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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


Reducing barriers to use of services

The first step to increasing use of services is to remove the barriers that keep people away. Talking with patients and community members can often identify such barriers. People may avoid health care services because of accessibility barriers, such as:

  • Laws, policies and regulations—do they place restrictions on young people or women using services, or require a parent’s or husband’s permission?
  • Location—can people reach the clinic easily? Mobile or satellite clinics can extend the reach of clinical services.
  • Hours—are opening hours of the clinic convenient for working people, students, and others? Special clinic sessions in the evening or at the weekend may make it possible for some people to attend who otherwise could not.
  • Cost—can people afford the clinic fees and additional costs for laboratory tests and medicines? Costs deter people, and in the end the cost to the community will be high if rates of STI/RTI and their complications remain high.

In addition, there may be barriers to acceptability of services, including:

  • Stigma—people are often afraid to use services because of critical or judgemental attitudes of staff. Non-respectful treatment by providers deters many adolescents from using health care services. Reproductive health services are often designed or perceived to be exclusively for women, which discourages men from using them.
  • Lack of privacy—young people particularly worry that information about their health or sexual behaviour will not be treated as confidential. Steps can be taken to ensure privacy during clinic visits and confidentiality of information (see Chapter 4).
  • Poorly managed health care facility—do people have confidence in the clinic and its staff, and feel that the quality of the services they receive is good? Improving services builds such confidence.
  • Inadequate supplies and drugs—can people get the tests and treatment they need on-site? If not, they may decide to go directly to a pharmacy for treatment in order to save time and money.
  • Incompetent and disrespectful health care providers—do people feel welcomed by clinic staff? Do they have confidence in the health care providers?

Addressing these barriers will make it easier to promote use of services for STI/RTI prevention and care.

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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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