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Integrating STI Services in Reproductive Health Services
Nevertheless, women do often present at reproductive health clinics with symptoms of STIs or other RTIs, and clinicians need to be able to respond with some level of care or referral for care. Quality reproductive health services attempt to meet clients’ broader sexual and reproductive health needs, beyond family planning or maternal care. In addition, many women who have STIs may not seek treatment of the infection because they have an asymptomatic infection and are unaware of it; they are too embarrassed to seek treatment, particularly if the clinic specializes in STI services; or they are unaware that their symptoms are abnormal. Many of these women may seek reproductive health services for other needs, such as family planning services or antenatal care, which presents an opportunity to identify STIs and other RTIs; to offer prevention, counseling, and care; or to refer the client for STI services. While setting up STI treatment services can be complicated and expensive, there is much that can be done short of setting up full-fledged services. Some STI screening activities, such as screening pregnant women for syphilis, are very simple and cost effective and can help prevent long-term complications for the mother and serious negative consequences for the child. Other services could include setting up referral mechanisms or could focus on specific STIs or RTIs that are known to be prevalent in the population. Few would debate the importance of integrating some level of STI and HIV prevention into reproductive health programs—prevention should be a priority. It is, therefore, important to integrate some level of STI/RTI care into reproductive health services. When services are integrated, women can seek care without fear of the stigma associated with seeking specialized STI services, women who are unaware of infection can sometimes be identified and offered care, and women who seek care because they are experiencing the pain or discomfort of STI or RTI symptoms can have their needs met. Decisions about what to integrate must often be made based on available resources, the service infrastructure, and local needs.
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It is sometimes asserted that reproductive health services should not
be the focus of major resources for STI care for a variety of reasons:
because prevalence is low in these populations; because most infections
would be missed since they are often asymptomatic in women; because women
are often the end of the line of infection, being less likely to pass
the infection on; or because women most often present with vaginal discharge,
which is difficult to treat with syndromic management, often the only
approach available. From a resource perspective, a greater public health
impact could be made by channeling resources into programs that target
core transmitter populations—those most likely to pass
the infections on to others.