1. Analytical summary

A global burden that is not receding

STIs remain a major public health issue: over one million new treatable infections are contracted every day worldwide (p. 1). In 2020, it was estimated that there were 374 million new cases of four treatable infections among those aged 15-49 (gonorrhoea 82.4 M; chlamydia 128.5 M; trichomoniasis 156.3 M; syphilis 7.1 M); by 2022, syphilis had reached 8.0 M new cases, including approximately 700,000 congenital syphilis cases (p. 1). Additionally, 520 M people live with HSV-2 and 300 M women are carriers of HPV (p. 1). The overall incidence is not decreasing. The persistent barriers: limited resources and political commitment, weak surveillance, antimicrobial resistance (N. gonorrhoeae, M. genitalium), asymptomatic infections that sustain transmission, and stigma that particularly affects key populations and adolescents (p. 1-2).

An integration framework, no new rules

The manual translates existing WHO recommendations into operational approaches, organised around the prevention-care cascade and its eight components (primary prevention; management of symptomatic STIs; detection of asymptomatic STIs; diagnosis; treatment; partner management; monitoring-evaluation-surveillance; enabling conditions for the delivery of services) (p. vi-vii). Each component is an entry point accompanied by basic interventions, implementation considerations, and relevant WHO resources. Cross-cutting themes run through the document: integration between care platforms, competence of caregivers, rights-based approach, use of data for decision-making, community engagement (p. vi-vii). Seven annexes provide ready-to-use tools: syndromic flowcharts, diagnostic approaches, treatment regimens, partner services and monitoring indicators. The final part places STIs within primary health care (PHC) and universal health coverage (p. 35-38).

2. Key points of the document

1️⃣ The prevention-care cascade as the backbone — The document structures the entire response into eight successive links and identifies where programmes most often fall short; it is the central organisational input, applicable regardless of the level of resources (p. vi; p. 5-6).

2️⃣ The burden of asymptomatic infections and targeted screening by thresholds — Chlamydia, gonorrhoea and latent syphilis often go unnoticed; WHO suggests targeted screening based on prevalence thresholds (gonorrhoea + chlamydia ≥ 10% in pregnant women, ≥ 15-20% in sexually active adolescents and young adults) rather than universal screening (p. 15).

3️⃣ Syndromic management and its five flowcharts — Without immediate laboratory, five syndromes (urethral discharge, vaginal discharge, genital ulcer, lower abdominal pain, anorectal discharge) allow for same-day treatment to be adapted to local epidemiology (p. 11-12 ; Annex 3, p. 50).

4️⃣ Four voluntary partner notification approaches — Notification by the patient, by the healthcare provider, deferred (contract), and expedited partner treatment where regulations allow — always voluntary, confidential, non-coercive, with assessment of violence risk (p. 26 ; Annex 6, p. 75).

5️⃣ Antimicrobial resistance as a priority and monitoring by indicators — The resistance of N. gonorrhoeae and M. genitalium is treated as a threat; participation in GASP/EGASP programmes, rational use of antibiotics (AWaRe categorisation) and 11 national monitoring indicators (p. 2 ; p. 28-29 ; Annex 7, p. 76).

3. Action points for local actors

1️⃣ Map one's own "weak link" — Revisit the cascade in eight links and identify where its system loses people (access, screening, treatment, partner follow-up); this is the most directly transferable use of the document (p. 5-6).

2️⃣ Rely on syndromic flowcharts to standardise orientation — When a laboratory result is not immediate, use the flowcharts from Annex 3 to standardise orientation and avoid follow-up losses, to be contextualised with local data (p. 11-12 ; Annex 3).

3️⃣ Mobilise community and peer approaches — For audiences distant from care and key populations, activate mediators and peers to improve access and acceptability of screening and prevention (p. 8 ; p. 32-33).

4️⃣ Formalise a non-judgemental and confidential welcoming posture — Translate the transversal requirements of the manual into a welcoming checklist (confidentiality, absence of judgement, consent): a documented lever for engagement for stigmatised audiences (p. 9 ; p. 26).

5️⃣ Group the actions into a single visit — During a single consultation: screening, partner notification, HIV/PrEP referral, HPV and hepatitis B vaccination, provision of condoms — the integration of services serves as a framework (p. 12 ; p. 26 ; Fig. 5, p. 33).

6️⃣ Bridge the gap with the French offer (unmet need) — The manual does not describe the French context: locally relay the national systems (My STI test, self-sampling, CeGIDD) is necessary to make the WHO framework operational here (adaptation to be added by the field actor).

4. Additional references

Internal references (Health Practices) — https://pratiquesensante.odoo.com/blog/tag/ist-213

External references (guides / assessments post-2024, verified URLs) :

• Public Health France — HIV and bacterial STIs in France. Assessment 2024 (national bulletin, 23 October 2025). French numerical framework complementary to the global vision of the manual. santepubliquefrance.fr

• Public Health France — World AIDS Day 2025: HIV and STI prevention (December 2025), including a thematic BEH on the social determinants of screening. Completes the axis "equity and determinants " of the manual. santepubliquefrance.fr

• BEH 2025 — Screening and diagnosis of HIV and three bacterial STIs in young people aged 15-25 (Public Health France, 2025). Informs the targeted audience of "adolescents and young adults" in the manual. beh.santepubliquefrance.fr

5. Frequently Asked Questions (FAQ)

1️⃣ Does this manual create new recommendations? — No. It consolidates and operationalises WHO recommendations already published between 2016 and 2025; it does not introduce any new rules (p. vi; p. 3).

2️⃣ What is the "prevention-care cascade"? — A framework of eight links describing how a person navigates the system, from primary prevention to partner follow-up, to identify points of failure (p. vi; p. 5-6).

3️⃣ When to screen for an asymptomatic STI? — In a targeted manner, according to prevalence thresholds and priority populations (pregnant women, youth, key populations), rather than universally; indicative thresholds p. 15.

4️⃣ Is syndromic management still valid? — Yes, especially in resource-limited settings: five flowcharts allow for same-day treatment; the aetiological test improves it when available (p. 11-12; Appendix 3).

5️⃣ How to manage partners without coercion? — Four voluntary and confidential approaches to the choice of the person, with an assessment of the risk of domestic violence before any action (p. 26 ; Annex 6).

6️⃣ Why insist on antimicrobial resistance? — Because the resistance of gonorrhoea and M. genitalium reduces the effectiveness of treatments; hence monitoring (GASP/EGASP) and rational use of antibiotics (p. 2 ; p. 28-29).

7️⃣ What does integration into primary care bring? — It links STIs to SSP and universal health coverage via 14 levers, to strengthen access, continuity and sustainable funding (p. 35-36, Table 3).

6. Rewriting in Easy-to-Read Language 

What is this document about?

• STIs are infections that are transmitted during sexual intercourse.

• There are many STIs in the world. The number is not decreasing.

• Often, an STI shows no signs. You cannot see it.

• This document comes from the WHO. The WHO helps countries with health.

• This document does not create new rules. It organizes the advice that already exists.

What should be remembered?

• We better treat STIs step by step: prevent, test, treat, follow up.

• A test should be offered to people who are at higher risk of an STI.

• Without a laboratory, treatment can be provided on the same day using simple regimens.

• We also inform partners. The person chooses how. It is free and confidential.

• Some STIs are resistant to medications. Antibiotics must be used properly.

• We welcome each person with respect. We do not judge. We keep the secret.

7. Cross-sectional analysis — values of Health Practices

• Literacy : the manual asks to adapt messages, education and advice to the language and literacy level of the audiences (p. 9), but provides few ready-to-use tools.

• Empowerment : it promotes informed choice and autonomy (self-sampling, testing, self-care) and the participation of communities in the design of services (p. 9 ; p. 32-33).

• Participation : it recommends the involvement of community organisations and key networks in the monitoring and interpretation of data (p. 29 ; p. 35).

• Community health : the collective dimension is central through peer-led and community approaches (p. 8 ; p. 32-33).

• Ethics : consent, confidentiality, absence of mandatory testing and assessment of risk of violence are set as safeguards (p. 9 ; p. 26-27).

• Human rights : the rights-based and equity approach is a guiding principle, with attention to social and structural determinants (p. 3 ; p. 43).

• Intersectorality : health, education, social protection, justice, work and youth are called to cooperate around the SSP (p. 2 ; p. 35).

• Partnership : collaboration models are formalised (SSP levers, private sector engagement, integrated platforms) in Table 3 (p. 36).

• Fight against discrimination : the stigmatisation of key populations and adolescents is named as a barrier, with a demand for non-judgmental and non-discriminatory services (p. 1 ; p. 9 ; p. 43).

8. Assessment of the reliability of the resource

Scientific relevance : high. Institutional reference source (WHO), derivative product based on recommendations developed according to the GRADE method and expert consultation with external review (Annex 2). The cited data are dated and referenced. Limitation: synthesis product, not an original systematic review; it is valued for its traceability to its source guidelines.

Operational relevance : good for programme managers and in resource-limited contexts, where the annexes (flowcharts, frameworks, indicators) are directly mobilisable. More indirect for the French field, already equipped with equivalent mechanisms: its utility is mainly that of a framework for coherence and an international perspective, which should be stated without overestimating a "turnkey" transposition.

9. Strategic hashtags

#SexualHealth #STIPrevention #HealthLiteracy #KeyPopulations #PrimaryCare #AntimicrobialResistance #CommunityApproach #healthpractices