Department of Reproductive Health and Research (RHR), World Health Organization
Sexually transmitted and other reproductive tract infections
A guide to essential practice
About the guide
This Guide has been developed for use in reproductive health care settings (family planning, and maternal and child health care clinics) and focuses on women, as they are the "traditional" clients in these settings. Unlike men, women rarely go to STI clinics with their problems, and are often asymptomatic if infected. Visits to their reproductive health care provider may be their only contact with the health care system. However, throughout the document men and adolescents are also considered, given the need to reach out and offer prevention services to these groups, in order to achieve favourable public health outcomes through the prevention and treatment of STIs/RTIs.
Human immunodeficiency virus (HIV) infection is not covered extensively in this document, but references to HIV are made where necessary. This is because, while HIV is technically an STI, it is not a reproductive tract infection. Hepatitis B and C are other examples of STIs that are not RTIs, and are not covered in this Guide. For further information on HIV infection, see Annex 5 (Additional resources and suggested reading) and visit the WHO HIV/AIDS web site at http://www.who.int/HIV.
This Guide is intended to be a reference manual, and a resource to educate and to remind health care workers of the need to consider STIs/RTIs when providing other reproductive health services. It recommends prevention and care practices for patients who have or may be at risk of acquiring a reproductive tract infection. As such, it could be used for preservice or in-service health provider education and training, as a source of up-to-date, evidence-based recommendations, and as a self-education tool for health care providers on the prevention, treatment, and diagnosis of RTIs.
Programme managers can use it as a starting-point for improving policies, programmes and training on the prevention and management of STI/RTI, adapting the information and recommendations as needed to local conditions1.
The information is grouped according to "reasons for visit". Providers are encouraged to consider the possibility of STI/RTI, educate and counsel clients about prevention, and offer necessary treatment. Providers can use the Guide as a whole, or focus on the sections that are relevant to their daily practice.
Not all sexually transmitted infections are reproductive tract infections; and not all reproductive tract infections are sexually transmitted; STI refers to the way of transmission whereas RTI refers to the site where the infections develop.
Reproductive tract infection is a broad term that includes sexually transmitted infections as well as other infections of the reproductive tract that are not transmitted through sexual intercourse. Conversely, because STIs in most cases have much more severe health consequences than other RTIs, the term STI/RTI is used throughout the Guide to highlight the importance of STIs within reproductive tract infections. When information provided in the document is relevant to sexually transmitted infections only, the term STI is used alone.
Structure of the Guide
The Guide is divided into three sections:
Each chapter begins with a summary of the information and recommendations it contains. Throughout the Guide, important steps in decision-making are explained in the text, and most recommendations are also presented in flowcharts and tables. Flowcharts can help to simplify complex problems and permit a standardized approach to management of STIs/RTIs. However, no flowchart can cover all possible clinical situations. Health care providers need to be able to recognize when to put the flowcharts aside and seek additional help. While this Guide will help health care providers to deal effectively with STI/RTI-related problems, knowing when to look beyond them can only be learned from experience.
20 Steps to fewer STIs/RTIs
1 An adaptation guide for programme managers is currently under preparation by WHO.
Infections of the male and female reproductive tract and their consequences:
Preventing STIs/RTIs and their complications
STI/RTI education and counselling
Promoting prevention of STI/RTI and use of services
STI/RTI Assessment during Routine Family Planning Visits
STI/RTI Assessment in pregnancy, childbirth and the postpartum period
Management of symptomatic STIs/RTIs
STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period
Annex 1. Clinical skills needed for STI/RTI
Annex 2. Disinfection and universal precautions
Annex 3. Laboratory tests for RTI
Annex 4. Medications