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Sexually transmitted and other reproductive tract infections - A guide to essential practice ( PDF 1,618 KB)Sexually transmitted and other reproductive tract infections - A guide to essential practice

2005 - 191 pages


Full text (PDF 1,618 KB)  - Order hard copy (free of charge)

Front cover (295 KB) - Back cover

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Arabic and Chinese versions under translation



This publication is intended to assist health care managers and practitioners in resource-limited reproductive health care settings around the world to meet the needs of individuals who may be at risk of reproductive tract infections (RTIs).

It is assumed that readers are familiar with certain clinical knowledge, such as drugs and their dosages, although they may not have experience with management of sexually transmitted infections (STIs) and RTIs.

The publication reflects the involvement of a large number of international experts who reviewed and debated aspects of the document to ensure that recommendations are based on the best available evidence as well as on what are considered favourable public health outcomes. Additionally, in order to validate the usefulness of the recommendations for reproductive health care settings around the world, the manual was thoroughly reviewed by practitioners and programme managers in a number of countries, prior to publication. Finally, this Guide has been pre-field tested in five countries: Brazil, China, Kenya, Jamaica and Latvia.

A companion publication to this Guide is available, entitled: Guidelines for the management of sexually transmitted infections. This publication presents the revised recommendations, both for a syndromic approach to the management of patients with STI symptoms and for the treatment of specific STIs, based on evidence and epidemiological surveillance data from around the world. It also provides information on the notification and management of sexual partners and on STIs in children and adolescents.

Another companion publication, Sexually transmitted and other reproductive tract infections: a pocket guide for essential practice is under development. This publication will contain a summary of essential information for ease of reference to management flowcharts, treatment tables, counselling points, and other information in a convenient-to-carry format. The pocket guide is intended to serve as a working tool for use by providers in their everyday interactions with their clients.



This practice guide is a collaborative effort of WHO’s Department of Reproductive Health and Research, Family Health International (FHI) and The Population Council’s FRONTIERS in Reproductive Health Program. It is based on the work of a large group of experts, who participated in consultations or reviews. WHO would like to thank the members of the technical review panel: Dinesh Agarwal, Kamal Alami, Adele Benzaken, Lalit Kumar Bhutani, Ward Cates, Anupong Chitwarakorn, Patricia Claeys, Gina Dallabetta, Patricia J. Garcia, David Grimes, Sarah Hawkes, Marie Laga, Gunta Lazdane, Philippe Mayaud, Andre Meheus, Linda Morison, Charles Morrison, Telma Queiroz, Laima Rudze, Moshira El-Shafei, Guida Silva, Jim Shelton, Marleen Temmerman, Johannes van Dam, Eddy van Dyck, Teodora Elvira Wi, and Guang Zeng.

Richard Steen (external consultant), Nathalie Broutet (WHO), and Irina Yacobson (FHI) constituted the core writing team and were leaders of the technical panel.

Ian Askew (Frontiers/Population Council), Nathalie Broutet (WHO), Florence Carayon (FHI), Saiqa Mullick (Frontiers/Population Council), and Robert Rice (FHI) coordinated the writing of the Guide.


WHO gratefully acknowledges the contributions of the many reviewers who assisted in field-testing the guide in Brazil, China, Jamaica, Kenya, and Latvia.

This publication was funded through Contraceptive Technology Research Agreement 96-05 CCP-A-00-95-00022-02 to Family Health International (FHI) and the FRONTIERS in Reproductive Health Cooperative Agreement HRN-A-0098-0001200 to the Population Council from the US Agency for International Development (USAID). The contents do not necessarily reflect FHI, the Population Council or USAID views and policy.


© World Health Organization 2005

All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857;
email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Marketing and Dissemination, at the above address
(fax: +41 22 791 4806; email: [email protected]).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

ISBN 92 4 159265 6 (NLM classification: WC 140)

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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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