The problem of infertility across all the social classes is increasing in India. This is due to prolonged studies, career related delay, open society with youngsters opting for one night stands and multiple partners. This allows a lot of opportunities for sexually transmitted disease (STD) as an important cause of infertility. These infections do not spare the males also. So it is essential for youngsters to be aware of STDs not only HIV/AIDs but also innocuous ones like Chlamydia that can silently destroy the reproductive system.
Infections that are passed from one human to another during unprotected sexual intercourse are called STDs. They can occur following vaginal, anal, oral or any other form of sex. Other routes of infection spread include sharing IV needles, from mother to child - intrauterine, during childbirth or breastfeeding.
Almost 3/4th of sexually active people will contract some type of infection during their lifetime. This is more common in young people in their teens and twenties. USA reports more than 19 million new cases of STIs every year and 25% of these are in the teens. The American Social Health Association puts the rate of STD related fertility problems as 15% of all infertilities. Recurrent episodes of PID further increase the risk of infertility. It is estimated that the risk of infertility with PID increases form 15% with 1 episode, to 35% and 75% with two and three episodes respectively. Further nine% of women who have PID caused by chlamydia will experience ectopic pregnancy.
Since majority of these infections are asymptomatic, it is essential for sexually active people to go for STD screening regularly and get treatment if needed to prevent future infertility problems.
TYPES OF STDS
Many organisms are sexually transmitted. Not all STDs affect fertility. The four common one causing infertility are
Often a combination of these causes the pelvic inflammatory disease (PID). This means an infection traveling from vagina upwards to the uterus and fallopian tubes following a vaginal intercourse with an infected partner. The primary bacteria responsible are chlamydia and gonorrhoea. When undiagnosed or left untreated this progresses to PID - involving the ovaries, tubes and peritoneum of pelvis. More than one million cases of PIDs occur and of which about hundred thousand can become infertile. Since, PID relatively remains asymptomatic in a vast majority of patients, it often goes undiagnosed.
This is a ruthless organism that is silent and destructive. Almost 40% untreated infections affect the fallopian tubes, causing them to swell and scar and block the tubes. It also causes partial tubal blocks leading to ectopic pregnancies. In men the infection spreads from the urethra to testicles and can cause permanent damage. US reports about a million new cases of chlamydia infection every year. It is not only prevalent among 15 to 19 year olds and African-Americans, but also in 10% of all female Army recruits, 10% of college students and 14% of young working women .In India the statistics are not known but could be as common. It is three times common in women as men seem to clear this infection easily.
Screening remains an important strategy in the prevention of infertility associated with chlamydia infection. Chlamydia is diagnosed with a simple urine test and can be treated with a single dose of antibiotics. Internationally it is recommended to test for chlamydia annually in all sexually active women under 26 years old; and in older women when have a change of sexual partner.
Obstacles in chlamydia screening: Main is simply lack of awareness. Also it produces fewer symptoms like vaginal discharge, bleeding between periods, painful intercourse and pelvic pain in women, and burning during urination in men which are not specific to chlamydia. Sometimes even doctors don't consider the possibility of chlamydia in middle-class patients, but all classes including models, businesswomen and professionals have it.
The CDC, along with the National Chlamydia Coalition is working to spread awareness on screening for chlamydia. Even after treatment, there is 25% reinfection rate within six months probably from untreated partners. The CDC recommends both partners are treated simultaneously, either with a weekly dose of doxycycline or a single dose of azithromycin. Chlamydia can be spread by oral or anal sex, as well as vaginal sex; condoms greatly reduce the transmission rate. Also asymptomatic infections can persist for an indefinite period of time and produce late effects like infertility.
This is another common STD that cause inflammation of fallopian tubes. This is a flagellate, which is picked up in smears and is difficult to culture. It produces a greenish yellow purulent discharge.
This causes abnormal bleeding, yellow or blood stained vaginal discharge (Vaginitis), pelvic infection (P.I.D) and in males it can cause epididymitis. This accounts for about 40% of PIDs.
Most infections have little or no effect in males. But some like the gonorrhoea affects the epididymis and causes block. HIV cause immunodeficiency and reduce semen quality.
PREVENTING STDS AND INFERTILITY
Ironically, many teens and young couples avoid consultation with the physician or gynaecologist as they consider even the possibility of having an STD as shameful. They also worry about what their peers think about and how their parents will react and shy away and thus delaying the treatment. This psychology of young people should be understood and they must be encouraged to approach the doctor in case of any symptoms. Repeated testing may be necessary as some infections may remain dormant for long time.
A major step to prevent the spread of STI and to protect from future infertility related problems is to provide good quality sex education. The only absolute way of protection from an STD is through abstinence. But using proper precautions like condoms, avoiding contact with blood and body fluids, avoiding sex when the partner is having symptoms are methods of practise of safer sex. While people may not fear the risk of morbidity due to infections, they can understand that today's behaviour may affect their future dream of becoming a parent.
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