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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



STI/RTI basics
Chapter 3. Detecting STI/RTI


Cervical infections

Cervical infections are much less common than vaginal infections, especially among women who use reproductive health services, and are usually asymptomatic. The cervix is the most common site of infection for gonorrhoea and chlamydia. Even if a woman is asymptomatic, it may be possible to detect signs of infection on careful speculum examination (Table 3.3). Speculum examination may also reveal signs of other infections, including cervical ulcers and warts.


Indications and opportunities for screening

Screening may be done:

  • any time a speculum examination is performed for other reasons;
  • during pregnancy.

People with frequent exposure to STI, such as sex workers, should be screened regularly.


Available screening tools

  • Careful speculum examination may detect many (but not all) cervical infections (Table 3.3).
  • Culture for gonorrhoea is accurate and not expensive or technically difficult to set up in established laboratories (Table 3.2).
  • Laboratory tests for chlamydial infection are expensive and miss many infections (Table 3.2). Polymerase chain reaction (PCR) is very accurate but very expensive.


Recommended approach

  • A careful speculum examination should be done to look for signs of cervical infection (Table 3.3). Speculum examination skills are reviewed in Annex 1. Some asymptomatic internal ulcers and genital warts may also be detected on speculum examination.
  • A swab should be collected from the cervical canal (endocervix). If the swab appears yellow when held up against white paper (positive swab test), cervical infection is likely and the woman should receive treatment for gonorrhoea and chlamydia.
  • Depending on laboratory resources, endocervical swab specimens can also be:

- cultured for gonorrhoea (Table 3.2);

- tested for chlamydial infection (Table 3.2).

Table 3.3. Clinical criteria for cervical infection

Screening method



Speculum examination detects some cases of cervical infection.

Mucopurulent discharge (non-clear, yellowish discharge from endocervix).

When any of these signs are present, patient should be treated for both gonorrhoea and chlamydia.

Note: at least half the women with cervicitis do not have these signs, and some women with these signs do not have gonorrhoea or chlamydia.

Friability (easy bleeding) when the cervix is touched with a swab.

Positive swab test (yellow discoloration of swab inserted in endocervix).


Screening is one of the few ways to detect cervical infection and it should not be limited to women with vaginal discharge. Cervical infection is usually asymptomatic and women without vaginal discharge are as likely to have gonorrhoea or chlamydial infection as women with discharge. Despite lack of symptoms, consequences can be severe if infection reaches the upper genital tract.


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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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