STDs And Infertility

Are you aware that sexually transmitted infections are classified as the most common preventable causes of infertility in the general population? According to the latest data reported by Centers for Disease Control and Prevention, investigators reported that 15% of all the females who develop chlamydia are at risk of developing chronic pelvic inflammatory disease – a leading cause of infertility in young females(1). In addition, STDs are also known to affect male fertility and sexual functions in chronic cases.

Pathophysiology Of STDs And Infertility

Chronic and poorly managed sexually transmitted infections in females are a constant source of inflammation of the genital passageways (also known as pelvic inflammatory disease). In long standing cases, the tubes and tissues may undergo permanent scarring or fibrosis. It is imperative to mention that most cases of PID are silent or asymptomatic. In other words, the ongoing infection slowly and irreversibly damages the uterus, fallopian tubes and surrounding tissues, long before the infection is even diagnosed. The resultant effects are:

• Narrow or occluded genital passageways that offer hindrance to the transportation of sperms; thereby delaying the conduit of sperms and resulting infertility.
• High risk of ectopic pregnancy due to implantation of zygote in the fallopian tubes.
• Infections like genital warts can affect normal childbirth. Likewise, other related infections (such as genital herpes) can cause pain and discomfort during sexual intercourse.
• Besides gonorrhea and chlamydia, some other sexually transmitted infections can aggravate the risk of scarring, fibrosis and other complications; for example, certain strains of human papillomavirus can cause cervical cancer and hence compromise fertility.
• Maternal STDs can complicate pregnancy and aggravate the risk of fetal transmission during pregnancy or at the time of childbirth.

Likewise, long standing sexually transmitted infections can also compromise the quality of sexual

life in males by causing:

• Epididymitis: Epididymis is a tube that helps in the transfer of mature sperms during the act of ejaculation. Inflammation of epididymis usually presents with swelling, redness and pain in testis and scrotum. Chronic epididymitis has been statistically proven to compromise sperm motility, physiological and morphological functions as well as overall count in the ejaculate.
• Urethritis: Inflammation of male urethra may by asymptomatic or symptomatic. Classic symptoms include dysuria, penile discharge, pain and redness of penis etc. (all of which may compromise sexual functions as well as help in the transmission of pathogens to female partner). In addition, urethritis can also lead to ascending infection (or epididymitis).

How To Detect Sexually Transmitted Infections?

In most cases, STDs may not present with classic symptoms; but presence of certain sign and symptoms can help in the diagnostic process; for example:

• Urinary symptoms: Increased urgency or higher frequency of urination, passage of foamy urine, burning while micturition are some classic symptoms that points to an ongoing sexually transmitted infection.
• Pelvic pain or discomfort: Chronic dull ache or persistent gnawing feeling in the pelvic region is also a sign of ascending sexually transmitted infection.
• Sexual symptoms: Passage of pus or foul smelling discharge, burning or pain during sexual intercourse, redness or itchiness of genitals and other nonspecific symptoms such as fever, nausea etc.

How To Prevent Infertility In The Setting Of STDs?

Each year, more than 15 million new cases of STDs are diagnosed in the United States. Such infections takes a huge toll on personal, economical and emotional state of affected individuals; however, with early diagnosis and prompt treatment, risk of long term sequelae can be largely minimized. CDC recommends periodic physical examination and laboratory workup for sexually active young females to detect sexually transmitted infections at an early stage. According to latest available data, more than 820,000 cases of gonorrhea and over 2.86 million cases of chlamydia are reported in the United States each year. More frequent follow-up visits are recommended for individuals with certain risk factors such as:

• Individuals who are in unsteady relationships (polygamous relationships or having multiple sex partners).
• Individuals who often engage in unprotected chance encounters
• Individuals in high risk occupations or lifestyle choices such as sex workers, intravenous drug abusers, chronic alcoholics etc.
• Individuals who have previously been diagnosed or treated with a sexually transmitted infection. For example, according to latest estimates, about 1.5% of the entire population under 25 years receive treatment for Chlamydia infection in the United States each year (4). The risk of recurrence is fairly high in such individuals.

References:

1. Workowski, K. A. (2015). Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clinical Infectious Diseases, 61(suppl 8), S759-S762.

2. McNicholas, C., Peipert, J. F., Maddipati, R., Madden, T., Allsworth, J. E., & Secura, G. M. (2013). Sexually Transmitted Infection Prevalence in a Population Seeking No Cost Contraception. Sexually transmitted diseases, 40(7), 546.

3. Weinstock, H., Berman, S., & Cates, W. (2004). Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on sexual and reproductive health, 36(1), 6-10.