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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


Health education

All patients need information about STIs/RTIs, how they are transmitted and how they can be prevented. Health care providers should express positive attitudes about sexuality and emphasize the benefits of enjoying a healthy sexual life while preserving health and fertility. Box 4.2 includes a checklist of essential information that should be provided during patient education. In addition:

  • If a client has come for family planning, she should be offered information about STI/RTI, how to prevent infection and how to recognize signs of infection. Stress that consistent condom use is the only way to avoid both pregnancy and exposure to sexually transmitted infections (dual protection).
  • If the patient is pregnant, she needs to understand the importance of preventing STI/RTI in pregnancy and of detecting syphilis, HIV and other infections that could be a danger to her or the pregnancy.
  • Patients who come to the clinic with STI/RTI symptoms should be urged to follow recommended treatment, discuss prevention and, if the infection is sexually transmitted, refer partners for treatment (see Chapter 8).

More specific advice on integrating education and prevention counselling into family planning and antenatal visits can be found in Chapter 6 and Chapter 7.


Box 4.2. Checklist: what patients should know

Information about STI/RTI

  • How STIs are passed between people (but other RTIs are not).

  • Consequences of STI/RTI including infertility and pregnancy loss.

  • Links between STI and HIV and behaviour that spreads both.

Prevention of STI

  • Where to get condoms.

  • Using condoms consistently and correctly (especially with new partners).

  • Limiting number of partners.

  • Delaying sex (adolescents).

  • Using alternatives to penetrative sex.

  • Negotiating skills.

Healthy sexuality

  • Normal biological and emotional changes.

  • Benefits of a healthy sexual life.

  • When and how to seek advice about problems.

STI/RTI symptoms

  • What to look for and what symptoms mean.

  • Early use of clinic services.

STI/RTI treatment

  • How to take medications.

  • Abstaining or having protected sex during treatment.

  • Importance of partner referral.

  • Signs that call for a return visit to the clinic.


Much of this information can be presented to groups of patients while they are waiting in the clinic to be seen. A health educator or other staff member can be trained to present basic sexual health information, including on STI prevention, using a flipchart or posters to reinforce messages. In some clinics, information can be presented using videos or audio tapes. Whatever the method, patients should be given a chance to discuss the information and ask questions in private during the examination or counselling session.

Such group presentations can help patients identify their concerns and ask specific questions. Health education should continue during the consultation and examination. For example, techniques for negotiating condom use can be discussed if the patient complains that she has trouble getting her partner to use them. Be sure to summarize important points at the end of the visit and offer patients a chance to ask questions.


Patient education about safer sex

We know that certain behaviours increase the risk of STI transmission. Some of these involve unprotected sexual contact with body fluids in the vagina, mouth, or anus. With others, such as sex work, it may be hard for the person to use condoms or other prevention methods.

Safer sex (Box 4.3) can be more pleasurable for both partners because it is less likely to cause worry, discomfort, or disease. Emphasize that safer sex is real sex—couples can talk about sex together to learn different ways of pleasing each other.


Box 4.3. What is safer sex?

Safer sex is any sexual activity that reduces the risk of passing STI and HIV from one person to another. Safer sex does not allow semen, vaginal fluid, or blood to enter the body through the vagina, anus, or any open sore or cut.

Some safer sex practices

  • Use a condom every time you have sex (especially with new partners).

  • Reduce the number of your sex partners—sex with an uninfected monogamous partner is the safest.

  • Try massage, rubbing, touching, dry kissing, hugging, or masturbation instead of intercourse.

  • Keep away from unsafe sexual practices, like "dry sex", which may break the skin—the vagina should be wet inside when you have intercourse.

  • If you have anal sex, always use a condom with lubrication because the mucous membrane there can tear easily.

  • DO NOT have intercourse or oral sex if you or your partner has genital sores or an abnormal discharge.


Patient education following STI/RTI treatment

Patients who are being treated for an STI/RTI need additional information to help ensure they complete their treatment and avoid reinfection. Box 4.4 summarizes essential information for patients who are being treated for an STI/RTI.


Box 4.4. Patient education as part of STI/RTI case management

  • Encourage patients to seek treatment from their clinic or doctor. Discourage self-medication or getting medication from unlicensed sources.

  • Encourage patients to complete their course of treatment. Stopping treatment too early, as soon as symptoms disappear, is a common reason for treatment failure. Discourage sharing of medicines.

  • Avoid labelling an infection as sexually transmitted when the diagnosis is not certain. Most RTIs are not sexually transmitted, and patients (and their partners) should understand this.

  • Encourage partner treatment when appropriate (see Chapter 8). Partner treatment is indicated for women who have genital ulcers, signs of cervicitis or PID, but careful counselling is needed to avoid misunderstanding and potential conflict between partners.

  • Emphasize what patients can do to prevent reinfection. This includes providing information on safer sex (Box 4.3) and condom use, and may require more in-depth counselling.


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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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