## Management of a Primigravida at High Risk of Sexually Transmitted Infections A 20-year-old primigravida attending the antenatal clinic for the first time should be assessed carefully because sexually transmitted infections (STIs) can affect both the mother and the developing fetus. The primary health care approach should be based on privacy, confidentiality, respectful communication, early diagnosis, treatment, prevention and follow-up. The first step is to establish a trusting relationship with the woman. The health worker should conduct the STI-related assessment privately and without judgment. A detailed history should be taken regarding previous or current genital infections, vaginal or urethral discharge, genital ulcers, itching, lower abdominal pain, painful urination and abnormal bleeding. Information about previous STI testing and treatment should also be obtained. Sexual history should be discussed sensitively, including number of partners, recent changes in partner, condom use and whether the partner has symptoms or a history of STI. The woman should be assured that the information will remain confidential. A physical examination should be performed according to clinical indications. The health worker should look for genital ulcers, abnormal vaginal or cervical discharge, warts, inflammation and other signs of infection. Pregnancy-related symptoms and general health should also be assessed. Appropriate laboratory investigations