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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 9. STI/RTI complications related to pregnancy, miscarriage, induced abortion, and the postpartum period


Vaginal discharge in pregnancy and the postpartum period

Vaginal discharge as a symptom or sign of RTI presents different challenges during pregnancy, because physiological changes during pregnancy can affect the normal microbiological environment (flora) of the vagina. For example, discharge may be more abundant and yeast infection is more common. Women with vaginal discharge should be carefully questioned and examined to make sure that the discharge is not an early sign of a more serious problem. For example:

  • In early pregnancy, discharge may mask spotting or light bleeding that could indicate ectopic pregnancy, threatened abortion, or cervical cancer.
  • A watery discharge in late pregnancy could be amniotic fluid from ruptured membranes.

A careful history and examination will usually provide clues that will help distinguish simple vaginitis from more serious conditions. When discharge is accompanied by bleeding, fever, abdominal pain or amniotic fluid leakage, the patient should be managed or referred for possible sepsis.

If pregnancy complications have been ruled out, all women with vaginal discharge should be treated for bacterial vaginosis, trichomoniasis and yeast infection. Yeast infection is very common during pregnancy and is often recurrent, so if a woman comes back with the same symptoms, she should be treated for yeast infection only.


Flowchart 9. vaginal discharge in pregnancy and postpartum period





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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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