This WHO operational handbook consolidates existing global guidance on sexually transmitted infections (STIs) into a single practical resource for strengthening prevention, diagnosis, treatment and care within primary health care and universal health coverage frameworks. It does not introduce new recommendations but translates WHO's STI guidelines (published 2016-2025) into actionable implementation guidance, organized around an eight-component STI prevention and care cascade: primary prevention, managing symptomatic STIs, identifying asymptomatic STIs, diagnostics, treatment, managing partners, monitoring/evaluation/surveillance, and enabling service delivery. It targets national and subnational programme managers, health workers, civil society organizations, and policy-makers, and supports progress toward the WHO Global Health Sector Strategy on HIV, viral hepatitis and STIs 2022-2030 and related Sustainable Development Goal 3 targets.
Key Insights
More than 1 million new curable STIs are acquired daily worldwide; an estimated 374 million new curable infections occurred among people aged 15-49 in 2020 (gonorrhoea 82.4 million, chlamydia 128.5 million, trichomoniasis 156.3 million, syphilis 7.1 million)
Estimated new syphilis cases rose to 8.0 million globally in 2022, including approximately 700,000 congenital syphilis cases
An estimated 520 million people aged 15-49 were living with HSV-2 in 2020, and 300 million women had HPV infection
The handbook is structured around eight core components: primary prevention, managing symptomatic STIs, identifying asymptomatic STIs, diagnostics, treatment, managing partners, monitoring/evaluation/surveillance, and enabling service delivery
WHO recommends syndromic management flowcharts for five syndromes: urethral discharge, vaginal discharge, genital ulcer disease, lower abdominal pain, and anorectal discharge
First-line treatment regimens include ceftriaxone for gonorrhoea, doxycycline for chlamydia, and benzathine penicillin for syphilis
WHO recommends gonorrhoea/chlamydia screening when combined prevalence is at least 10% among pregnant women or 15-20% among sexually active adolescents and young adults
HPV vaccination is recommended for girls aged 9-14 as the primary cervical cancer elimination strategy
All pregnant women should be screened for syphilis at the first antenatal care visit regardless of local prevalence
Partner notification approaches include patient referral, provider referral, contract (delayed provider) referral, and expedited partner therapy where permitted
Key populations disproportionately affected include men who have sex with men, transgender people, sex workers, people who inject drugs, and people in prisons or closed settings
The handbook was developed following planning clearance approved by the WHO Guideline Review Committee in 2021
