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Unmentionable diseases

No one likes to broadcast intimate embarrassing details about their life. They may talk about their tonsillectomies, appendectomies, typhoid or fractures but is anyone willing to discuss pelvic infections and sexually transmitted diseases (STDs)? Getting the “clap”, herpes or HIV infection is considered disgraceful and taboo. This is a pity, because 2 per cent of women in the reproductive age do develop these diseases. Some are unaware that they have an infection. Others suffer in silence because of embarrassment. Lack of knowledge hampers adequate treatment and leads to needless complications.

The pelvic organs consist of the cervix, uterus, fallopian tubes and ovaries. These are all housed in the rigid bony pelvis. Infection reaches these organs through the vagina and cervix. Infection, once established, proceeds upwards into the uterus and fallopian tubes.

The manifestations of pelvic infections are myriad. There may be no symptoms at all. There may be just vague abdominal discomfort, low-grade fever and a feeling of “being sick”. Sometimes there may be high fever with chills and vomiting. The symptoms may be more subtle with vague, non-localised lower abdominal pain and burning while passing urine. Pain can be referred to the right side of the abdomen, resembling appendicitis, or to the upper abdomen resembling gall bladder disease or peptic ulcer. There may be vaginal discharge which changes in character, from its original translucent white to yellow and becomes malodorous, frothy and itchy. The menstruation may become irregular with painful periods and increased bleeding. A constant inexplicable dull backache may develop.

Patients cannot pinpoint the problem. In this day and age of specialisation they are not quite sure of whom to consult. They begin to doctor shop, moving from physicians and surgeons to orthopaedics.

The vague symptoms and signs may cause the diagnosis to be missed. A suspected urinary tract infection may be ineffectively treated. Lumbar belts and exercises may be prescribed. Embarrassment or ignorance may prevent the patient from mentioning the menstrual irregularities or abnormal discharge. They may eventually end up with the disposable parts of their anatomy, like the appendix or gall bladder, removed.

If the woman is lucky, she may be referred to a gynaecologist. An examination of the pelvis or an ultrasound may then eventually establish the diagnosis.

Pelvic infections urgently need to be looked into as the bacterial organisms responsible can damage and distort the fallopian tubes. The egg has to travel successfully through these tubes to be fertilised. Distortion may result in infertility. In some women the fertilised egg may remain in the tube instead of proceeding to the uterus. The tube cannot provide adequate space or blood supply for growth of the baby. The foetus may die in the tube, causing an ectopic pregnancy. It may rupture and the episode can be life threatening.

Pelvic infections can occur as a result of —

Unprotected (no condom) intercourse with an infected partner

A spontaneous or induced abortion

An intrauterine contraceptive device

Surgical procedures

Tuberculous infection of the pelvic organs can also occur. This is difficult to diagnose. It occurs many years after an initial unrecognised infection in an apparently healthy woman. It is usually picked up during investigations for infertility. The old adage stated “if an unmarried girl has a pelvic infection it must be tuberculosis”. This statement can no longer be blindly accepted. Unfortunately, (despite all the statements to the contrary from our moral police), 15-30 per cent of unmarried boys and 10 per cent of unmarried girls are engaged in unprotected high-risk sexually active behaviour. Teenage girls are also more prone to infection after intercourse as the cells lining their cervix are not mature enough.

Syphilis was the commonest STD but its place is now usurped by gonorrhoea and chlamydia. If partially or inadequately treated, these infections can become indolent and affect other organs in the body.

Viruses like herpes and HIV cause chronic infections which can be suppressed with treatment but not cured.

Infections after surgery or abortions tend to be caused by a mixed bag of organisms. This results in presumptive and prolonged treatment.

Untreated pelvic infection causes fatigue and chronic ill health. It often results in infertility. Prolonged expensive interventions may then be needed to have a child.

Pelvic infections in the regional language often roughly translates to “women’s disease” or “white discharge”. But it is not a problem of women alone. For every infected woman there is usually a male partner silently harbouring the infection and passing it on.

Treatment for pelvic infections has to be given adequately and simultaneously to both partners. Otherwise reinfection occurs and the treatment is doomed to failure.

Prevention of STD is better and safer than treatment of an acquired infection. To do this:

Follow the safe dictum of “one partner for life”

Sexually active adults should use condoms for mutual protection. Condoms prevent both pregnancy and disease.

Source: The Telegraph (Kolkata, India)

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