Sexually Transmitted Diseases (STDs) & Infertility

Reproductive health has been defined by the World Health Organisation (WHO) as the total well-being in all aspects of reproduction, that is, physical, emotional, behavioural and social. In many countries, public health programmes aim to maintain reproductive health by creating awareness about sexually transmitted diseases (STDs), their causes, modes of transmission, consequences and prevention. The following sections explain common STDs, their diagnosis and treatment, prevention strategies, and clinical solutions for infertility.

Sexually Transmitted Diseases

Sexually Transmitted Diseases (STDs)

Sexually transmitted diseases (STDs), also called venereal diseases or reproductive tract infections (RTIs), are infections that are commonly transmitted through sexual contact. Causative agents include bacteria, viruses and parasites. Examples of important STDs are AIDS (HIV infection), gonorrhoea, syphilis, genital herpes, genital warts (human papillomavirus, HPV), chlamydiosis and hepatitis B.

Many STDs remain asymptomatic (show no obvious signs) for weeks, months or longer; this increases the risk of spread and of late complications such as pelvic inflammatory disease (PID), infertility, ectopic pregnancy, adverse pregnancy outcomes, and in some cases cancer of the reproductive tract. Typical signs where present include unusual genital discharge, genital ulcers or sores, itching and swelling.

Although sexual contact is the common mode of spread, some STDs can also be transmitted by non-sexual routes. Non-sexual modes include transfusion of contaminated blood or blood products, sharing of contaminated needles or syringes, from mother to child during pregnancy, childbirth or breastfeeding, and less commonly through close non-sexual contact with infected lesions.

Diagnosis and prompt treatment are important. Bacterial STDs are often curable with appropriate antibiotics. Viral STDs such as hepatitis B, HIV and genital herpes are generally managed with antiviral medicines to control disease and reduce transmission, though they are not usually cured. Vaccination is effective for prevention of some infections, for example hepatitis B and human papillomavirus (HPV).

Strategies for Prevention

Prevention of STDs combines education, behavioural measures, clinical services and vaccination. Public health efforts focus on increasing awareness, providing sex education, improving access to diagnosis and treatment, and offering preventive services.

• Introduce and provide accurate age-appropriate sex education to increase awareness about safe sexual practices.
• Use barrier methods of protection such as condoms consistently and correctly during vaginal, anal and oral sex to reduce transmission.
• Avoid sexual contact with multiple or unknown partners; reduce risky sexual behaviour.
• Undergo regular screening and medical check-ups if sexually active, especially for those with new or multiple partners.
• Seek prompt medical advice and complete the full course of prescribed treatment if an infection is suspected or diagnosed.
• Inform and treat sexual partners to prevent reinfection and further spread (partner notification).
• Practice safe injection and blood-screening procedures; do not share needles or syringes.
• Use vaccination where available: vaccination against hepatitis B and HPV prevents associated disease and reduces cancer risk.
• Ensure screening and treatment during pregnancy to reduce mother-to-child transmission of infections such as HIV, syphilis and hepatitis B.

Infertility

Infertility affects a significant proportion of couples of reproductive age. When a couple fails to conceive after one year of regular unprotected intercourse (or earlier if known risk factors exist), they should seek medical assessment. Causes may be male, female or combined, and sometimes the cause remains unexplained.

Common causes of infertility

• Female factors: ovulatory disorders (irregular or absent ovulation), blocked or damaged fallopian tubes, endometriosis, uterine abnormalities, age-related decline in ovarian reserve.
• Male factors: low sperm count, poor sperm motility or morphology, genetic causes, infections affecting reproductive organs, hormonal disorders.
• Couple factors: combinations of above or unexplained causes in which standard tests are normal.

Assisted Reproductive Technology (ART)

 Assisted Reproductive Technology (ART) includes various methods to help individuals or couples conceive a child when they face difficulties in doing so naturally. One of the most well-known methods within ART is In Vitro Fertilization (IVF), which involves fertilizing an egg with sperm outside the body under controlled laboratory conditions. 

1. In Vitro Fertilisation (IVF) and Embryo Transfer (ET)

• In vitro fertilisation (IVF) means fertilisation outside the body under conditions similar to those inside the body.
• Commonly called the test tube baby programme.
• Ova are collected from the wife or a donor female.
• Sperms are collected from the husband or a donor male.
• Fertilisation is induced in the laboratory to form a zygote.

2. Types of Embryo Transfer

ZIFT (Zygote Intra Fallopian Transfer)

• Zygote or early embryo with up to 8 blastomeres
• Transferred into the fallopian tube
  

IUT (Intra Uterine Transfer)

• Embryos with more than 8 blastomeres
• Transferred into the uterus

Embryos formed by in vivo fertilisation can also be transferred to assist females unable to conceive naturally.

3. Gamete Intra Fallopian Transfer (GIFT)

Ovum from a donor is transferred into the fallopian tube of another female.

Used when the recipient female:

• Cannot produce ova

• Can provide a suitable environment for fertilisation and development

4. Intra Cytoplasmic Sperm Injection (ICSI)

A single sperm is directly injected into the ovum in the laboratory. Used in severe male infertility cases.

5. Artificial Insemination (AI)

Used when infertility is due to:

• Inability of the male to inseminate
• Very low sperm count

Semen from husband or healthy donor is artificially introduced into:

• Vagina, or
• Uterus (IUI - Intra Uterine Insemination)

6. Limitations of ART

• Require: High precision handling, Specialised professionals and Expensive instrumentation
• Available only in few centres.
• Affordable to limited number of people.
• Emotional, religious, and social factors act as deterrents.

7. Adoption as an Alternative

• India has many orphaned and destitute children.
• Legal adoption is permitted by law.
• Adoption is considered one of the best options for parenthood.