Introduction
Sexually transmitted infections (STIs), synonymously called sexually transmitted diseases (STDs) are conditions that can spread from an infected person usually via sexual interaction when the infective agent is present in the semen, vaginal fluids, anal secretions, saliva, blood. Some of these infections may also spread through skin contact, infected needles or from mother to child in pregnancy/childbirth or breastmilk. Micro-organisms can directly enter the uterus if they cross the cervical barrier during delivery, miscarriage, pelvic examinations or intrauterine device insertion. These STI’s can impact sexual health and reproductive fitness.
STI affect fertility:
Sexually transmitted infections are one of the major factors associated with tubal factor infertility in women. The infection, if undiagnosed and not treated, can severely affect ovaries, fallopian tubes, uterus, and cervix by causing inflammation, scarring and blockage. This makes it difficult for the release and passage of eggs from the ovaries into the tube for fertilisation and eventually into the uterus. Scarring of the uterine lining can cause problems with implantation of the fertilised egg.
In males, an untreated infection can cause reduced sperm count, erectile dysfunction, and tubal blockage hampering sperm movement.
In infected pregnant mothers, the babies are at risk of having birth defects, prematurity and associated complications, low birth weight, stillbirth, and neonatal death.
Risky behavior:
- Unprotected sexual intercourse (without condoms) is one of the major risk factors for contracting STIS. Most of the infections do not show symptoms, or symptoms may appear much later. The infected person is unaware of carrying the infection, so if not careful, they risk passing it to their partner(s) unknowingly.
- Engaging in sexual activities with multiple partners
- Sharing of needles (substance abuse and unsafe drug use), razors, and toothbrushes
Common symptoms:
These infections may not always show symptoms immediately in most cases. If the infection spreads further, there may be some major indicators like:
- Persistent lower abdominal, back pain
- Unusual vaginal or penile discharge (with/without foul smell and weird colour)
- Pain and burning on urination
- Untimely bleeding/ spotting
- Pain in the testis for men
- Fever
Common Sexually transmitted infections:
Syphilis:
The syphilis rash (sore) containing bacteria is contagious, and any contact with it can lead to the spread through sexual transmission. It is also known to pass from an infected mother to the child during pregnancy.
Untreated disease can cause scarring and blockage of the epididymis in men (epididymitis), and erectile dysfunction in the long-run in men. It also leads to increased risk for miscarriages, stillbirth and affected children (congenital syphilis) in infected pregnant women.
Gonorrhoea:
It is caused by bacteria and can spread through oral, vaginal or anal sex, affecting not only the genitalia but also the throat and anus. It can lead to epididymitis in men. Sperms thus cannot travel into the ejaculate from the testes, hampering fertility.
Chlamydia:
It is a bacterial infection that can cause severe harm to the fallopian tubes, gradually leading to infertility in women. In men, it may reduce sperm quality, lead to swelling of the urethra, epididymis and prostate gland, all amounting to infertility.
Chlamydia and gonorrhoea are the most common Sexually transmitted infections reported and are mainly associated with PID (about 90% PID cases).
Trichomoniasis:
It can lead to very foul smelling and frothy vaginal discharge of grey/green/yellow colour, itching/burning/swelling/redness of the genitalia. If it occurs with other Sexually transmitted infections can increase PID risk. It also increases the risk of pre-term delivery and smaller babies in pregnant women.
Mycoplasma Genitalium:
It is a fairly newly identified bacterial infection. It can cause urethral and cervical inflammation, PID in women and urethral inflammation along with other common symptoms in men.
Pelvic Inflammatory Disease (PID):
It is an effect of the long-term progression of untreated Sexually transmitted infections. 10-15% of women with untreated chlamydia can have PID. Re-infection with gonorrhoea can increase the risk of developing PID. The bacteria enter through the vagina during sexual contact and can spread to the uterus, fallopian tubes and ovaries over time.
PID can lead to scarring and blockage of the fallopian tubes, which makes passage of the egg to the uterus difficult. If fertilised in the tube, it can lead to a fatal condition called ectopic pregnancy, where the fertilised egg implants in the tube itself.
Apart from the common STI symptoms, other indicative signs of PID are:
- Pain in the upper abdomen
- Pain during sexual contact and around the time of ovulation
- Fatigue, vomiting, fainting
Sexually active women under 25 years having unprotected sex, use of intrauterine contraceptive devices, douching and past PID history all increase the risk of PID.
The expert doctor will check for discomfort and swelling around the uterus, ovaries, cervix, vagina. Diagnosis may be confirmed on sonography, pelvic or even laparoscopic examination.
Rarely, surgery might be required if infection leads to pus formation, to remove it.
Herpes simplex virus (HSV):
It is a viral infection that can pass via genital blisters through sexual contact. The genital blisters can be very painful and limiting. It can have serious effects on the baby of an affected mother, if infected during vaginal delivery. It indirectly causes reduced fertility as partners don’t engage in sexual activity, which delays conception.
Human papillomavirus (HPV):
HPV is transmitted through skin contact, which leads to the development of warts in the genitalia and on the skin. Like with HSV, these warts and their treatment (which can take years) can be sexually limiting, pushing time for conception. Some HPV virus types can lead to cervical cancer in women and genital cancers in men, hampering fertility.
Human Immunodeficiency Virus (HIV):
A serious viral infection that spreads via sexual activities, to the baby of an infected mother via breastmilk or during pregnancy. The affected individual is asymptomatic for a couple of months and symptoms gradually develop over the years, progressing to AIDS. There is no cure for HIV, though medications can improve the quality and years of life. However, since the usual baby-making route is risky, couples with an affected partner wanting children can opt for ART.
Hepatitis:
Hepatitis B is mostly transmitted by sexual contact as it is present in genital fluids. Homosexual men are more at-risk of contracting hepatitis A through anal sex. Hepatitis B infection leads to poor sperm motility and number in men, as well as tubal factor infertility and susceptibility to PID in women.
Diagnosis:
Regular STI testing is strongly recommended for sexually active individuals, especially in cases of multiple partners, getting into a new relationship, a partner diagnosed with an STI or before planning a pregnancy under an expert, even if asymptomatic. Pregnant women are also advised to undergo STI testing in early pregnancy.
Blood test (for antibody or antigen detection)– Syphilis, hepatitis, HIV, herpes. Urine test – Trichomoniasis, gonorrhoea, chlamydia
Swabs (vaginal/cervical for women, penile for men) for either bacterial culture test or microbial DNA test – HPV, chlamydia, herpes, gonorrhoea
Physical examination of the vagina, cervix to check for blisters, sores, warts or any cancerous growth Earlier the diagnosis, easier the treatment and preventable are the serious long-term effects.
Prevention / Treatment:
You should do STI checks prior to conceiving, under a doctor’s guidance.
In case of a known STI, abstinence from sex till the infection is cleared is the most effective prevention method.
Use of condoms can also help to prevent transmission
Bacterial Sexually transmitted infections can be treated with an antibiotic course fairly easily if detected in the early stages. You must complete the treatment thoroughly to flush out all the bacteria and prevent re-infection. If the infection persists, doctors may prescribe stronger antibiotics.
Doctors cannot completely cure viral STIs, but anti-viral medication can reduce the severity of symptoms and flare-ups.
Vaccines are available for HPV, Hep B. Staying up-to-date on the vaccinations can also help prevent the infections.
If STIs affect the tubes, doctors need to repair them either non-surgically by tube cannulation (doctors insert a long, flexible tube into the fallopian tubes to remove the block) or surgically by salpingectomy (doctors remove the affected part of the tube) / salpingostomy (doctors create another opening around the ovary). The type of treatment will depend on the severity and location of the blockage.
If severe damage makes the tubes unsalvageable, you can seek IVF as an option for pregnancy. However, the infection must be cleared before conception.
Conclusion
If you’re planning to start a family, getting tested for sexually transmitted infections (STIs) is a simple but important step to protect your fertility. At Femcare Fertility, with a trusted IVF center in Pune and Kolkata, we’re here to guide you through STI testing and explain how it can affect your chances of conception. And if treatment or surgical care is needed, our experienced team offers personalised solutions to help you move forward with confidence.
FAQs (Frequently Asked Questions):
Question: Can STIs or STDs cause infertility in men and women?
Answer: Yes, untreated STIs like chlamydia and gonorrhea can lead to infertility. In women, they may cause pelvic inflammatory disease (PID), which damages fallopian tubes. In men, they can affect sperm production or block the reproductive tract.
Question: How do healthcare providers diagnose and treat STIs before couples try to conceive?
Answer: Healthcare providers diagnose STIs through blood tests, urine tests, or swabs. They can treat most bacterial infections with antibiotics. It’s crucial to complete treatment before attempting to conceive and ensure both partners receive testing and treatment.
Question: Where can I get STI/STD testing and fertility support in Pune or Kolkata?
Answer: At Femcare Fertility, we offer comprehensive STI or STD screening, fertility assessments, and advanced treatments. Our clinics in Pune and Kolkata are among the best fertility centres for helping couples conceive safely and confidently.