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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





Adnexae: ovaries, fallopian tubes and supporting structures.

Algorithm: a sequence of logical steps that should be taken when dealing with a given task.

Birth plan: a plan for giving birth that takes into account the woman’s or couple’s preferences as well as special circumstances and possible complications or emergency situations.

Clue cells: vaginal cells covered with bacteria; commonly present in women who have a vaginal infection.

Complicated abortion: spontaneous or induced abortion that results in complications, such as infection or bleeding.

Curd-like vaginal discharge: whitish vaginal discharge, like cottage cheese; common in yeast infection.

Dilatation and curettage: a technique that may be used for induced abortion. It involves stretching the cervical channel and scraping the interior of the uterine cavity to remove products of conception.

Dry sex: a sexual practice that involves penetrative vaginal sex where the woman has a dry vagina. Sometimes herbs are used to increase the dryness. Dry sex increases the risks of sexually transmitted infections, including HIV.

Dual method use: using a barrier method for protection against sexually transmitted infection and another method for contraception.

Dual protection: prevention of both STI/HIV infection and unwanted pregnancy. This can be achieved by the correct and consistent use of condoms alone or by the simultaneous use of two methods, one of which must be a condom.

Dual risk: risk of both pregnancy and STI/HIV.

Dyspareunia: painful intercourse.

Dysuria: difficult or painful urination.

Ectopic pregnancy: a pregnancy in which the fertilized egg implants outside of the uterus, and the placenta and fetus begin to develop there. The most common site is within a fallopian tube.

Epididymitis: inflammation of the epididymis; occasional complication of untreated urethral infection.

Epithelialize: to become covered with epithelial tissue (to heal).

Female reproductive tract: includes vulva, vagina, uterine cavity and the fallopian tubes (see figure).

Forensic examination: examination to look for evidence that can later be used in legal proceedings; should be done by specially trained professional.

Health care providers: individuals who are trained to provide various health services.

HIV voluntary counselling and testing (VCT): counselling prior to HIV test, testing itself, and post-test counselling conducted when results of the test are given to the patient.

Incidence rate: the number of new cases of a disease in a defined population over a specified period of time.

Index patient: the original patient diagnosed for a particular infection.

Induced abortion: intentional termination of pregnancy prior to fetus reaching the state of viability by mechanical (surgical) means or by drugs.

Infertility: inability to conceive; usually assumed to exist if pregnancy is not achieved after 12 months of regular sexual intercourse, without the use of any form of birth control.

Infestation: development of a pathogenic agent on the body, e.g., body lice.

Integrated services: availability of multiple health services—for instance, family planning and STI treatment—through a single facility or at a single visit.

Integration: incorporation of other services into already existing services.

Lochia: postpartum discharge which is often blood-stained, but not foul-smelling.

Lower genital tract infection: includes vaginal and cervical infection.

Manual vacuum aspiration (MVA): a technique for evacuating the contents of the uterus through use of a specially designed hand-held syringe.

Medical eligibility criteria: criteria for a woman’s eligibility to use a contraceptive method, based on the relative health risks and benefits of using such a method for a woman with a given condition.

Milking: checking for penile discharge by placing the fingers of one hand several centimetres behind the scrotum and bringing them upward and forward towards the base of the penis.

Morbidity: a state of disease.

Mother-to-child transmission (MTCT): transmission of HIV from an infected mother to her infant during pregnancy, labour or after delivery through breast milk.

Outpatient: a patient who receives treatment without being hospitalized.

Parenteral therapy: therapy given by some other means than through the gastrointestinal tract; usually refers to drugs given intravenously, intramuscularly or subcutaneously.

Pathogen: a microorganism, such as a bacterium, that lives on and feeds from a host and causes disease.

Postabortion: period of time that immediately follows abortion, usually no longer than 2 weeks.

Postabortion care: care given to manage complications of abortion. Key elements include emergency treatment of abortion complications, family planning counselling and services, and links to comprehensive reproductive health services.

Postpartum: the first 6 weeks after childbirth.

Preferred method: contraceptive method that patient thinks she would like to use.

Prelabour rupture of membranes: rupture of membranes before labour has begun. (1) Pretermwhen fetus is immature <37 weeks (2) Termwhen fetus is mature >37 weeks.

Presumptive treatment: treatment with a full curative dose of drugs (e.g., antibiotics) based on assumption that person is infected, not on evidence of the disease.

Preterm rupture of membrane: rupture of membranes before 37 weeks of gestation (before pregnancy is carried to term).

Prevalence rate: the number of cases of a disease existing in a given population at a specific point or period of time.

Primary infertility: infertility in a couple that has never conceived.

Prophylactic treatment: often refers to a partial dose of drugs (in comparison to the full curative dose) that may prevent a process than can lead to disease.

Prophylaxis: prevention of disease or of a process that can lead to disease.

Screening: examination of usually symptom-free individuals to detect those with signs of a given disease.

Secondary infertility: infertility in a couple that has previously conceived at least once.

Sepsis: presence of pathogenic organisms or their toxins in the blood.

Serial monogamy: situation in which a person has a series of consecutive sexual relations of various durations, such that he or she has multiple partners over time, but never more than one partner at any single point in time.

Sexual violence: any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic women’s sexuality, using coercion, threats of harm or physical force, by any person regardless of relationship to the victim, in any setting, including but not limited to home and work.

Signs: abnormalities indicative of disease identified by health care provider on examination of the patient.

Spontaneous abortion: abortion that was not artificially induced; miscarriage.

Swab: a rolled piece of cotton or gauze attached to the end of a stick or clamp, used for applying medications or collecting biological samples from a surface.

Symptom: abnormal phenomenon experienced by patient and indicative of disease.

Teratogenicity: the ability to cause defects in a developing fetus—a potential side-effect of many drugs.

Transcervical procedure: any procedure that requires passage of an instrument or device through the cervix into the uterus (e.g. IUD insertion, MVA, endometrial biopsy).

Transmission: passage of disease-causing microorganisms from one person to another.

Upper genital tract infection: includes infection of endometrium, fallopian tubes, ovaries and surrounding tissues.



1 The definitions given here apply to terms as used in this publication; they are not necessarily applicablein other contexts.

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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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