India’s young women have begun to speak openly about menstruation, but a culture of self-neglect and silence continues to shroud another vital aspect of women’s health: reproductive tract infections (RTIs).

Also known as genital tract infections, RTIs are very common and cut across boundaries of class and privilege. They are caused by a wide variety of microorganisms and can be focalized in any part of the genital tract, from the cervix and vagina, to the uterus, Fallopian tubes and other organs in the pelvic region. Some RTIs, such as syphilis and gonorrhoea, are sexually transmitted, but many are not; some, such as yeast infection and bacterial vaginosis, are merely an imbalance of the microorganisms naturally found in the vagina.

“Trichomoniasis and candidiasis [yeast infection] are very common. We also see a lot of cases of bacterial vaginosis. They are all mild and easily treatable, and don’t have long-term consequences,” says Dr Suneeta Mittal, the director and head of obstetrics and gynecology at Fortis Hospitals Gurgaon, and former director of the All India Institute of Medical Sciences, Delhi.

“Women who have diabetes are prone to more fungal infections,” she adds, explaining that higher blood sugar levels aid the growth of fungal infections like candidiasis, especially in the vaginal area.

Because RTIs are so diverse, their symptoms can range from itching to boils, to ulcers in the vaginal area, to abnormal vaginal discharge and odor, to urinary tract infection, to painful intercourse and/or bleeding after sexual activity. But the red flags don’t always appear – some infections never develop into noticeable symptoms in women.

The good news is, experts say most RTIs are curable, given timely diagnosis.

The bad news is, women don’t urgently seek treatment for RTIs. A 2011 study in The Journal of Family Welfare, based on health ministry data, reveals that “urban women had nine percent less chance of seeking treatment [for RTIs] as compared to rural women.” It says that urban Indian women “neglect the problem.”

The “neglect” is often the result of a lack of awareness, or stigma. “Gynecological conditions such as white discharge are considered to be normal and not serious enough to require outside care, or are perceived to be linked with promiscuity, deterring women from availing care for the same,” suggests the study.

Dr Mittal shared that most people have reservations speaking about RTIs: “There is not much [awareness]. It hasn’t been built because people don’t talk about [RTIs]. If someone has a cardiac problem, they would tell more people – those will in turn become aware. They don’t even discuss it with close friends.”

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According to WHO, the consequences of RTIs “for women are more common and more severe than for men.”

Pelvic inflammatory disease (PID), or, upper genital tract infection, is among the most critical consequences of RTI in women. Per WHO, it is caused “when an infection of the lower genital tract (cervix or vagina) or outside organisms reach the upper genital tract (uterus, Fallopian tubes, ovaries and surrounding structures).”

Left untreated, RTIs can complicate fertility, pregnancy and childbirth. It is well documented that untreated TB in the genital tract is a major cause of ectopic pregnancies. And HPV, a sexually transmitted RTI that often has no obvious symptoms, is the primary cause of cervical cancer.

According to Dr Abhas, a former junior resident doctor at the capital’s Lok Nayak Hospital and an MD student at the University of Chester, the government must initiate an awareness campaign. “Just how many health fliers do we expect from doctors who are treating RTIs? There should be a concentrated government drive to bolster reproductive health and prevent RTIs.”

At the time of writing this article, there is no central government hygiene checklist or sex education manual to educate girls and women about RTIs. Nor has the government included on its immunization schedule the vaccine that prevents HPV infection of the reproductive tract and, consequently, prevents cervical cancer.

Sex education, which Dr Mittal says could go a long way in preventing RTIs that are sexually transmitted, is also lacking. As of August 2018, the Center was considering making comprehensive sex education a part of school curriculum. And the National Council of Education Research and Training (NCERT) is “likely to consider a proposal”for the same.

In the absence of strident government efforts, though, the scope for conversation is limited and the stigma is harder to overcome.

Dr Rishma Pai, a consultant gynecologist and obstetrician at Mumbai’s Lilavati, Jaslok and Hinduja hospitals, explained that, while there isn’t adequate data on those affected by RTIs, the infections are fairly ordinary. But they have remained a virtual blind spot in India’s healthcare ecosystem because of the sheer number of other illnesses that both the government and the media prioritize over RTIs.

“It makes for ‘very boring news.’ There is no information or conversation, nor is it a part of the educational curriculum,” she points out.

When to see a gynec about a possible RTI

• If you ever experience vaginal itching for long periods, consult a gynecologist
• If you ever experience vaginal discharge of an unusual odour, smell, consult a gynecologist
• If you ever experience abdominal pain, consult a physician
• If you ever bleed after sexual activity, consult a gynecologist
• On a yearly basis, consult a gynecologist for a standard reproductive tract check-up and Pap smear
• After any time you have unprotected sex with a new partner, get an STI test from your gynec

How to prevent reproductive tract infections

• Don’t terminate unwanted pregnancy using home remedies
• Don’t have unprotected sex
• Don’t use cloth to absorb menstrual blood during your period
• Don’t use toiletries such as soap and shampoo to cleanse inside your vagina
• Don’t use a vaginal douche
• Wear breathable underwear