For long a public health issue, the effects of Sexually Transmitted Infections (STIs) are wide-ranging. Whilst not being a particularly talked about subject, STIs are very common: if you are sexually active, then you are at risk of STIs.
Even if you’re not planning on conceiving in the short term, it’s wise to know that some STIs can make it harder to get pregnant, especially if an infection remains undetected. Dreaming of Baby discusses STIs and fertility with Dr. Amesh Adalja, a board certified infectious diseases physician.
Daniela: Today we have with us Dr. Amesh Adalja, a board certified infectious diseases physician, with whom we shall be discussing STIs that lead to infertility as well as standard screening procedures. Good afternoon Dr. Adalja and welcome to Dreaming of Baby; to better inform our readers, can you tell us about your experience working in this field?
Dr. Amesh Adalja: Infertility is one of the most feared complications of a sexually transmitted infection. Fortunately, not every infection leads to infertility and if infections are caught early enough, they can usually be treated easily. Sexually transmitted infections are one of the most common types of infectious diseases and are a major burden on the human race.
STIs as a Public Health Issue
Daniela: On this note, how much of a public health issue are STIs in reality?
Dr. Amesh Adalja: STIs are a major public health threat and have been for centuries. They are stigmatizing, confront societal taboos, and can be difficult to create interventions for. Remember HIV is an STI and has killed millions upon millions of people.
Daniela: When you say that STIs are difficult to create interventions for, in what sense is this so?
Dr. Amesh Adalja: Acquiring an STI is a process that is not solely determined by the microbe and the individual — they are rooted in how sex is treated in a society and, as such, there is extensive need for understanding how a disease is spreading in a population to target those at highest risk.
Dr. Amesh Adalja: For example, is an STI primarily occurring in commercial sex workers, teenagers in high school, men who have sex with men, in the club scene, in those who use computer dating applications?
Dr. Amesh Adalja: An intervention should ideally be targeted at those who are at highest risk and at those in whom interrupting transmission would have the biggest impact on the population as a whole.
Daniela: That is very informative, thank you for clarifying. Before we move on to the focus of our interview, I see that you use the term STIs instead of STDs. Are these used interchangeably or they denote two separate issues?
Dr. Amesh Adalja: STD and STI are often used interchangeably, but STI — sexually transmitted infection — is a more accurate term for what is occurring. Many infections have no symptoms at all and that situation is difficult to describe as a “disease”.
STIs and Infertility
Daniela: Thank you. Moving on to the subject of fertility and STIs; out of all STIs, which are the ones that can lead to infertility, both in respect of men, and women?
Dr. Amesh Adalja: For females, the real worry is a condition called Pelvic Inflammatory Disease, or PID. This is often caused by gonorrhea or chlamydia.
Dr. Amesh Adalja: In men, the problem isn’t as much of a concern. Zika is one potential STI that can diminish sperm counts in a male.
Daniela: We’ve had readers express concern that, since some STIs have no recognizable symptoms, the infection might be missed. What should people stay on the lookout for and what would you recommend for this not to happen.
Dr. Amesh Adalja: Safe sex is the cornerstone of prevention. While many STIs – including gonorrhea and chlamydia which can cause PID – may be clinically silent, PID often causes pain, vaginal bleeding, painful sexual intercourse, and vaginal discharge. Though some cases could be asymptomatic.
Dr. Amesh Adalja: I would like to also mention something about men. In rare cases, epididymitis can leave a man infertile and this can be caused by gonorrhea and chlamydia.
Dr. ADALJA: “For females, the real worry is a condition called Pelvic Inflammatory Disease, or PID. This is often caused by gonorrhea or chlamydia.”
Daniela: Can you elaborate a little further on the asymptomatic cases please?
Dr. Amesh Adalja: Asymptomatic PID could involve someone who had ongoing infection gonorrhea and/or chlamydia that was not noticed and progressed to a point that it scarred the reproductive organs. It’s hard to estimate how many PID cases are asymptomatic because cases may be missed when the symptoms are mild or non-specific.
Daniela: Going back to male fertility and STIs. You mentioned earlier that Zika is a potential STI for men that can affect sperm count. For the concerned male, what are the symptoms of Zika and what does the screening procedure look like?
Dr. Amesh Adalja: The vast majority of Zika cases have no symptoms or only mild symptoms. When symptoms occur they include fever, muscle aches and pains, rash, and red eyes. Testing involves looking for the virus in the urine and/or blood
Daniela: For both Zika and epididymitis as mentioned before, are the effects on male fertility permanent?
Dr. Amesh Adalja: It’s too early to know the full story with Zika – right now people are noting diminished sperm counts which will have to be followed over time. Diminished sperm counts aren’t exactly the same thing as infertility.
Dr. Amesh Adalja: With epididymitis, if scarring has occurred, it could be permanent.
Daniela: For the man with epididymitis, and with the ultimate aim of preserving fertility, what would the treatment process look like?
Dr. Amesh Adalja: Epididiymitis is treated with a standard course of antibiotics.
Daniela: And for how long after epididymitis is fertility usually affected for?
Dr. Amesh Adalja: It is a very rare complication of epididymitis and not the usual course. However, if the infection was that severe to impact fertility it might be permanent.
Daniela: Thank you for clarifying. Apart from safe sex, is there anything else men can do to ensure their reproductive health?
Dr. Amesh Adalja: Men should be alert to penile discharge, testicular pain or testicular swelling.
Daniela: Moving on to women and STIs. Let’s say a woman missed receiving a diagnosis for gonorrhea or chlamydia and the infection has progressed to PID, what is the screening process like as well as eventual treatment?
Dr. Amesh Adalja: There is no “screening” for PID. It would usually be diagnosed when symptoms appeared. Treatment would involve antibiotics and possible surgical interventions if a pus collection/abscess (tubo-ovarian abscess) developed
Daniela: Would the impact on fertility be long-term in this case?
Dr. Amesh Adalja: Again, not every case of PID leads to infertility.
Dr. Amesh Adalja: When infertility does occur from PID, there could be some nuances to it and in some instances, may not be complete and might be overcome using assisted reproductive technology.
Daniela: Thank you for clarifying. Another question expressed by our readers is this: Are there any STIs which, whilst not affecting fertility, will affect pregnancy if and when this occurs?
Dr. Amesh Adalja: Yes, STIs can negatively impact pregnancy. For example, HIV, Zika, and syphilis are STIs which can all negatively impact a pregnancy. Herpes as well.
Daniela: In terms of syphillis, in what way would this affect pregnancy?
Dr. Amesh Adalja: The bacteria that causes syphilis can infect the fetus and cause various abnormalities which are termed “congenital syphilis”. This can range from miscarriage to severe deformities.
Dr. AdaljA: “Since it is also an STI, practicing safe sex if one has been in a Zika-prone area is also important.”
Daniela: We’ve heard a whole lot about Zika lately, what precautions can both women and men take to prevent its spreading as well as its effects on both reproductive health and pregnancy?
Dr. Amesh Adalja: With Zika, the primary means of transmission is via mosquitoes so avoidance of mosquito bites with DEET-based repellents, keeping windows screened, and dumping standing water are very important. Also, since it is also an STI, practicing safe sex if one has been in a Zika-prone area is also important.
Daniela: Thank you. I do have one final question that is a common concern amongst our readers and this concerns Human Papillomavirus (HPV). Apart from the infections that we have already discussed, does HPV affect fertility?
Dr. Amesh Adalja: HPV doesn’t directly impact fertility though it can negatively impact pregnancy.
Daniela: And on a final note, what would be that one piece of advice that you’d give in relation to fertility and STDs?
Dr. Amesh Adalja: Infertility from STIs can be prevented if people are routinely tested and treated for STIs before it is too late.
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