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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 4. STI/RTI education and counselling


Key points

  • Health education for STI/RTI prevention should address:

- correct and consistent condom use,

- reducing the number of sex partners or delaying sexual activity,

- recognizing symptoms and early use of services.

  • Providing essential health education for STI/RTI takes little time. All patients with an STI/RTI should be given information about completing their treatment and preventing reinfection.
  • The partners of patients who are treated for infections that are clearly sexually transmitted should also be treated. Partner treatment is not needed for non-sexually-transmitted RTI, however, and care must be taken not to mislabel infections as sexually transmitted when they are not.
  • Counselling should always be flexible, be adapted to the needs and circumstances of each patient, and take into account barriers to behaviour change.

  • Counselling should stress the importance of STI/RTI prevention in

- maintaining fertility,

- ensuring safe pregnancy and preventing congenital infection,

- reducing risk of HIV infection, and

- helping people find ways to lead enjoyable sex lives.

  • Sexuality must be clearly and directly addressed in STI/RTI prevention.


People may be at risk of STI because of their behaviour, yet this behaviour may be difficult to change because of factors or circumstances—including gender, cultural expectations, poverty, migration and family disruption—that may limit their options and increase their vulnerability. To effectively reduce risk and vulnerability, people may need not only specific information about STI transmission but also support in making changes in their lives. Health care providers can help by providing:

  • health education during clinic visits;

  • counselling to support people in changing behaviour;
  • community education to raise awareness about STI/RTI and help change negative ideas and attitudes that may be barriers to healthy sexuality.


There is a big difference between health education and counselling. Health education is the provision of essential information related to the prevention or treatment of STI/RTI and need not take much time. Counselling, on the other hand, requires time to establish trust, assess the person’s individual situation, and relate prevention information directly to the person’s life. Busy health care providers rarely have the time to counsel every patient with an STI/RTI.

Clinic-based interventions are the subject of this chapter and are outlined in Table 4.1. Chapter 5 addresses education at the community level.


Table 4.1. Steps in patient education and counselling

Health education


To raise awareness

For prevention

As part of STI/RTI management

Talk about STIs/RTIs and complications

Promote correct and consistent condom use

Emphasize compliance with treatment

Discuss risk and vulnerability

Examine barriers to prevention

Discuss solutions and build skills for safer sex

Make a plan and follow up

Explain about symptoms and how to recognize them

Encourage fewer sex partners

Promote condom use (including during treatment to prevent reinfection)

Promote early use of services

Support delay in starting sex (for young people)

Encourage referral of partners for treatment



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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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