Teenage obstetric and gynaecological problems in an African city.

A survey of 181 Ethiopian females ages 14-19 years recruited from health facilities in Addis Ababa revealed a high incidence of obstetric and gynecologic problems. All subjects completed a questionnaire administered by a female health worker and underwent a gynecologic examination and serologic tests. 49% of subjects were married and 18% were divorced; 11% were prostitutes. Age at first intercourse was under 12 years in 18% 13-15 years in 38% and 16 years or above in 44%; 40% were sexually active before menarche. 92% of adolescents had at least one sexually transmitted disease (STD) predominantly gonorrhea (40%) genital chlamydia (51%) hepatitis B (36%) herpes simplex virus (32%) and syphilis (21%) and 43% had clinical signs of pelvic inflammatory disease (PID). 53% had had at least one pregnancy. The earlier the age at first intercourse the more likely it was that the adolescent would have multiple sexual partners and several STDs; adolescents in this category were also more likely to be from poor families from rural areas. Only 21% were attending a family planning clinic for annual check-ups; 14% of these females were using contraception. Although only 8% were infertile at the time of assessment 23% had clinical evidence of salpingitis--a risk factor for future infertility. Given the long-term health risks (e.g. infertility cervical cancer and gonorrhea-related infant morbidity) associated with the patterns observed among these adolescents it is recommended that STD education receive higher priority and that the Ethiopian Government consider greater enforcement of the law prohibiting sexual intercourse and marriage before the age of 16 years.