Reproductive Tract Infections

More than a million women and children died from the complications of reproductive tract infection (RTI) every year during the 1990s. RTI causes a heavy emotional burden, especially when they damage fertility; while about 5 per cent of women world- wide are unable to bear children due to some inherited or hormonal disorder.

Much larger numbers are rendered infertile by damage to their reproductive tract. Young women may suffer from infections of the reproductive tract that can have a major impact on their ability to bear children.

Many infections are the consequences of non-sterile conditions during childbirth. Poor hygiene and unsanitary living conditions generally associated with poverty and with limited access to well trained health care providers, increase women's exposure to reproductive tract infections.

Abortion-related infections are especially common in countries where abortion is legally restricted, which may cause women of all ages to resort to unsafe procedures.

Sexually transmitted diseases (STDs) are a major cause of reproductive tract infections. More than 300 million cases of curable STDs- trichomoniasis, chlamydia, gonorrhoea and syphilis are estimated to occur world- wide each year.

Current estimates from the developed North America and Western Europe indicate that eight or nine of every 100 persons aged 15-49 are infected with curable STD each year. Further, rates of infection in some regions of the developing world are as much as three times as high. World-wide, STDs (including AIDS) Account for 16 per cent of the time that women of reproductive age lose to disability- about the same as time lost s a result of maternal conditions

While people of all ages can be affected by STDs, young women are especially susceptible to STD transmission. They have fewer protective antibodies than older women do, and the immaturity of their cervix increases the likelihood that exposure to the infectious agents will result in the diseases being transmitted.

A young woman's low social status can also raise her risk for infection with STDs. In cultures where women have little decision-making power over many aspects of their lives, an adolescent woman - married or unmarried - who fears infection from her partner may none the less be unable to refuse his sexual advances or insist that a condom be used. Adolescents who are homeless and those living or working on the streets are especially at risk because their desperate circumstances often lead them to engage in dangerous behaviours.

Having multiple sex partners, engaging in prostitution and using drugs and alcohol are all common among these youths, and all increase the risk of STD infection. Untreated STDs can have devastating health effects.

Untreated gonorrhea, for example, can lead to sterility in men and to ectopic pregnancy, tubal infertility and chronic pelvic pain in women. Infection with human papilloma virus is associated with the development of 'Wt cervical cancer. STD infection during pregnancy affect the new-born's health as well, potentially resulting in low birth weight, prematurity and increased susceptibility to infections and diseases.

Young women frequently bear the most serious consequences of STDs because infections in women often cause no symptoms initially, they do not realise that they are infected, and so they do not seek treatment.

Young people are vulnerable to STDs for both biological and hehavioural reasons. in fact, worldwide, the highest reported rates of STDs are found among young people aged 15-19 and 20-24. In the developed world, two-thirds of all reported STD infections occur among men and women under the age of 25. In developing countries the proportions are even higher.

Adolescents represent a large proportion of overall chlamydia infection worldwide - at least one-third. Rates of gonorrhoea are often highest among adolescents.

As is true of other curable STDs, South Africa and sub-Saharan Africa have a disproportionate number of these infections, and adolescents comprise about one-third of all cases.

Syphilis in contrast to gonorrhoea and chlamydia, is the most common among adults but remains a major problem for teenagers in developing countries.

Trichomonal infections are the most common curable STD world-wide, representing more than half of all treatable STD cases. Adolescents make up a disproportionate share of these cases.

Bacterial vaginitis is a common condition among sexually active women though its prevalence among adolescents is not specifically known. Although generally less prevalent among young adults, infection with the Herpes's simplex virus nevertheless affects adolescents, often leading to genital ulceration.

Adolescents have a higher prevalence of genital human papilloma virus than other age groups. Hepatitis B virus is widespread, especially in Asia, and has possibly severe health consequences for both adolescents and their offspring.

About one half of all human immuno-deficiency virus (HIV) infections occur among men and women aged 24 and younger. Up to 60 per cent of new infections in developing countries occur among 15-24 year-olds. Twice as many young women as men in this age group are newly infected.

Vulnerability of adolescents: For biological, behavioural, and cultural reasons, young people are especially at high risk of contracting STDs, including HIV. Sizeable numbers of adolescents are sexually active. In some places, sexual activities begin in early adolescents in some countries of the world. It may be within or outside of marriage. Young age at first intercourse is a strong risk factor for STDs.

The immature reproductive and immune systems make adolescents more vulnerable to infection by various STD agents. Adolescents, especially young girls, are less able to refuse sex and/ or less able to insist on adequate protection.

Sometimes sexual activity involves abuse or coercion which, in turn, is linked to young age at first intercourse and to more than one sexual partner - both are STD risk factors. Conditions such as poverty, homelessness, political strife and dislocation, which are increasingly common among young people in developing countries, are associated with sexual abuse or with sexual intercourse exchanged for money or support for basic needs.

Young people are ill informed about STDs, their symptoms, the need for treatment, and where to obtain treatment. Reproductive health care service providers tend not to welcome adolescent clients.

In some developing countries it has been found that adolescent clients are denied privacy an confidentiality at which the staff are often rude or moralizing.

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