Knowledge, health seeking behavior and barriers for treatment of reproductive tract infections among married women of reproductive age in Delhi

Background: Reproductive tract infections including sexually transmitted infections are an important public health problem among women of reproductive age group in developing countries. The perceptions or taboos related to RTIs act as an obstacle for seeking treatment ultimately leading to complications. The aim of the study was to assess the knowledge, health seeking behavior and barriers for treatment of reproductive tract infections among married women of reproductive age in Delhi.Methods: A community based cross-sectional study was undertaken in an urban field practice area of department of Community Medicine of VMMC and Safdarjung Hospital, New Delhi from November 2017 to April 2019. Sample size of 270 was collected using predesigned and pre- tested questionnaire by systematic random sampling.Results: Mere 16.6% of the women knew about symptoms of RTI/STIs. Out of 81 women having RTI/STI in past 3 months 30% did not seek treatment and out of 70% who took treatment for RTI, 30% did not complete treatment. Majority of the women who sought treatment preferred government hospital. The main barrier for seeking treatment was embarrassment, not considering it as an important health problem, lack of time.Conclusions: The overall knowledge about symptoms, mode of spread of RTIs/STIs was very poor among the study participants. Women seeking treatment are not completing it. Thus, there is need to emphasize on spreading knowledge about symptoms, mode of spread, need for treatment and its completion and clearing barriers related to RTI/STI among women.

Comparative study of syndromic and etiological diagnosis of reproductive tract infections/sexually transmitted infections in women in Delhi

SummaryBackgroundThe adequacy of the World Health Organization's syndromic approach for the diagnosis and management of sexually transmitted diseases (STDs), especially at primary health centers (PHCs) and at other levels, is still debatable in different settings in India and requires validation.ObjectivesA cross-sectional study was carried out in women attending the peripheral government clinics of Delhi in order to (1) enumerate their self-reported reproductive tract infection (RTI)/sexually transmitted infection (STI) symptoms; (2) assess their clinical status; (3) determine the syndromic diagnosis of RTI/STI in symptomatic women and etiological diagnosis in both symptomatic and asymptomatic women; and (4) compare the level of agreement between self-reporting of morbidity and syndromic and etiological diagnosis.Materials and methodsThe study was conducted over 26 months in 4090 women attending peripheral government healthcare centers, both rural and urban, in four zones of Delhi. They were recruited into four different study groups: group I, non-pregnant, reporting with symptoms of RTI/STI; group II, with a bad obstetric history or infertility; group III, pregnant women in any trimester attending the antenatal clinic; and group IV, the control group. Gynecological examination, followed by the collection of genital specimens and blood, were performed after informed and written consent was obtained. Every symptomatic patient was managed on the basis of algorithms of the syndromic approach as recommended by the National AIDS Control Organisation (NACO), India. All specimens were transported to the STD Reference Laboratory, Safdarjung Hospital, New Delhi and processed by standard methods to diagnose the various STDs. Laboratory reports were sent to the clinicians and appropriate treatment was instituted. Data were analyzed by applying statistical methods.ResultsOverall, self-reporting of morbidity was 65.0%. However, the percentage of women with some STD-related syndrome was 71.4%. The rural women were observed to have significantly more STD syndromes than their urban counterparts. The etiological diagnosis could be established in only 32.2% of cases.ConclusionsThis study highlights the wide variation between self-reporting of morbidity and syndromic- and etiology-based diagnosis in women from both rural and urban settings. This has implications for the syndromic approach to STI case management. These observations call for a review of the diagnostic policy for RTIs/STIs by national authorities in order to avoid the overuse of antimicrobials. The study also highlights the need for the introduction and/or strengthening of facilities for simple diagnostic tests for RTIs/STIs, especially at the peripheral healthcare level

PROFILE OF SEXUALLY TRANSMITTED INFECTIONS AMONG ATTENDEES OF SPECIAL (SURAKSHA) CLINICS AT AN APEX REGIONAL SEXUALLY TRANSMITTED DISEASE CENTRE IN NORTH INDIA- A FIVE-YEAR STUDY

Introduction: Sexually transmitted infections (STIs) present significant global and national health challenges, particularly in India.  Objective: This study investigates the prevalence and characteristics of STIs among attendees at the Suraksha clinic in the Apex Regional STD Centre, Safdarjung Hospital.  Methods: Retrospective data from January 2018 to December 2022 were statistically analyzed using Excel and SPSS. The study includes the examination for diagnosis of various STIs, such as syphilis, HIV, gonorrhea, chlamydiasis, trichomoniasis, candidiasis, bacterial vaginosis (BV), chancroid and genital herpes. .  Gender distribution and syndromic diagnoses, including Vaginal/Cervical Discharge and Genital ulcers, were also considered. Referrals to Integrated Counseling and Testing Centres for HIV testing were analyzed. Results:  The results reveal a substantial burden of STIs, with 3.06% showing reactivity to syphilis , 1.74% testing positive for HIV, 3.36% for Gonorrhoea, 11.78% for Chlamydiasis, 1.05% for Trichomoniasis, 26.24% for Candidiasis, 9.97% for Bacterial Vaginosis (BV), 7.80% for Chancroid, 11.64% for Herpes genitalis , and 4.01% for other non STI infections.  Attendees' interactions included 34.36% of referrals to Integrated Counseling and Testing Centres for HIV testing. The gender distribution showed 58.92% male and 40.94% female attendees. Conclusion: Syndromic diagnoses, including Vaginal/Cervical Discharge (21.22%) and Genital Warts (8.00%), highlight prevalent conditions, necessitating routine screening, early detection, and targeted interventions for effective disease control and prevention. These findings underscore the significance of integrated screening, patient education, and proactive strategies to safeguard public health in the face of rising STI rates

A community-based study on the prevalence of reproductive tract infections/sexually transmitted infections and their associated factors among married women of reproductive age in Delhi

Introduction: Reproductive tract infections/sexually transmitted infections (RTIs/STIs) and their sequelae are an important public health problem, particularly among women. Although high prevalence of RTIs has been reported by community-based studies in India, very few of them have included asymptomatic women. Objective: The objective of the study was to determine the prevalence of RTIs/STIs based on symptoms, clinical examination, and laboratory investigations and factors associated with it among married women of reproductive age in an urbanized village in Delhi. Methods: A community-based cross-sectional study was carried out among married women in the age group of 15–49 years, residing in an urban field practice area of the Department of Community Medicine of VMMC and Safdarjung Hospital from November 2017 to April 2019. The study was carried out using an interviewer-administered questionnaire in the field followed by clinical examination and sample collection for investigations conducted at urban health training center. Statistical Data Analysis: Data were entered into MS Excel and analyzed using licensed the Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The prevalence of RTI/STI based on symptoms was 53.7%, clinical 39.2%, and laboratory confirmed 36.7%. The prevalence of laboratory-confirmed RTI/STI among asymptomatic women was 21.6%. Women using cloth during menstruation (odds ratio [OR] = 2.242), having a positive history of abortion (OR = 2.373), not using condoms during last sexual intercourse (OR = 1.998), and washing genital area with only water during menstruation (OR = 1.929) had higher odds of having RTI/STI. Conclusions: The prevalence of laboratory-confirmed RTI/STI among married women was quite high even among asymptomatic women indicating the need for opportunistic screening for RTI/STI among women visiting hospitals or health centers for other health problems for its early diagnosis and management

A novel polyherbal microbicide with inhibitory effect on bacterial, fungal and viral genital pathogens

A polyherbal cream (Basant) has been formulated using diferuloylmethane (curcumin), purified extracts of Emblica officinalis (Amla), purified saponins from Sapindus mukorossi, Aloe vera and rose water along with pharmacopoeially approved excipients and preservatives. Basant inhibits the growth of WHO strains and clinical isolates of Neisseria gonorrhoeae, including those resistant to penicillin, tetracycline, nalidixic acid and ciprofloxacin. It has pronounced inhibitory action against Candida glabrata, Candida albicans and Candida tropicalis isolated from women with vulvovaginal candidiasis, including three isolates resistant to azole drugs and amphotericin B. Basant displayed a high virucidal action against human immunodeficiency virus HIV-1NL4.3 in CEM-GFP reporter T and P4 (Hela-CD4-LTR-&#946;Gal) cell lines with a 50% effective concentration (EC<SUB>50</SUB>) of 1:20 000 dilution and nearly complete (98-99%) inhibition at 1:1000 dilution. It also prevented the entry of HIV-1(IIIB) virus into P4-CCR5 cells (EC<SUB>50</SUB>~1:2492). Two ingredients, Aloe and Amla, inhibited the transduction of human papillomavirus type 16 (HPV-16) pseudovirus in HeLa cells at concentrations far below those that are cytotoxic and those used in the formulation. Basant was found to be totally safe according to pre-clinical toxicology carried out on rabbit vagina after application for 7 consecutive days or twice daily for 3 weeks. Basant has the potential of regressing vulvovaginal candidiasis and preventing N. gonorrhoeae, HIV and HPV infections

Issues in antifungal stewardship: an opportunity that should not be lost

Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario

Validation of a Genome-Wide Polygenic Score for Coronary Artery Disease in South Asians.

BACKGROUND: Genome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. OBJECTIVES: This analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. METHODS: This GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. RESULTS: The GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p < 0.001 for each). Next, individuals of the Indian case-control study were projected onto static reference distributions, observing an OR/SD of 1.66 (p < 0.001). Compared with the middle quintile, risk for CAD was most pronounced for those in the top 5% of the GPSCAD distribution-ORs of 4.16, 2.46, and 3.22 in the South Asian UK Biobank, Bangladeshi, and Indian studies, respectively (p < 0.05 for each). CONCLUSIONS: The new GPSCAD has been developed and tested using 3 distinct South Asian studies, and provides a generalizable framework for ancestry-specific GPS assessment.Dr. Patel is supported by grant T32HL007208 from the National Heart, Lung, and Blood Institute; Dr. Kathiresan is supported by the Ofer and Shelly Nemirovsky Research Scholar Award from Massachusetts General Hospital and the National Human Genome Research Institute under award number 5UM1HG008895; Dr. Khera is supported by an institutional grant from the Broad Institute of MIT and Harvard (BroadIgnite), award numbers 1K08HG010155 and 5UM1HG008895 from the National Human Genome Research Institute, a Hassenfeld Scholar Award from Massachusetts General Hospital, and a sponsored research agreement from IBM Research