STI/RTI basics
Chapter 1. Infections of the male and female reproductive tract and their consequences

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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