Department of Reproductive Health and Research (RHR), World Health Organization
Sexually transmitted and other reproductive tract infections
A guide to essential practice
Improving services for
prevention and treatment of STI/RTI
Family planning methods and STIs/RTIs
Most family planning methods do not protect against STIs. Table 6.1 presents estimates of contraceptive effectiveness and STI protection for common methods. Some contraceptive methods actually increase the risk of non-sexually transmitted RTI or their complications, and clients may abandon a method (and risk pregnancy) if they think it is causing problems. Yeast infection, for example, is more common in women using oral contraceptives, and bacterial vaginosis occurs more frequently in women using the diaphragm with spermicide. Health care providers should be aware of such method-related problems and be able to counsel patients about management or alternative methods.
Table 6.1. Family planning methods: protection from pregnancy and STIs
a. Effectiveness in normal (“typical”) use.
Dual protection and emergency contraception
Only correct and consistent condom use provides reliable protection against STIs. Counselling on dual protection should thus always include promotion of condoms. When used consistently and correctly, condoms also provide good protection against pregnancy. Couples who want additional protection against pregnancy can combine condoms with another method, or use emergency contraception as back-up protection in the event of condom misuse or failure. Box 6.2 describes how to provide emergency contraception using different types of emergency contraceptive pills, including commonly available oral contraceptives.
Intrauterine device (IUD)
For women with a high individual likelihood of exposure to gonorrhoea or chlamydial infection, IUD use is usually not recommended unless other more appropriate methods are unavailable or unacceptable. Other women at increased risk of STIs can generally use the IUD. Precautions to reduce risk of iatrogenic infection during IUD insertion are described in Box 6.3.
Box 6.3. Reducing risk of iatrogenic RTI with IUD insertion
Any woman with signs of cervical infection (mucopurulent cervical discharge or cervical friability) should be treated for gonorrhoea and chlamydia using Treatment table 2 (Chapter 8); her partner should also receive treatment. The insertion of an IUD must be delayed until the infection is cured. The patient should also be counselled about dual protection.
Women with lower abdominal, uterine, adnexal or cervical motion tenderness should be treated for PID using Treatment table 3 in Chapter 8 and counselled about alternative contraceptive methods (emphasizing dual protection). Women who are at high individual risk for gonorrhoea or chlamydial infection should usually not use the IUD, unless other more appropriate methods are unavailable or unacceptable.
If a woman develops PID, purulent cervicitis, chlamydial infection or gonorrhoea while using the IUD, there is usually no need to remove the IUD while being treated for the infection if the woman wishes to continue IUD use.
Spermicides and diaphragm with spermicides
Women at high risk for HIV infection or those already HIV-infected should not use spermicides. Repeated and high-dose use of the spermicide nonoxynol-9 is associated with an increased risk of genital lesions, which may increase the risk of acquiring HIV infection. Women at high risk of HIV infection or those who are HIV-infected should not use the diaphragm with spermicides unless other more appropriate methods are unavailable or unacceptable.
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