BACKGROUND: Reproductive tract infections (RTIs) including sexually transmitted infections (STIs), endogenous and iatrogenic infections are a major health concern globally, particularly among young women in developing nations. If untreated, they can lead to infertility, increased HIV susceptibility, and cervical cancer. This study examines RTI symptoms prevalence, risk factors, and hesitancy toward STI vaccination. METHODS: A cross-sectional study was conducted among 1,920 urban women (predominantly aged 18-25) in Delhi/NCR using a structured questionnaire. Data on demographics, reproductive health, RTI symptoms, and vaccine awareness were analyzed using SPSS 20. Chi-square tests, Fisher's exact tests, and Bonferroni corrections were applied, with multinomial logistic regression identifying RTI risk predictors. RESULTS: Among respondents, 1,240 (64.6%) reported RTI symptoms, with 1,029 (83%) experiencing vaginal discharge and 974 (78.5%) vulval itching. Significant risk factors included early menarche, irregular menstrual cycles, poor menstrual hygiene, and prior RTI medication use. Additionally, 1,033 (53.8%) were hesitant about STI vaccination, citing safety concerns (36%, 372) and cost (18.6%, 192). However, 826 (43%) reported that healthcare provider recommendations positively influenced their decision to vaccinate. CONCLUSION: The high prevalence of RTI symptoms highlights the urgent need for improved awareness, accessible healthcare services, and stronger vaccination promotion efforts to enhance RTI prevention and management.