Sexually transmitted infections (STIs) are not just a “youth issue” or something that happens to “other people.” In India, community‑based estimates suggest that more than 6% of adults experience an STI or reproductive tract infection each year, translating into tens of millions of episodes. Women carry a disproportionate share of the health impact: untreated STIs can lead to pelvic inflammatory disease, infertility, ectopic pregnancy, pregnancy complications, chronic pelvic pain, and an increased risk of HIV.​

The good news is that most STIs are preventable and many are easily treatable if diagnosed in time. This blog focuses on testing and prevention strategies for women, using concepts relevant to India’s public‑health approach.

Common STIs Affecting Women

STIs can be bacterial, viral, or parasitic. Important ones for women’s health include:​

  • Bacterial
    • Chlamydia
    • Gonorrhoea
    • Syphilis
    • Chancroid and other less common bacterial STIs
  • Viral
    • Human papillomavirus (HPV)
    • Herpes simplex virus (HSV)
    • Human immunodeficiency virus (HIV)
    • Hepatitis B
  • Parasitic / others
    • Trichomoniasis
    • Some vaginal infections that overlap with reproductive tract infections

Many of these may not cause obvious symptoms, especially in women, which is why proactive testing is crucial.

 

Why STIs Are a Major Concern for Women in India

  • STIs increase the biological risk of acquiring and transmitting HIV; effective STI control is a recognised HIV‑prevention strategy.​
  • Estimates indicate that at any given time, around 40% of women may have some form of RTI/STI, but only about 1% complete full treatment along with their partners.​
  • Social stigma and lack of privacy mean women often delay care, self‑medicate, or seek help only when complications develop.​

Improving awareness of testing and prevention is essential to break this cycle.

 

Typical Symptoms of STIs in Women (and Why Many Are Silent)

Possible symptoms include:​

  • Unusual vaginal discharge (change in colour, smell, or quantity).
  • Burning or pain during urination.
  • Lower abdominal or pelvic pain.
  • Itching, redness, or sores on the genital area.
  • Pain or bleeding during or after sex.
  • Irregular vaginal bleeding, including after intercourse.

However:

  • Many infections like chlamydia and early HIV can be asymptomatic or have very mild symptoms.
  • Syndromic approaches (treating based on symptoms like discharge) may miss cervical infections in women.​

Therefore, regular screening in at‑risk women, not just symptom‑based treatment, is key.

 

How Are STIs Diagnosed in Women?

1) Syndromic Management (Current Public‑Health Backbone in India)

  • In many primary health centres and Suraksha/STI clinics, doctors use syndromic algorithms: they look at the pattern of symptoms (e.g., vaginal discharge, genital ulcer) and treat for the most likely infections without waiting for lab tests.​
  • This approach is cost‑effective and allows immediate treatment, which is vital where labs are limited.
  • However, it can lead to both under‑diagnosis & over‑treatment, especially for cervical infections like chlamydia and gonorrhoea.​

2) Etiological / Test‑Based Diagnosis (Growing Emphasis)

Where lab facilities are available, more specific tests are used:​

  • Nucleic acid amplification tests (NAATs) for chlamydia and gonorrhoea.
  • Blood tests for syphilis, HIV, and hepatitis B.
  • Microscopy, culture, and point‑of‑care tests for trichomonas and others.

National guidelines are gradually encouraging greater use of diagnostic testing and sentinel surveillance, especially as point‑of‑care tests become more affordable.​

 

Who Should Get Tested and When?

Adapted from international recommendations and national strategies:​

  • Sexually active women under 25 – screen periodically for chlamydia and gonorrhoea, especially with new or multiple partners.
  • Women over 25 with risk factors (new partner, multiple partners, partner with an STI, inconsistent condom use).
  • Pregnant women – routine testing for syphilis, HIV, and often hepatitis B, sometimes chlamydia/gonorrhoea where feasible.
  • Women with symptoms: discharge, ulcers, pelvic pain, or contact with someone known to have an STI.
  • Women planning pregnancy or undergoing infertility evaluation.

In India, STI/RTI clinics, antenatal clinics, and some gynaecology services integrate screening into routine reproductive health visits.​

 

Prevention Strategies: What Really Works

1) Safer Sexual Practices

  • Correct and consistent condom use significantly reduces the risk of most STIs, including HIV.​
  • Mutual monogamy between partners who are both tested and uninfected.
  • Avoiding high‑risk behaviours (multiple partners, unprotected sex with partners whose status is unknown).

2) Vaccination

  • HPV vaccination helps prevent infections with high‑risk HPV types that cause cervical cancer and some genital warts.
  • Hepatitis B vaccination reduces sexually and blood‑borne transmission and protects liver health.​

Vaccines do not replace condoms or testing but significantly lower specific infection risks.

3) Regular Screening and Early Treatment

  • Proactive testing in sexually active women, even when asymptomatic, allows early cure for bacterial STIs and reduces onward transmission.
  • Partner notification and treatment (including expedited partner therapy models discussed in emerging guidelines) can reduce re‑infection rates.​

4) Education, Counselling, and De‑Stigmatisation

  • Counselling about symptoms, risks, condom negotiation, and partner communication is an integral part of STI/RTI services under India’s National AIDS Control Programme.​
  • Reducing shame and fear encourages women to seek care earlier and complete treatment.

 

Complications of Untreated STIs in Women

If not diagnosed and treated promptly, STIs can cause:​

  • Pelvic inflammatory disease (PID) – infection spreading to uterus, tubes, ovaries.
  • Infertility due to tubal damage or blockage.
  • Ectopic pregnancy with life‑threatening bleeding.
  • Chronic pelvic pain and painful intercourse.
  • Pregnancy complications – miscarriage, stillbirth, premature labour, neonatal infections.
  • Increased risk of HIV acquisition and transmission.

These outcomes are largely preventable with robust testing and treatment coverage.

 

STI Services and Public‑Health Approach in India (Snapshot)

  • Under the National AIDS Control Programme, India has established a network of STI/RTI clinics (e.g., Suraksha Clinics) providing standardised syndromic management, counselling, partner management, and syphilis testing.​
  • Data suggest over 6% adult prevalence of STI/RTI episodes annually, but routine data are incomplete, and many women have infections without seeking formal care.​
  • National technical guidelines emphasise:
    • Integrating STI care into reproductive and adolescent health services.
    • Improving lab infrastructure and point‑of‑care testing.
    • Sentinel surveillance to better understand trends and refine strategies.​

Practical Tips for Women

  • Do not ignore persistent discharge, itching, pain, or bleeding—consult a qualified provider.
  • Ask for confidential counselling and testing; government clinics often offer services free or at low cost.
  • Ensure your partner is treated if advised; otherwise re‑infection is common.
  • Keep a record of previous infections and treatments to share with future doctors, especially before pregnancy.

FAQ

1) I have no symptoms. Do I still need STI testing?
Yes, sometimes. Many STIs—especially chlamydia, early gonorrhoea, and early HIV—can be silent in women. Guidelines recommend routine screening for sexually active younger women and those with risk factors, even without symptoms, because untreated “hidden” infections can still damage fallopian tubes, increase HIV risk, and affect future fertility. Testing during routine gynaecology or pre‑pregnancy visits is a good strategy.​

2) If I am treated for an STI once, can I get it again?
Yes. Treatment cures the current infection but does not make you permanently immune. Re‑infection is common when partners are not treated simultaneously or when high‑risk behaviours continue. That’s why partner notification, follow‑up testing where recommended, and consistent condom use are essential parts of STI prevention.​

3) How confidential are STI services in India?
National programme guidelines stress confidential counselling and respectful care at designated STI/RTI clinics and other facilities. Trained counsellors and doctors are expected to protect privacy while offering testing, treatment, and partner‑management support. While experiences vary, the formal system is designed to provide confidential and stigma‑free services, and patients are encouraged to seek care rather than delay due to fear.​