Abstract
BACKGROUND: Reproductive tract infections (RTIs) remain a major public health concern among women of reproductive age, but limited evidence exists on their association with knowledge, attitudes, and practices (KAP) in university settings. This study examined the prevalence of RTIs and their relationship with KAP and sociodemographic factors among university-affiliated women. METHODS: A cross-sectional survey was conducted from October 2023 to March 2024 among 457 women aged 18-48 years at a large comprehensive university in Tianjin, China, including students, faculty, administrative staff, and contracted workers. Participants were recruited through stratified convenience sampling and completed a validated 23-item KAP questionnaire, followed by standardized clinical examination and standardized clinical assessment with targeted laboratory testing. Associations between KAP, sociodemographic characteristics, and RTI prevalence were assessed using descriptive statistics and chi-square tests. RESULTS: The mean KAP score was 50 (SD 14); 34.5% of participants were categorized as low, 46.3% as medium, and 19.0% as high. Overall RTI prevalence was 37.6%, with endometritis (17.7%) and salpingitis (17.2%) most common. Higher KAP levels were inversely associated with RTI prevalence (p < 0.001). Marked gradients were observed by education and expenditure: prevalence was 24.5% among women with a master's degree or above versus 50.8% among college students, and 70.7% among those with monthly expenditure < 2,000 RMB. CONCLUSIONS: Institutional affiliation alone did not confer adequate sexual health; persistent occupational and socioeconomic gradients indicate that structural socioeconomic and cultural barriers-rather than educational access per se-drive disparities. Equity-oriented, culturally appropriate, KAP-based interventions and longitudinal evaluation are warranted.