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Department of Reproductive Health and Research (RHR), World Health Organization

Sexually transmitted and other reproductive tract infections

A guide to essential practice



Annex 2. Disinfection and universal precautions


Preventing infection in clinical settings1

Wash your hands before and after caring for another person. It is the most important way to kill germs on your skin. You need to wash your hands even more thoroughly and for a longer time:

  • before and after helping someone give birth;
  • before and after touching a wound or broken skin;
  • before and after giving an injection, or cutting or piercing a body part;
  • after touching blood, urine, stool, mucus, or fluid from the vagina;
  • after removing gloves.


Use soap or other disinfectant to remove dirt and germs. Count to 30 as you scrub your hands all over with the soapy lather. Use a brush or soft stick to clean under your nails. Then rinse, using running water. Do not reuse water.


Disinfect or sterilize equipment and instruments. Cleaning instruments and equipment to get rid of nearly all the germs is called high-level disinfection. Instruments must first be washed and then disinfected if they are to be used to:

  • cut or pierce skin;
  • give an injection;
  • cut the cord during childbirth;
  • examine the vagina, especially during or after childbirth, a miscarriage, or an induced abortion.
  • perform any transcervical procedure.


High-level disinfection: three steps1

1. Soaking. Soak instruments for 10 minutes. If possible, use a 0.5% solution of bleach (chlorine) (see below). Soaking instruments in bleach solution will help protect you from infection when cleaning them. If you do not have bleach, soak your instruments in water.

2. Washing. Wash all instruments with soapy water and a brush until each one looks very clean, and rinse them with clean water. Be careful not to cut yourself on sharp edges or points. Wear gloves when washing instruments; if possible, use heavy gloves.

3. Disinfecting. Steam or boil the instruments for 20 minutes.

  • To steam them, you need a pot with a lid. The water does not need to cover the instruments, but use enough water to keep steam coming out of the sides of the lid for 20 minutes. Do not overload. No instruments should protrude above the rim of the pot.
  • To boil them, you do not need to fill the whole pot with water. But you should make sure the water covers everything in the pot for the entire time. Put a lid on the pot.
  • For both steaming and boiling, start timing the 20 minutes after the water with the instruments is fully boiling. Do not add anything new to the pot once you begin to count.
  • How to make a disinfection solution of 0.5% bleach
  • If the label on your bleach says:
  • - 2% available chlorine —use 1 part bleach to 3 parts water
  • - 5% available chlorine —use 1 part bleach to 9 parts water
  • - 10% available chlorine —use 1 part bleach to 19 parts water
  • - 15% available chlorine —use 1 part bleach to 29 parts water
  • Mix just enough solution for one day. Do not use it again the next day. It will no longer be strong enough to kill germs.


Universal precautions1

The same precautions against spreading infection —universal precautions —should be used with all patients whether they appear sick or well, and whether or not you know their HIV or other infection status.

A number of RTIs can be spread from patient to health care provider or to other patients if basic precautions are not followed. Hepatitis B and C viruses and HIV are incurable infections that are easily transmitted by reuse of contaminated sharps. Because RTIs are often asymptomatic, it is not possible to know which patients have an infection. For this reason, universal precautions should be followed for all patients regardless of known or suspected infection status.

Use precautions with every person you see. Every time you have to cut the skin or touch body fluids, follow the advice below. This includes any time you must give an injection, stitch skin or tissue, help with childbirth, or examine a woman’s vagina.

If you follow these rules, there is no risk of spreading infection from one person to others, or of being infected yourself.

  • Avoid touching body fluids, such as blood, vomit, stool and urine.
  • Do not share anything that touches blood. This includes razors, needles, any sharp instruments that cut the skin, and toothbrushes. If you must share such things, disinfect them before another person uses them.
  • Keep wounds covered with a clean bandage or cloth.
  • Use gloves or a piece of plastic to handle dirty bandages, cloths, blood, vomit or stool.
  • Wash your hands with soap and water after changing dirty bedding and clothes.
  • Keep bedding and clothing clean. This helps keep sick people comfortable and helps prevent skin problems. Handle clothing or sheets stained with blood, diarrhoea or other body fluids carefully. Separate from other laundry for washing. Dry laundry thoroughly in the sun if possible or iron after drying.


1 Adapted from Burns et al. Where women have no doctor. Berkeley, CA, USA, Hesperian Foundation, 1997.


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Infections of the male and female reproductive tract and their consequences:

What are RTIs?

Why STI/RTIs are important?

What can be done about RTIs?

The role of clinical services in reducing the burden of STI/RTI

Preventing STIs/RTIs and their complications

How to prevent STI

How to prevent iatrogenic infections

How to prevent endogenous infections

Detecting STI/RTI

Detecting STI/RTI


Vaginal infections

Cervical infections

Pelvic inflammatory disease

HIV counselling and testing

STI/RTI education and counselling

Key points

Privacy and confidentiality

General skills for STI/RTI education and counselling

Health education


Promoting prevention of STI/RTI and use of services

Key points

Reducing barriers to use of services

Raising awareness and promoting services

Reaching groups that do not typically use reproductive health services

STI/RTI Assessment during Routine Family Planning Visits

Key points

Integrating STI/RTI assessment into routine FP services

Family planning methods and STIs/RTIs

STI/RTI Assessment in pregnancy, childbirth and the postpartum period

Key points

Management of symptomatic STIs/RTIs

Syndromic management of STI/RTI

Management of common syndromes

STI case management and prevention of new infections

STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period

Key points

Infection in early pregnancy

Infection in lated pregnancy

Infection following childbirth

Vaginal discharge in pregnancy and the postpartum period

Sexual violence

Key points

Medical and other care for survivors of sexual assault

Annex 1. Clinical skills needed for STI/RTI


Common STI/RTI symptoms

Examining patients

Annex 2. Disinfection and universal precautions

Preventing infection in clinical settings

High-level disinfection: three steps

Universal precautions

Annex 3. Laboratory tests for RTI

Interpreting syphilis test results

Clinical criteria for bacterial vaginosis (BV)

Wet mount microscopy

Gram stain microscopy of vaginal smears

Use of Gram stain for diagnosis of cervical infection

Annex 4. Medications

Medications in pregnancy

Antibiotic treatments for gonorrhoa

Annex 5.

STI/RTI reference table


Additionnal resources


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