The Link between STD’s and Male Infertility

Sexually Transmitted Diseases (STDs) – An Overview

Sexually transmitted diseases or STDs are infections that are passed on from one individual to another during sexual activities that may be during vaginal, anal, and or oral sex. It may also get transmitted through skin to skin contact with an infected area or sore or through contamination of body fluids. All STDs are caused by viruses, bacteria, yeast, parasites and other microorganisms. STDs used to be called venereal diseases or VD and in recent years have emerged as one of the most common contagious diseases.

Types of Sexually Transmitted Diseases – A Summary

There are more than 20 types of STDs out of which the famous five include:

• Gonorrhea
• Hepatitis B and C
• HIV
• Chlamydia
• Syphilis

STDs if left untreated can increase the risk of acquiring another STD such as HIV with some untreated STDs that can also lead to male infertility. The symptoms of STDs are not always obvious and even with no marked symptoms, a person can pass the infection to his or her sexual partner or partners. The five STD types as mentioned above are discussed in brief with their symptoms, diagnosis, treatment and their effect on male infertility:

Gonorrhea – Symptoms, Diagnosis, Treatment and its effect on male infertility

Gonorrhea is a bacterial infection of the genital tract which infects the genital tract, mouth or anus. The first gonorrhea symptoms usually appear within 10 days after exposure even though some people may be infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea may include:

• Painful sensation during urination
• Thick, cloudy or bloody discharge from the vagina or penis
• Pain and swelling in the testicles and at the opening of the penis

Physicians will detect and diagnose gonorrhea with laboratory tests. Treatment is done with antibiotics even though it is becoming difficult due to the increased prevalence of drug-resistant strains. Gonorrhea may cause permanent scarring and blockages in the sperm production cycle leading to male infertility.

Hepatitis B and C – Symptoms, Diagnosis, Treatment and its effect on male infertility

Hepatitis B is a liver infection caused by the Hepatitis B Virus (HBV) in some people. Hepatitis C is another type of liver disease popularly known as “hep C”. Hepatitis B and Hepatitis C (HCV) stays in the body causing chronic disease and long-term liver problems. Hepatitis C is a blood-borne disease and those who engage in anal sex have an increased risk of contracting Hepatitis C virus because of fragile tissue of the anus.
The Hepatitis B virus can be transmitted through semen (during sexual intercourse), vaginal fluids and blood and it can be transmitted from a mother to a newborn during delivery. The common symptoms of Hepatitis B and Hepatitis C include-

• Fever
• Jaundice (Yellow colored skin or eye)
• Fatigue
• Nausea and vomiting
• Loss of appetite
• Weight loss
• Stomach pain

The diagnosis of Hepatitis B and Hepatitis C is usually through blood test. There is no specific treatment, cure or medication for Hepatitis B and Hepatitis C. However, in case of chronic HBV infection – the treatment is provided through antiviral medication and supportive care.
Of the five hepatitis viruses – only hepatitis B is associated with impaired fertility in males due to lower sperm motility and reduction in the fertilization rate of sperm. Male patients with chronic hepatitis C virus (HCV) infection have a significant decrease in semen volume, sperm count and progressive sperm motility and abnormal sperm morphology when compared with healthy controls.

HIV – Symptoms, Diagnosis, Treatment, and effect on male infertility

The Human Immunodeficiency Virus (HIV) also known as AIDS (acquired immunodeficiency syndrome) is one of the most deadly diseases in human history that destroys lymphocytes which are part of human body’s immune system (defense system that fights infections) that leads to the risk of serious infections and certain cancers. HIV usually spreads through unprotected sex with an infected person or through sharing of infected drug needles or through contact with the blood of the infected person.
The common symptoms or signs of HIV and or AIDS may include:

• Thrush-a thick whitish coating of the tongue or mouth, accompanied with Sore throat,
• Extreme fatigue or weakness
• Swollen lymph glands
• Rapid weight loss
• Heavy sweating during the night

The diagnosis of HIV begins with an HIV test that can be either a blood test or a swab taken from inside the cheek of the patient. There is no specified cure for HIV/AIDS but there exist many effective medicines to fight the infection and people with HIV can now have longer and healthier lives.
The types of medicines include Reverse Transcriptase (RT) inhibitors, Protease inhibitors, Fusion inhibitors, Integrase inhibitors and Multidrug combinations. Men with HIV have Hypogonadism that leads to low level of testosterone among HIV-infected men. With the progression of HIV or AIDS, low testosterone levels become more frequent leading to male infertility.

Chlamydia – Symptoms, Diagnosis, Treatment, and effect on male infertility

Chlamydia is one of the most common STD associated with male infertility and the symptoms of its active infection may include burning sensation during urination, light-colored discharge from the penis, tender, and swollen testicles. Chlamydia as a sexually transmitted disease is caused by a bacteria known as Chlamydia trachomatis.
Chlamydia is diagnosed by the routine urine test; the treatment involves prescribing antibiotics by the physician to clear the infection within seven to ten days. Chlamydia results in male infertility due to permanent scarring and blockages in the cells associated with sperm production.
Men with Chlamydia have more than three times of DNA fragmentation in their sperm with infected men having a higher percentage of malformed and immotile sperm than healthy men.

Syphilis – Symptoms, Diagnosis, Treatment, and effect on male infertility

Syphilis is a sexually transmitted infection which is caused by the bacteria Treponema palladium.
This infection primarily starts with sores which is the main cause and spreads through the contact of the sores during vaginal, oral or anal sex.
Syphilis is diagnosed by antibody testing such as Treponemal antibody testing which includes Fluorescent Treponemal Antibody Absorption Test [FTA-ABS] which is done after 3-4 weeks of exposure and Non-treponemal antibody testing such as Venereal Disease Research Laboratory testing (VDRL) and Rapid plasma Reagin (RPR) tests.
An antibiotic treatment with Penicillin is the best to treat Syphilis but one dose of penicillin works only for primary syphilis, later stages requires longer treatment. Other antibiotics used to treat syphilis are Doxycycline, Azithromycin and Ceftriaxone.
The effect of syphilis has not been reported in any literature, but the complications arising from syphilis can impact one’s fertility. Syphilis of the testicles confined to the epididymis has more chances to cause obstruction of the epididymis (Syphilitic epididymitis). Long term syphilis infection (Tertiary infection) causes gummatous lesions, if it occurs in the testicles it may have an impact on testicular function and infertility. An indirect effect of Neurosyphilis results in the slow degeneration of the spinal cord which in turn causes Erectile Dysfunction.
In summary, pathological changes of the reproductive system caused by any of the STDs can have an effect on a Man’s fertility and in some cases be the cause of their infertility issues.