In a previous article, I alluded to the fact that infection is the commonest cause of infertility. A presentation made at the world fertility congress gave a detailed exposition of these infections which are sexually transmitted. The summary of the presentation is presented below:
Sexually transmitted infections are highly prevalent in developing countries, especially Africa, despite all efforts to prevent the spread of the diseases. Unfortunately, women bear the burden of such diseases most of the time.
Early intervention and prevention are, therefore, very necessary due to the adverse effects of STIs on reproductive health and fertility.
Most African countries, including Nigeria, have a high incidence of sexually transmitted diseases. But the extent of the damage that they cause is yet to be determined as data is limited.
This presentation gives the highlight of most commonly seen sexually transmitted diseases and it reviews some of those that relate to infertility. The bacteria that cause STIs include Neisseria gonorrhoeae, Chlamydia, Candida albicans, Trichomonas vaginalis, bacterial vaginosis, syphilis (Treponema), Lymphogranuloma venerum and others.
Sexually transmitted infections affect the most vulnerable populations — women, children and youths — between the ages of 15 and 44. They are also the major causes of infertility, morbidity and mortality.
The clinical manifestations are usually asymptomatic. They cause infections affecting the genital tracts of both sexes, thus leading to salpingitis (infection of the fallopian tube) and tubal blockage in females, stricture of the vas deference (narrowing of the tube that transports the sperm), epididymitis and ductile obstructions in males.
The World Health Organisation postulates that approximately 340 million new cases of the four main curable sexually transmitted infections — gonorrhea, chlamydia, syphilis and trichomoniasis — occur every year, with 75-85 per cent of them in developing countries. The rise in the incidence of STIs in developing countries tends to be linked with increasing urbanisation, travel, low socioeconomic level, multiple sexual partners and the practice of unprotected sexual intercourse.
The clinical presentations, when they occur, include fishy offensive discharge, whitish or yellowish discharge and sometimes pain on urination, as well as tenderness in the pelvic region to mention a few.
STIs are a common cause of human infertility worldwide and their effect on fertility tends to be more specific. They are also associated with an increased risk of miscarriage and infant mortality. Reduced fertility contributes to reduced reproductive success in the host leading to destabilising partnerships and increasing promiscuity.
Major human STIs that affect fertility and reproduction
The bacteria, Neisseria gonorrhea and chlamydia trachomatis, are major causes of pelvic inflammatory disease, which, in untreated women, results in tubal factor infertility in about 10-40 percent of the cases and increases the chances of ectopic pregnancy.
Chlamydia “the silent epidemic” tends to cause an estimated 4 to 8 million new cases each year. Neisseria gonorrhea and, to a lesser extent C.trachomatis, have also been associated with male fertility and both bacteria have been linked to increased risk of perinatal complications.
While it seems clear that STIs increase the risk of infertility in infected persons, there seems to be no proof for the adaptive traits. N. gonorrhea infects non-ciliated cells of the tubal mucosa but destroys predominantly the uninfected ciliated cells that have the crucial role in the transport of fertilised eggs to the uterus.
Available data from previous studies suggest that STIs constitute great medical, social and economic burden in Nigeria. Recent surveys report gonorrhea prevalence to be as high as 2.3 per cent with a reported incidence of 49.7 per 1000 population, the prevalence of C.trachomatis in women in the African region is 2.6 per cent with a reported incidence of 22.3 per 1000 population.
In addition to these major bacterial STDs, a number of other bacteria can potentially be transmitted via sexual contact like ureaplasma urealyticum, mycoplasma genitalium, gadnerella vaginalis, mycoplasma hominis and treponema pallidium. Also the eukaryotic parasite Trichomonas vaginalis, which tends to infect more than 270 million people per year and increases pre- term birth, PID (Pelvic Inflammatory Disease), female and male infertility.
In addition, some viruses are transmitted through sexual intercourse: genital herpes, human immunodeficiency virus hepatitis B virus. Genital ulcer disease is important due to association with HIV; increases predilection for HIV. In Nigeria, more women tend to present at the STI clinic than men.
Adverse effects of STI on reproductive health
STIs have been related to a number of adverse pregnancy outcomes such as spontaneous abortion, stillbirth, low birth weight) endometritis and various complications in childhood.
Untreated STI linked to congenital and perinatal infections, syphilis could result in stillbirth and neonatal death, while N.gonorrhoea could result to spontaneous abortions, premature deliveries serious congenital eye infections (opthalmia neonatarum) which could lead to infant blindness. According to WHO, cervical cancer caused by HPV is responsible for about 11 per cent deaths globally.
How can one prevent STIs?
The following steps are the key methods:
Abstinence: Depending on the age of affected individual use of protective barriers.
Early observation of pain on urination, genital discharge of any type in male or not related to menstruation will require immediate visit to the doctor for early diagnosis and proper treatment.