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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



Management of STIs/RTIs
Chapter 10. Sexual violence


Key points

  • Sexual violence is common but is frequently not talked about by the person concerned—health care workers should maintain a high index of suspicion. They should ask about experience of sexual violence or abuse.
  • Clinic policies and practice guidelines should be developed in accordance with local legal requirements.
  • Women or children who have been sexually abused may need shelter and legal protection. Psychosocial management includes counselling and supportive services, which should be available on-site or by referral.
  • Medical management includes prevention of pregnancy and infection, in addition to care of injuries. STI prophylaxis and emergency contraception should be available.
  • Forensic examination should be available to document evidence if the person chooses to take legal action. Staff should be trained in how to take forensic specimens, or referral links should be made.
  • Referral should be available if services cannot be provided on-site.


Sexual violence is defined as “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 work1.

Sexual violence is common. Both males and females are vulnerable in childhood, but women are much more at risk in adolescence and adulthood. Box 10.1 gives some information on the occurrence of sexual violence.


Box 10.1. Sexual violence—some statistics

Studies from different parts of the world have found that 7–36% of girls and 3–29% of boys suffer from sexual abuse in childhood, with a majority of studies reporting 1.5–3 times more sexual violence against girls than boys.

The percentage of adolescents who have been coerced into sex can range from approximately 7% to 46% of females and 3% to 20% of males, depending on the country.

Population-based studies report that between 6% and 46% of women have experienced attempted or completed forced sex by an intimate partner or ex-partner at some time in their life.

Rape and domestic violence account for an estimated 5–16% of healthy years of life lost in women of reproductive age.

STI has been found in up to 43% of people who have been raped, with most studies reporting rates between 5% and 15% depending on the disease and type of test used.


It is important that health care providers have a high index of suspicion and awareness about sexual violence. Many individuals are reluctant to talk directly about abuse by their intimate partner. They may be ashamed to discuss it, or they may be afraid of future violence if the situation is exposed. Often, because they feel uncomfortable talking about sexual violence, individuals may come to the clinic with other non-specific complaints or requesting a check-up—assuming that the health care provider will notice anything abnormal that needs treatment.

This chapter cannot cover all the medical, social and legal aspects of sexual violence that should be addressed. Rather, it focuses on recommendations for preventing direct adverse consequences of sexual assault, particularly STI and pregnancy. The resources listed in Annex 6 provide guidance for establishing services and protocols for comprehensive care of survivors of sexual violence and examples of screening protocols that can be used to identify those exposed to gender-based violence.


World Report on violence and Health. Geneva, World Health Organization, 2002.


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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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