Although RTIs affect both women and men, research shows that women are more susceptible to infection and often less likely to seek treatment than men. In addition, complications can be more serious in women and infections can be transmitted to the offspring of pregnant women.

The symptoms associated with STIs and other RTIs vary from none to severe. You cannot always tell if a person has an STI, and people without symptoms often transmit the infection to others unknowingly. If you believe you have an RTI or have been exposed to or at risk for STIs, you should talk to a health care provider as soon as possible.

Reproductive tract infections are being increasingly recognized as a serious global health problem with impact on individual women and men, their families and communities. They can have severe consequences, including infertility, ectopic pregnancy, chronic pelvic pain, miscarriage, and increased risk of HIV transmission.

TYPES OF INFECTION
Reproductive tract infections (RTIs) refer to three different types of infection which affect the reproductive tract:

Endogenous infections are probably the most common RTIs worldwide. They result from an overgrowth of organisms normally present in the vagina. Endogenous infections include bacterial vaginosis and candidiasis. These infections can be easily treated and cured.

Iatrogenic infections occur when the cause of infection (a bacterium or other micro-organism) is introduced into the reproductive tract through a medical procedure such as menstrual regulation, induced abortion, the insertion of an IUD or during childbirth. This can happen if surgical instruments used during the procedure have not been properly sterilized, or if an infection that was already present in the lower reproductive tract is pushed through the cervix into the upper reproductive tract.

Sexually transmitted infections (STls) are caused by viruses, bacteria, or parasitic microorganisms that are transmitted through sexual activity with an infected partner. About 30 different sexually transmitted infections have been identified, some of which are easily treatable, many of which are not. HIV, the virus that causes AIDS, is perhaps the most serious sexually transmitted infection as it eventually leads to death. STIs affect both men and women, and can also be transmitted from mothers to children during pregnancy and childbirth.

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BACTERIAL VAGINOSIS

What is bacterial vaginosis?
Bacterial vaginosis (BV) occurs when the normal balance of bacteria in the vagina changes and an overgrowth of some bacteria normally found in the vagina occurs. Studies indicate that a woman with bacterial vaginosis has an increased chance of having a variety of other reproductive tract problems. Therefore, diagnosis and treatment are important.

How does someone get bacterial vaginosis?
Bacterial vaginosis occurs when some types of bacteria that are normally found in the vagina begin to grow in large numbers. It is unclear why this occurs, although some risk factors have been identified. Bacterial vaginosis is not transmitted during sex.

What are the risk factors for bacterial vaginosis?
Douching, the use of feminine hygiene products (such as vaginal sprays and wipes), and bubble baths may lead to BV. Although not an STI, sex without a condom can cause BV or make it worse because of the effect of semen on bacteria in the vagina. It appears that the presence of an STI increases the risk of BV; up to 64% of women with STIs will also have bacterial vaginosis, compared to 10-20% of all women.

How can you protect yourself from getting bacterial vaginosis?
To reduce your chances of getting bacterial vaginosis:
1) Avoid douching and the use of other feminine-hygiene products
2)Use condoms during sex
3)Clean reusable contraceptives (such as diaphragms, cervical caps, and spermicide applicators) well after each use

What are some symptoms of bacterial vaginosis?
Some women have no symptoms. When symptoms occur, they may include:
Unusual vaginal discharge with an unpleasant odor, Vaginal itching or irritation.

Can infection with bacterial vaginosis lead to other health problems?
Bacterial vaginosis may increase a woman's chance of having other reproductive tract problems, including: The risk of pelvic inflammatory disease (PID) if present with either chlamydia or gonorrhea The risk of infection following vaginal surgery or abortion

What is the impact of bacterial vaginosis on pregnancy?
Bacterial vaginosis has been associated with early labor and delivery in pregnant women and low birth weight in newborns.

How is bacterial vaginosis diagnosed?
Most commonly, bacterial vaginosis is diagnosed by examination of vaginal discharge to evaluate the acidity, odor, and microscopic characteristics of the discharge.

Is there a treatment or cure for bacterial vaginosis?
Bacterial vaginosis can be easily treated and cured with antibiotics--usually a drug called metronidazole (Flagyl). This treatment can cause side effects such as mild nausea, vomiting, and metallic taste in the mouth. Nonetheless, in order for the treatment to work it is important to take the medication as prescribed. It can also cause a bad reaction when mixed with alcohol; avoid drinking until 24 hours after you finish taking the medicine. It should not be used during early pregnancy.

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YEAST INFECTION
Women who experience mild to severe itchiness of the vulva may have a yeast infection. Typically the vaginal discharge is thick, white and in curds which may resemble cottage cheese. The vagina and vulva may become red and swollen. There are many popular non-prescription treatments for yeast infections, which are now available both in the United States and Canada.

What is the cause of yeast infections?
Yeast infections are normally caused by a fungus, which is part of the candida family. This fungus can become a problem when the normal biological balance of the vagina is disturbed. Disturbances may include changes in hormone levels during pregnancy, use of the birth control pill and the change in the normal pH level of the vagina experienced during menstruation. These all change the balance of bacteria and microorganisms in the vagina, which increases the likelihood of a yeast infection.

How are yeast infections contracted?
As mentioned above, the change in the biological balance of the vagina can increase the likelihood of a yeast infection. Both the male and female may carry such a condition although men usually do not experience any symptoms. Men may however experience some irritation of the glans, which can indicate the presence of a yeast infection. Yeast infections can be spread through intimate contact of infected regions.

How are yeast infections treated?
There are an abundance of possible treatments for those who are suffering with a yeast infection. Anti-fungal creams, vaginal suppositories and medicated tampons are usually all available at your local pharmacy. For extreme pain and discomfort, your physician may wish to prescribe a mild steroid cream. Treatment must continue during menstruation but tampons, which absorb the medication, should not be used.

Please contact your physician.

GLOBAL BURDEN
RTIs are widespread. The World Health Organization estimates that each year, there are over 333 million new cases of curable STIs. In addition, UNAIDS calculates that in 2000 alone, 5.3 million people became infected with HIV. RTIs that are not sexually transmitted are considered even more common.

RTIs result in numerous serious consequences, particularly in women. Pregnancy-related complications, as well as congenital infections, can result from RTIs. Pelvic inflammatory disease (PID) can develop, and can cause infertility, ectopic pregnancy, and chronic pain. Recently, it has been shown that certain infections can increase the chances of HIV transmission. Unfortunately, symptoms and signs of many infections may not appear until it is too late to avoid such consequences and damage to the reproductive organs.

RTIs affect more than health. The morbidity associated with RTIs also affects the economic productivity and quality of life of many individual women and men, and consequently, of whole communities