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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



Improving services for prevention and treatment of STI/RTI
Chapter 5. Promoting prevention of STI/RTI and use of services


Key points

  • A public health approach to prevention and control of STI/RTI includes reducing barriers to services, raising awareness in the community, promoting services, and reaching out to people who do not typically use reproductive health services.
  • Services should be accessible and acceptable, so that people do not hesitate to use them if they have concerns about STI/RTI.
  • The community should be made aware of STIs/RTIs and their complications, and early use of services should be promoted.
  • The role of untreated STIs/RTIs in infertility, pregnancy complications and HIV infection should be emphasized to encourage use of preventive and care services.
  • Men should be encouraged to participate in STI/RTI prevention. Special services or referrals may need to be developed to address STI/RTI in men.
  • Services need to reach young people who are often at high risk of STIs/RTIs and their complications, yet are often reluctant to attend clinics.
  • Finding ways to reach the groups at highest risk of infection—such as sex workers and their clients—is key to reducing STI transmission.


As noted in Chapter 1, communities with good access to effective prevention and treatment services have lower rates of STI/RTI and their complications than communities where services are poor, disrupted or not used by people at risk of infection. This chapter looks at what can be done to reach more people in need of STI/RTI services and convince them to use the clinic. This involves:

  • reducing barriers to use of services;
  • raising awareness of STI/RTI and promoting use of services;
  • reaching out to those who do not normally use reproductive health services.


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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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