STD Related Infertility
STD related infertility overview
- Sexually transmitted diseases (STDs) are diseases transmitted from person to person through sexual contact, and are particularly common in adults 25 years old and younger.
- Sexually transmitted infections (STIs) are caused by bacteria or a virus that spreads in the body, leading to STDs.
- Problems with the fallopian tubes cause about 30% of female infertility, and STDs are a common cause of what is known as tubal factor infertility.
- Pelvic inflammatory disease (PID), an infection commonly caused by STDs, can lead to tubal factor infertility as well as damaging the ovaries, which can also contribute to infertility.
- Some STDs, such as gonorrhea and chlamydia, can affect fertility in men and women; these often go unnoticed due to lack of symptoms, resulting in more damage.
- It’s easy and cheap to screen for STDs, which are the most preventable cause of infertility.
How do STDs cause infertility?
Sexually transmitted diseases can directly or indirectly cause infertility in women and in men. When STDs are left untreated, infections can develop that cause infertility by moving up the reproductive system and spreading to the woman’s uterus, ovaries and fallopian tubes causing damage, scarring or inflammation. The two major causes of STD-related infertility are pelvic inflammatory disease (PID) and damage to the fallopian tubes.
PID and tubal factor infertility
PID is most often caused by the STDs gonorrhea or chlamydia when bacteria enter the reproductive system. PID causes scarring of the cervix, vagina, ovaries, fallopian tubes and uterus. If left untreated, PID can cause irreversible damage resulting in infertility.
Problems with the fallopian tubes is a leading cause of female infertility and such problems can be caused by STDs. PID is one cause of what is called tubal factor infertility. The American Society for Reproductive Medicine (ASRM) reports that 25%–35% of female infertility is due to tubal factors. If the fallopian tubes are damaged or blocked, this can result in infertility in two ways: it can prevent sperm from reaching the egg in the fallopian tube for fertilization, and it can prevent a fertilized egg from entering the uterus to implant for pregnancy.
STDs that indirectly cause infertility
Herpes simplex virus (HSV), human papillomavirus (HPV) and syphilis can indirectly affect fertility. HSV can cause the couple to abstain from sexual intercourse, which limits the chances of becoming pregnant. HPV can cause genital warts that may take months or years to treat. And some strains of HPV can also lead to cervical cancer or precancerous cells, the treatment of which can affect fertility. Syphilis if left untreated can affect infertility in women and men.
Treatment is important
Untreated STDs are a huge contributing factor when it comes to infertility. If STDs are diagnosed and treated sufficiently, they are less likely to have a negative impact on fertility. Screening for STDs is accessible and low cost. The earlier STDs are diagnosed, the better the chances of them not affecting infertility.
Steps to prevent STDs as well as treatments for the STDs themselves are at the end of this article.
STDs affecting infertility in women and male infertility
STDs are a group of more than 20 diseases that can cause specific health complications. When these infections are left untreated, there can be irreversible damage present often leading to infertility.
The connection between STDs and male infertility is not completely clear, according to a report published by the National Institutes of Health. But they can have a direct effect on male sexual performance such as erectile dysfunction. A significant aspect of STDs in males affecting fertility is that the diseases are passed on to the female, causing infertility in her.
Chlamydia (chlamydia trachomatis)
According to the American College of Obstetrics and Gynecologists (ACOG), chlamydia is the most commonly reported STD. Chlamydia is passed through sexual contact and can infect both men and women. Many people who have chlamydia aren’t aware of it because the disease often has no symptoms.
In females, chlamydia can cause damage and scarring to the uterus or fallopian tubes if left untreated, resulting in a decreased chance of becoming pregnant. The CDC reports that if chlamydia is left untreated, about 10%-15% of women will develop PID. In males, chlamydia can impact sperm health, contributing to male infertility.
Gonorrhea can be contracted by anyone who is sexually active. Transmitted through vaginal, anal or oral sex, the prevalence of gonorrhea in young adults ages 15-24 is common because they are more sexually active. Without treatment, gonorrhea can lead to very serious complications in men and women.
Gonorrhea can thrive in a female’s reproductive tract, specifically in the uterus and the fallopian tubes causing PID and tubal factor infertility. In males, gonorrhea can cause the sperm ducts to become inflamed, called epididymitis. If left untreated, this can cause male infertility through scarring that blocks the duct and prevents sperm from entering the female during intercourse.
Human papillomavirus (HPV)
According to ACOG, HPV is the most common STI in the United States and is transferred primarily by skin-to-skin contact. HPV is a viral infection that generally causes warts on the skin and in the genital area. Treating these warts can take a long time, altering the sexual relations of a couple.
Some strains of HPV can increase the possibility of a woman developing precancerous cells and cervical cancer. The process of removing cancerous and precancerous cells from the cervix can affect fertility. The procedures to remove these cells can change the production of cervical mucus, affecting a woman’s ability to conceive. In males, some HPV types can cause persistent infection and progressively turn into genital cancers affecting fertility.
Herpes simplex virus (HSV)
HSV is a sexually transmitted infection that cause herpes. Genital herpes is most commonly caused by the type 2 virus (HSV-2) and are small blisters that appear on the genitals. If a woman with HSV becomes pregnant, passing the virus to the infant through vaginal delivery can be life threatening for the baby. HSV can have an indirect effect on fertility by causing a couple to avoid sexual contact during outbreaks, which can prolong the process of trying to conceive.
Syphilis is an STD caused by a bacterial infection usually spread by sexual contact. But it can also be transmitted through contact with a syphilis sore. If left untreated, mothers can also pass syphilis to their unborn babies. Women with untreated syphilis who become pregnant have a 50% chance of miscarriage or stillbirth, which has a direct impact on the ability to have a child.
Although syphilis doesn’t have a direct effect on male fertility, complications from the disease can cause epididymitis. Scarring of the sperm ducts from this condition can prevent sperm from being released during ejaculation, causing male infertility. If syphilis goes untreated for a long period of time, the disease can begin degenerating nerves and eventually lead to erectile dysfunction.
Treating infertility caused by sexually transmitted diseases
Tubal factor infertility can be treated with two main treatments to repair the damaged tubes, which are surgical and nonsurgical and are determined by the location and amount of damage. One surgical option to remove the blockage is a salpingostomy, where a new opening is created near the ovary. The other option is a salpingectomy, which involves removing a part of the blocked tube. Tubal ligation reversal surgery is the untying or reopening the fallopian tubes that have previously been “tied” or in some other way blocked as a means of sterilization.
The nonsurgical option to treat blocked tubes is called tubal cannulation. During this procedure a catheter is used to find the blockage and remove it from the fallopian tubes.
In some cases, damaged or blocked fallopian tubes cannot be treated, and in vitro fertilization (IVF) is the next recommended step.
Treatment for PID can often be oral antibiotics along with avoiding sexual contact until the medication is finished. Women with PID may require prolonged treatment with antibiotics. In some of the more severe cases of PID, surgery may be required to remove advanced infections.
Male infertility caused by syphilis-related epididymitis can be treated with antibiotics taken for 4 to 6 weeks, anti-inflammatory medicine, and abstaining from sexual contact until the medications have been completed. In some instances, surgery may be required if no other treatments are successful.
Chlamydia is caused by bacteria, which means that it can be treated with antibiotics. It is important not to have sex during treatment and to complete the full dosage of medication to ensure the infection clears up fully. Retesting three months after treatment is essential to prevent reinfection. It is often recommended to have any partners treated as well to prevent reinfection.
Treatment for gonorrhea includes antibiotics for both males and females. All prescribed medication should be finished, and patients should follow up with their doctor if symptoms persist. To avoid reinfection, partners of the infected person should go through testing even if they show no symptoms.
Although there is no cure for the virus, there are treatments available for the symptoms of infections such as genital warts, which can be treated with a prescription medication. There are also treatments for cervical pre-cancer and other HPV-related cancers. If the type of HPV found can lead to cancer, then further monitoring will be done for abnormal cell changes in the cervix. These changes may be a sign of cervical cancer and can be treated with several methods that include removing the abnormal cells.
There is no cure for genital herpes, yet medication is available to help reduce outbreaks. Antiviral medications can help accelerate the healing of sores and other symptoms.
In its early stages, syphilis can be treated with penicillin, an antibiotic medicine that can eradicate the organism that causes syphilis. The recommended treatment for later stages of syphilis is a single injection of penicillin, though for some people additional doses may be necessary.
- The most effective way to prevent an STD or STI is to not have sex. Using condoms correctly can lessen the chance of getting an STD. And always avoid sexual intercourse with anyone showing symptoms such as a rash, genital sores or discharge.
- Having fewer partners and getting tested with a partner can lower the chances of contracting an STD.
- Getting vaccinated can prevent catching some of the most common STDs.
- Communicate with any sexual partners about staying safe from STDs before having sex.
- Get tested to confirm the possibility of having an STD.
- Follow up with treatment, as many STDs are curable and all are treatable.
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