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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 1. Infections of the male and female reproductive tract and their consequences


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

There are a number of challenges to providing effective STI/RTI services to the people who need them (Figure 1.3). Many people with an STI/RTI do not seek treatment because they are asymptomatic or have mild symptoms and do not realize that anything is wrong. Others who have symptoms may prefer to treat themselves or seek treatment at pharmacies or from traditional healers. Even those who come to a clinic may not be properly diagnosed and treated. In the end, only a small proportion of people with an STI/RTI may be cured and avoid reinfection; this Guide aims to help increase that proportion.


Figure 1.3. Challenges of STI/RTI service provision

People with STI/RTI



Seek care      

Accurate diagnosis

Correct treatment

Completed treatment



Many of these challenges can be addressed by making the most of opportunities to promote prevention, improve health-seeking behaviour, and detect and manage existing infections. Health care providers should:

  • Raise awareness in the community about STIs/RTIs and how they can be prevented—especially among populations who may be at high risk.
  • Promote early use of clinic services to cure STIs/RTIs and prevent complications. Teach people how to recognize symptoms and when to seek care.
  • Promote safer sexual practices—including consistent condom use, fewer partners, and delaying sexual onset—when counselling clients.
  • Detect infections that are not obvious. Ask about symptoms of STI/RTI when patients attend for family planning or other reasons. Look for signs of STI/RTI when doing examinations. Screen for asymptomatic infection when possible.
  • Prevent iatrogenic infection by following universal precautions, using aseptic technique, and ruling out or treating cervical infection before performing transcervical procedures.
  • Manage symptomatic STI/RTI effectively. Follow syndromic management guidelines for STI/RTI case management.
  • Counsel patients on staying uninfected after treatment. Encourage them to comply with treatment, assist with partner notification and treatment, and reinforce prevention.

STI/RTI services should never be seen as an optional component of reproductive health services. The 1994 International Conference on Population and Development, held in Cairo, Egypt, emphasized that provision of clinical services to reduce STIs in family planning services was essential for ensuring a healthy reproductive future. Clearly, there is an opportunity to reach many women whose only contact with the health care system is reproductive health services. Most of these women are sexually active, many are at risk of infection and some have an existing infection.

A combined strategy of effective community interventions and improved clinical services can have a large impact on STIs/RTIs and their complications. Better clinical services increase the number of people who are cured. More effective prevention in the community, especially when it reaches those at highest risk, can reduce the overall STI/RTI problem. The combination of strategies benefits everyone.



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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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