Sexually Transmitted Infections and Reproductive Tract Infections

Sexually transmitted infections (STIs) are defined as infections that spread primarily through person-toperson sexual contact. However, several of these infections, in particular HIV, syphilis and hepatitis B, can also be transmitted via mother-to-childtransmission during pregnancy and childbirth, blood products or tissue transfer. There are more than 30 different sexually transmissible bacteria, viruses and parasites1. STIs should be distinguished from reproductive tract infections (RTIs). RTIs are defined as infections of the genital organs and include endogenous infections such as bacterial vaginosis and vulvovaginitis candidiasis. These two infections are mostly not sexually transmitted and they can occur in women who have never had a sexual relationship. RTIs also include exogenous infections, such as septic abortion due to unsafe procedures and post-partum infections. Thus the term STIs and RTIs only partly overlap. The concept of STI refers to the way of transmission, and the concept RTI to the site where the infection develops. The following chapter includes selected curable STIs and RTIs based on a synthesis of what is generally discussed in textbooks of gynecology and obstetrics and World Health Organization (WHO) publications on STIs as well as treatment guidelines. Treatment advice is based on WHO treatment guidelines2,3 and Cochrane reviews4,5, and is restricted to drugs listed in the Interagency List of Essential Medicines for Reproductive Health6. The STIs discussed in this chapter include bacterial vaginosis, trichomoniasis, candidiasis, chlamydia, gonorrhea, pelvic inflammatory disease (PID), syphilis, genital herpes, chancroids, lymphogranuloma venereum, granuloma venereum, condylomata acuminata and septic abortion. This chapter will not include human papilloma virus (HPV) and cervical cancer (Chapter 26), or HIV (Chapter 18). Other STIs such as hepatitis B which do not cause infections of the sexual organs, or post-partum infections which are discussed in textbooks of obstetrics, are not included in this chapter.