Curable reproductive tract infections: a cross-sectional survey of perceptions related to symptoms and associated treatments among health-care providers at health facilities in Tanzania

A cross-sectional survey was conducted among 131 health-care providers in rural Tanzania to examine the knowledge and availability of treatment for syndromes related to curable sexually transmitted and reproductive tract infections (STIs/RTIs) in pregnancy: (1) lower abdominal pain (gonorrhoea and chlamydia), (2) vaginal discharge (bacterial vaginosis, trichomoniasis and yeast infection), (3) genital or vaginal ulcers (syphilis, gonorrhoea, chlamydia, and chancroid), and (4) genital or vaginal itchiness (yeast infection). Perceptions of harm attributable to these syndromes, and to treatment, were recorded. Nine of ten providers believed lower abdominal pain, vaginal discharge, genital or vaginal ulcers were extremely harmful to mothers (89%, 93%, and 95%, respectively); three-quarters (78%) responded similarly about genital or vaginal itchiness. Comparable proportions of providers said syndromes 1-3 were extemely harmful to unborn babies (88%, 94%, and 90%, respectively); three-quarters (76%) considered symdrome 4 to be extremely harmful. Nearly one-third of providers reported that the treatment of lower abdominal pain, vaginal discharge, genital or vaginal ulcers was harmful to mothers (32%, 30%, and 32%, respectively); whereas one in six (16%) providers said treatment of genital or vaginal itchiness was harmful to mothers. Similar proportions of providers reported syndromes 1-3 would be extremely harmful to unborn babies (31%, 35%, and 33%, respectively); one in five (19%) providers believed that treatment of syndrome 4 was harmful to unborn babies. Treatment for these four syndromes was available in 59%, 65%, 46%, and 47% of facilities, respectively, but only one-quarter of 397 pregnant women at the same facilities who reported having an STI/RTI syndrome in the previous four weeks received treatment. These findings suggest that reducing the burden of curable STIs/RTIs during pregnancy will, in part, require investment in retraining to reduce the occasions when some providers may withhold treatment of curable STIs/RTIs out of concern that treatment may be harmful to mothers or unborn babies.