.78), abortion history (COR=4.77; 95% CI:1.72, 13.23) and place of delivery (COR=2.76; 95% CI:1.14 6.69, 13.23) were factors significantly associated with uterine prolapse. Conclusions: This study reveals that nearly one fourth of women suffer with uterine prolapse. This finding indicated that uterine prolapse is a major public health issue in Ethiopia. Therefore, the local government should give emphasis for older and rural women. Health institution delivery should also be advocated to minimize the proportion of home deliveries.

Pressure and Persuasion: Young Fijian Women's Experiences of Sexual and Reproductive Coercion in Romantic Relationships.

Intimate partner violence (IPV) is a violation of women's human rights and dramatically increases women's vulnerability to sexual and reproductive health morbidities. This article examines young iTaukei (Indigenous Fijian) women's experiences of, and responses to, nonphysical forms of coercion in romantic relationships. It draws on ethnographic research with young unmarried women attending university in Suva, Fiji. Young women disclosed experiencing a continuum of coercive behaviors, including verbal pressure, deception, and manipulation by male partners to initiate sexual intercourse, unprotected sex, and unsafe abortions. Findings indicate an urgent need to address IPV within premarital relationships in Fiji to promote young women's sexual and reproductive health and autonomy.

HIV Status in Sero-Discordant Couples: Prevalence and Pattern among Pregnant Women in Plateau State, Nigeria

Nigeria is one of the high-burden countries in sub-Saharan Africa for HIV/AIDS and contributes to reproductive health morbidities and mortalities. This study was aimed at determining the prevalence of HIV-discordant rate among pregnant women in Plateau state Nigeria. The study sought to determine the prevalence and trend of HIV sero-discordance among pregnant women in Plateau state, Nigeria. The study was a 5-year descriptive analysis of HIV sero-discordance among pregnant women accessing prenatal care and their partners in Plateau state, Nigeria based on data generated between January 2012 and December 2016. The data was disaggregated by year, HIV concordant negative, HIV concordant positive, and HIV sero-discordant prevalence in the software and analysis were done using excel to obtained the proportions and trend of HIV sero-discordant prevalence among the antenatal population. Out of a total of 7,851 partners of pregnant women studied, 969 (16.3%) were HIV sero-discordant, 5,795 (73.8%) were HIV concordant negative, and 773 (9.9%) were HIV concordant positive. HIV sero-discordant positive males accounted for 12.3% while females were 4.0%. The prevalence of HIV sero-discordance was low with a high proportion of HIV positive male partners in Plateau state with grave public health implications for new HIV infections among partners and eroding the gains made in the Prevention of mother-to-child transmission of HIV.

The influence of consanguinity on reproductive health in a population of western Algeria (SABRA)

Background Inbreeding refers to unions between two people with at least one common ancestor. The practice of this type of marriage in Algeria and in the Arab-Muslim world is still commonplace. The purpose of this study is to determine the prevalence of consanguinity and to examine the impact of this practice on a few health parameters, including reproductive health: fertility, prenatal, perinatal, neonatal and postnatal mortality. Methods A prospective cohort study was conducted on 123 people randomly recruited from the Sabra Public Health Proximity Institution (EPSP). The data were collected using a pre-established questionnaire, which included questions about women's clinical, sociodemographic, and reproductive history characteristics. These data were processed by the khideux test. Results The consanguineous unions all degrees combined in our population represent a proportion of 33.33% with a slight preference for unions between first cousins. Our results also show an early marriage age and increased fertility, as well as a significant association between consanguinity and reproductive health (abortion, mortality, and morbidity). Conclusion Consanguineous marriage seems to be a predictive risk factor for certain fitness parameters, which is why setting up a health education program is fundamental to targeting prevention in terms of risk, which can have adverse effects on health, particularly the reproductive health that can weigh heavily on the family and the community.

Rural-urban correlates of reproductive health with mental health in women in Odisha, India

Background: Mental health and reproductive health are closely related. Women of reproductive age are most vulnerable. Odisha has poor maternal health indicators. Very few Indian studies comparing urban-rural differences in women’s mental health. Methods: Random sampling from respective field practice areas. GHQ-12 Mental Health screening tool used to assess health status. Pre-tested questionnaire applied to enquire about domestic and familial status, reproductive health morbidities. Results: Proportion of reported extramarital relationships of the respondents’ husband was observed to be more than twice as much in urban as compared to rural areas. Prevalence of domestic violence was found to be 43.2% in urban area as compared to 27.2% in rural areas. Significant differences were seen between urban and rural arms of the study regarding adverse pregnancy outcomes (p&lt;0.001), induced abortion (p&lt;0.0001), menstrual problems (p&lt;0.0004) and gynaecological problems (p=0.0031). In these cases, rural women were observed to have significantly more combined (reproductive and mental health) morbidity than their urban counterparts. Conclusions: Findings of the study indicate that though familial and spousal and social support parameters were more adverse in urban women, reproductive health problems and their association with poor mental health was strikingly more common in the rural populace. This may indicate an erosion of the traditional buffers against adverse mental health outcomes in the rural setting and needs further investigation.

Committee Opinion No 706 Summary: Sexual Health.

Sexuality involves a broad range of expressions of intimacy and is fundamental to self-dentification, with strong cultural, biologic, and psychologic components. Obstetrician-gynecologists often are consulted by patients about sexual health and are in a unique position to open a dialogue on sexual health issues. Several obstacles to frank conversations with patients about sexual health exist, including a lack of adequate training and confidence in the topic, a perception that there are few treatment options, a lack of adequate clinical time to obtain a sexual history, patients' reluctance to initiate the conversation, and the underestimation of the prevalence of sexual dysfunction. However, data on reproductive and sexual health morbidity suggest sexual health is an important health care issue. Each year, an estimated 45,000 new cases of human immunodeficiency virus (HIV) and approximately 20 million sexually transmitted infections occur, 3 million women experience unintended pregnancies, and 1 million women are sexually assaulted. Openly discussing sexual health has the potential to prevent these unnecessary sexual health-related outcomes. Clinical conversations should acknowledge the contributions of sexuality, relationships, and sexual behavior to overall health. Obstetrician-gynecologists can address sexual health issues across a lifespan with their patients and encourage a strategic foundation for women's sexual health issues, resulting in improved public health overall. Obstetrician-gynecologists also can support policies that broaden the coalition for effective prevention of sexually transmitted infections and promote healthy sexuality, with the ultimate goal of improving health outcomes and public health.

Committee Opinion No 706: Sexual Health.

Sexuality involves a broad range of expressions of intimacy and is fundamental to self-dentification, with strong cultural, biologic, and psychologic components. Obstetrician-gynecologists often are consulted by patients about sexual health and are in a unique position to open a dialogue on sexual health issues. Several obstacles to frank conversations with patients about sexual health exist, including a lack of adequate training and confidence in the topic, a perception that there are few treatment options, a lack of adequate clinical time to obtain a sexual history, patients' reluctance to initiate the conversation, and the underestimation of the prevalence of sexual dysfunction. However, data on reproductive and sexual health morbidity suggest sexual health is an important health care issue. Each year, an estimated 45,000 new cases of human immunodeficiency virus (HIV) and approximately 20 million sexually transmitted infections occur, 3 million women experience unintended pregnancies, and 1 million women are sexually assaulted. Openly discussing sexual health has the potential to prevent these unnecessary sexual health-related outcomes. Clinical conversations should acknowledge the contributions of sexuality, relationships, and sexual behavior to overall health. Obstetrician-gynecologists can address sexual health issues across a lifespan with their patients and encourage a strategic foundation for women's sexual health issues, resulting in improved public health overall. Obstetrician-gynecologists also can support policies that broaden the coalition for effective prevention of sexually transmitted infections and promote healthy sexuality, with the ultimate goal of improving health outcomes and public health.

Sexual practices and knowledge of sexually transmitted infections among hairdressers in Ibadan, Southwest Nigeria

The environment in salons provides hairdressers the opportunity to discuss sexual exploits which may promote unhealthy sexual behaviour and increase the risk of sexually transmitted infections (STIs). The aim of the study was to determine sexual practices and knowledge and experience of STIs among hairdressers.The study was carried out in Ibadan, Southwest Nigeria. A total of 1700 hairdressers were selected by cluster sampling technique. Predictors of risky sexual behaviour, knowledge and experience of STIs were identified.Their mean age was 27.0 ± 8.1 years, 860 (50.6%) were single. Majority of them, 1453(85.5%) had ever had sex. The mean age at sexual debut was 15.9 years. Mean knowledge score of STIs was 14.0 out of 25. Only 158(9.3%) experienced symptoms of STIs in the last 12 months. Among singles, senior secondary education was a predictor of ever had sex (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.53–3.13), good knowledge of STIs (OR: 2.04, 95% CI: 1.45–2.83) and experience of STIs in the last 12 months (OR: 2.20, 95% CI: 1.53–3.13).Hairdressers, especially singles, are a vulnerable group at risk of reproductive health morbidities. There is a need to focus reproductive health interventions on this occupational group.

A study to evaluate the abnormal menstrual patterns among adolescent girls in Bareilly

Background: Menstrual cycle abnormalities have been considered a common occurrence during puberty. Numerous earlier studies have analyzed the various patterns seen in the epidemiological data regarding menstrual cycle of adolescent girls. But there is dearth of data from Rohilkhand region of central UP state. Aims: To find out the abnormal menstrual patterns among adolescent girls in Bareilly city. Materials and Methods: A cross sectional study conducted by presenting a pre-designed and pre-tested self administered questionnaire, containing questions pertaining to menstrual practices and knowledge to 994 adolescent girls of urban schools in Bareilly city. Results: Mean age of menarche was 13.11±0.95 years. 6.07% girls in the study reported cycles of abnormal lengths. This subset also had significantly higher prevalence of irregularity. Presence of irregular menses beyond 3 gynaecological years diminished the possibility of their regularization in near future. Among the girls with excessive dysmenorrhea, nearly 1/3rd had associated menstrual disturbances also. Conclusion: Incidence of irregular menstrual cycle was 20.75% and it was significantly more in oligomennorheic cycles. Among normal menstrual cycles also, presence of IMC was significantly more in adolescents having mild oligomennorhea. 6.07% of girls reported abnormal cycle lengths. 77.70% reported dysmennorhea. Chances of menstrual cycles getting regularized after 5 years of menarchy are minimal. Adequate knowledge regarding abnormal variations in the menstrual cycle pattern during adolescence may permit implementation of strategies for preventing potential reproductive and other health morbidities in adulthood.

The Pattern of Female Genital Mutilation in Port Harcourt, Southern Nigeria

Aims: Female genital mutilation is a harmful traditional practice which is an infringement on the sexual and reproductive rights of women and girls and has profound psychosocial as well as reproductive health morbidities. This study aimed at measuring the change in the incidence of the female genital mutilation in Port Harcourt, South-South Nigeria. Study Design: A cross-sectional study. Place and Duration of Study: Department of ObstetricGynaecology of the University Port Harcourt Teaching Hospital (UPTH) between 1 January and 31 January 2009. Methodology: Five hundred clients were selected randomly and agreed to participate in the study. They were interviewed using a structured questionnaire and examined clinically. Data management was with SPSS 15.0 for Windows statistical software. Results: The prevalence of female genital mutilation (FGM) was 34%. Four hundred and eighty one (96.2%) were aware of female circumcision generally. Ninety five (55.8%) of those circumcised, had it done in infancy. Thirty seven percent of the practitioners of female circumcision were traditional birth attendants while 14.7% were trained health Original Research Article International Journal of TROPICAL DISEASE & Health, 4(4): 469-476, 2014 470 professionals. The commonest reason for female circumcision included reduction of sexual passion/promiscuity and conformity with tradition. Type 1 female genital mutilation was the commonest (58.2%). Among those clients aged 50 years and above, 78.8% had FGM while 9.1% of those aged 10 – 19 years had FGM. This showed a downward trend. Conclusion: Female circumcision is a harmful traditional practice which has remained a serious health problem. Its prevalence is still high in our environment. This study suggests that it is on a downward trend.

Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review.

BackgroundFemale sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation.MethodsIn November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community.ResultsOf 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.ConclusionsMost FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.

P3.061 Mycoplasma Genitalium DNA Detected from Adolescent Males in a Longitudinal Cohort

BackgroundMycoplasma genitalium (MG) causes non-gonococcal urethritis as well as asymptomatic infections although most data on the incidence and natural history of MG is from adults.MethodsParticipants were 14–17 year old men...

Sexually transmitted infections and reproductive health morbidity in a cohort of female sex workers screened for a microbicide feasibility study in Nellore, India

Short Summary: Four-month placebo vaginal gel trial conducted to determine the feasibility of recruiting FSWs for future Phase 2/3 microbicide trials. RH morbidity and HIV and STI prevalence are reported.Women constitute 38% of India’s 2.4 million HIV-infected persons. Microbicides are potential HIV-prevention products currently undergoing clinical trials for efficacy. A four-month placebo vaginal gel trial was conducted in Nellore, India to determine the feasibility of recruiting a suitable cohort of female sex workers (FSWs) for a future vaginal microbicide efficacy trial. We report on the HIV and STI prevalence and reproductive health (RH) morbidity of FSWs screened for the trial. Results: 529 FSWs completed screening procedures; of those 33.6% were found ineligible. The mean age was 30.9 years; 68.6% women were married and 57.5% were home-based FSWs. Self-reported symptoms included abnormal vaginal discharge (31.6%), genital itching (3.4%), uterine mass/prolapse (3%) and painful intercourse (2.6%). Gynecological surgery was reported by 73.2% of participants; of those 10.5% had undergone a hysterectomy. Female sterilization was the most commonly reported contraceptive method. Pelvic examination showed vaginal discharge (50.7%), cervical discharge (5.3%), uterine/vaginal wall prolapse (2.6%), and cervical mass/nodule/vesicles/genital warts (4.2%). Common epithelial findings included erythema (79.1%) and vesicles/bullae (6%); 46% of participants had Papanicolaou tests graded as inflammatory and 1.1% as malignant. HSV-2 was the mostly commonly detected STI (60.7%) followed by trichomoniasis (15.5%), HIV (5.3%), syphilis (2.8%), chlamydia (2.2%) and gonorrhoea (0.7%). RTIs were more common: bacterial vaginosis (27.8%) and candidiasis (18.9%). Conclusions: The low HIV prevalence and high RH morbidity in the population makes this site unsuitable for a future phase 2 or 3 microbicide efficacy trial. HIV prevention programs targeting this population should include access to RH services.

Reproductive Health Morbidities among Adolescent Girls. Breaking the Silence!

Reproductive Health Morbidities among Adolescent Girls. Breaking the Silence!

Reproductive Health Morbidities among Adolescent Girls: Breaking the Silence!

Reproductive Health Morbidities among Adolescent Girls: Breaking the Silence!