Chapter 1. Infections of the male and female reproductive
tract and their consequences
- Reproductive tract infections (RTIs) are caused by organisms
normally present in the reproductive tract, or introduced from the
outside during sexual contact or medical procedures. These different
but overlapping categories of RTI are called endogenous, sexually
transmitted infections (STIs) and iatrogenic, reflecting
how they are acquired and spread.
- Over 340 million curable, and many more incurable, STIs occur each
year. Among women, non-sexually-transmitted RTIs are usually even more
- STIs/RTIs are among the most important causes of maternal and
perinatal morbidity and mortality. Serious complications of STIs/RTIs—ectopic
pregnancy, pelvic inflammatory disease, preterm labour, miscarriage,
stillbirth, congenital infection—may lead to chronic disability (such
as infertility and genital cancer) and death. Increased risk of
HIV/AIDS is another consequence of STIs/RTIs.
- To reduce the burden of RTI, efforts are needed in both health
care facilities and in the community.
- Effective prevention and case management practised by
health workers reduce the STI/RTI burden in several ways. Effective
treatment reduces STI transmission in the community, and safe and
appropriate clinical procedures mean fewer iatrogenic infections.
- Community education and outreach are needed to promote
prevention of infection and use of health care services and thus
further reduce disease transmission within the community.
What are RTIs?
Reproductive tract infections are infections of the genital tract.
They affect both women and men. Some RTIs (such as syphilis and
gonorrhoea) are sexually transmitted, but many are not. In women,
overgrowth of endogenous microorganisms normally found in the
vagina may cause RTI (yeast infection, bacterial vaginosis). Medical
interventions may provoke iatrogenic infection in several
ways—endogenous organisms from the vagina or sexually transmitted
organisms in the cervix may be pushed during a transcervical procedure
into the upper genital tract and cause serious infection of the uterus,
fallopian tubes and other pelvic organs. Organisms from outside the body
can also be introduced into the upper genital tract during medical
procedures if infection control is poor. In men, sexually transmitted
infections are much more common than endogenous or iatrogenic
These different categories of infections are included together in
this Guide for several reasons:
- Prevention of STIs/RTIs and their complications requires a common
approach within reproductive health services.
- The clinical appearance of different STIs/RTIs overlaps,
especially in women. Symptoms noticed by patients, and even the
clinical signs found by health care providers, are often similar,
making the distinction between sexually and non-sexually transmitted
- In reproductive health settings such as antenatal and family
planning clinics, non-sexually-transmitted RTIs are usually more
common than STIs. Different approaches to management are needed to
provide appropriate care and minimize stigma. Health care providers
should recognize that labelling a condition as sexually transmitted
may be inaccurate and have serious social consequences for the couple.
Where they come from
How they spread
Organisms normally found in vagina
Usually not spread from person to person, but
overgrowth can lead to symptoms
Yeast infection, bacterial vaginosis
Sexually transmitted infections
Sexual partners with STI
Sexual contact with infected partner
Gonorrhoea, chlamydia, syphilis, chancroid,
trichomoniasis, genital herpes, genital warts, HIV
Inside or outside the body:
By medical procedures or following examination or
intervention during pregnancy, childbirth, the postpartum period or
in family planning (e.g., IUD insertion) and gynaecology settings.
Infection may be pushed through the cervix into the upper genital
tract and cause serious infection of the uterus, fallopian tubes and
other pelvic organs.
Contaminated needles or other instruments, e.g.
uterine sounds, may transmit infection if infection control is poor.
Pelvic inflammatory disease (PID) following abortion
or other transcervical procedure. Also, many infectious
complications of pregnancy and postpartum period.
Figure 1.1. Sites of infection