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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



STI/RTI basics
Chapter 3. Detecting STI/RTI


Vaginal infections

Vaginal infections (yeast infection, bacterial vaginosis and trichomoniasis) are very common in women of reproductive age, are almost always symptomatic and rarely cause complications.


In non-pregnant women, there is no need to look for asymptomatic cases. Asymptomatic women should not be treated for yeast or bacterial vaginosis on the basis of microscopy findings alone.

In pregnant women, however, bacterial vaginosis (BV) and trichomoniasis may cause complications such as prelabour rupture of membranes and preterm delivery. Women at risk for these conditions should be screened regardless of symptoms.


Indications for screening

  • Pregnant women with a history of spontaneous abortion or preterm delivery should be screened.


Available screening tools (see Annex 3)

  • BV can be detected by Gram stain microscopy of a vaginal smear or simple bedside methods (see Annex 3).
  • Motile Trichomonas protozoa (trichomonads) can be seen on microscopic examination of a fresh wet mount of vaginal fluid in a drop of normal saline.


Recommended approach

  • Pregnant women with a history of spontaneous abortion or preterm delivery should be screened for BV and trichomoniasis. Those who test positive should be treated (after the first trimester of pregnancy) with metronidazole, 500 mg three times a day for seven days, to reduce risk of adverse pregnancy outcome.
  • Women with symptomatic vaginal discharge in the second or third trimester should be treated (without screening) as above for BV, trichomoniasis, and yeast infection (see Flowchart 9 in Chapter 9).
  • Non-pregnant women with abnormal vaginal discharge should be managed according to Flowchart 1 in Chapter 8.


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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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