Sunday, August 10, 2014

Reproductive tract infection alert

Advice - Mind, Body and Family, Aug '14
By Dr. Tirthankar Guha Thakurta

In the previous issue we discussed about sexually transmitted infections or STIs. This issue will focus on the basic idea about reproductive tract infections or RTIs.

What is a reproductive tract infection?
The male and female organs of reproduction are often called reproductive tracts. Any infection of the reproductive tract can be called a reproductive tract infection.

Does this mean that RTIs are the same STIs?
Not necessarily. RTIs are broadly divided into three classes – endogenous or internally acquired RTIs, sexually transmitted RTIs and Iatrogenic or treatment induced RTIs. The second category, that is, sexually transmitted RTIs are also included under STIs.

What is an endogenous RTI?
Our body normally harbours many bacteria and fungi. They live in concert with our body; helping each other. For example, some bacteria like Lactobacillus acidophilus may live in the vagina of females helping maintain the acidic environment of the vagina, and in turn getting shelter and nutrients. These endogenous organisms can sometimes overgrow and produce symptoms. This is called an endogenous RTI. Common endogenous RTIs include yeast infections of the penis or vagina, and bacterial vaginosis.

What is a sexually transmitted RTI?
Diseases like gonorrhoea, syphilis and herpes simplex that are transmitted sexually and can cause infections of the reproductive tract are called sexually transmitted RTIs. Safer sex is the best means of prevention of these RTIs.

So STIs and sexually transmitted RTIs are synonymous?
Not really. Just as all RTIs are not sexually transmitted, all STIs do not necessarily affect the reproductive tract. Hepatitis B, for example, can be sexually transmitted but affects the liver and not reproductive organs. So it can be an STI, but not an RTI.

What are Iatrogenic RTIs?
When an RTI occurs during a medical procedure, like vaginal examination, childbirth, urinary catheterization in males and females or implantation of intrauterine devices (like a copper-T for contraception), it is called Iatrogenic. These RTIs can be largely prevented by taking sterility precautions.

What are the symptoms of RTIs?
They vary according to the nature and severity of the infections. Some individuals may be asymptomatic. Some may complain of a foul smelling discharge from the penis or vagina. There may be a burning sensation during urination. In case of herpes simplex, syphilis or chancroid, there may be genital ulcers.

Can RTIs be transmitted from mother to child?
Some of the RTIs can be transmitted from mother to child, during pregnancy or during childbirth. While some of them can be treated in the child with drugs (like neonatal eye infection by gonorrhoea), some can leave a lasting impact (like congenital syphilis that causes various deformities).

How can we screen for RTIs during pregnancy?
Regular gynaecological check-ups can detect RTIs at an early stage of pregnancy. In some cases the mother is advised to get a TORCH screen done. TORCH stands for some common infections that can be transmitted from mother to child, and include toxoplasma, rubella, cytomegalovirus and herpes simplex. An HIV screening is also encouraged during pregnancy.

How are RTIs treated?
RTIs can be treated much the same way as STIs. They can be treated with specific antibiotics for each infection, and where an accurate diagnosis of an RTI is difficult because of lack of privacy, medical infrastructure or experts, the RTI is treated through syndromic management. A syndrome is a collection of symptoms. When an RTI cannot be pin-pointed, a broad treatment encompassing all possible causes (RTIs) for the symptoms present is provided. This is called syndromic management.

Where to seek help if there is suspicion of an RTI?
The gynaecology, skin and medicine departments of all medical colleges and hospitals in India are equipped with treatment facilities for RTIs. The departments are also linked to the Integrated Counselling and Testing Centres for free HIV screening.

For more information on RTIs and RTI treatment facilities, don’t hesitate to write to us at the contact information given below. 

Confused? Disturbed? Just inquisitive? Write in any query on the mind, body and family to, and Dr. Tirthankar Guha Thakurta, teaching faculty at a Kolkata-based medical college, will be happy to answer them – with due respect to confidentiality.

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