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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 1. Infections of the male and female reproductive tract and their consequences


Key points

  • 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 common.
  • 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 infections.

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 RTIs difficult.
  • 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

Common examples

Endogenous infections

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

Iatrogenic infections

Inside or outside the body:

  • Endogenous (vagina)

  • STI (cervix or vagina)

  • Contamination from outside

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

Female anatomy Male anatomy


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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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