Rahil Prasad

A00071199

Link between STI’s and Infertility in Women

Labasa hospital serves as the main referral center for the health services in the Northern

Division. In my attachment with the Obstetrics and Gynaecological Unit I have had the

opportunity to interact with and support the treatment of women who have trouble conceiving.

More often than not infertility in these cases are treated by correcting sexual practices and

optimizing the timing of conception. However, in some cases higher levels of intervention are

needed. As such I feel it is important to consider sexually transmitted diseases as cause of

infertility as I have noted that many women have never had STI screening and counseling. The

following paper will focus on the relationship between common STI infections and infertility in

women as a learning issue.

A 2017 review article from the American Journal of Obstetrics and gynecology looked at the link

between sexually transmitted diseases and infertility. The article focused on female infertility and

the effect of four specific infections- C. trachomatis, N. gonorrhoeae, M. genitalium and T.

vaginalis (Tsevat et al, 2017). The Review searched CINAHL, Medline, Embase and Web of

Science and included articles that included the terms female infertility and the 4 infective

organisms and included articles from 1975 and 2016. Articles that did not report sufficient data

and had a low number of participants were excluded, and the reference lists were scrutinized.

The results from this review were not combined. However, the article did not give a confidence

interval and comment on the precision of the results.

The review found that gonorrhea and chlamydia have a strong link with infertility as the

infections cause tubal damage and occlusion. This was determined by correlating seropositivity

1
Rahil Prasad
A00071199

of C trachomatis with hysterosalpingogram showing occlusion and histological evidence of

cellular damage and N gonorrhoeae infection. The authors also found an increased incidence of

ectopic pregnancy in patients with Chlamydia and Gonorrhea. However, the authors suggest that

more research is needed into the link between infertility and M genitalium and T vaginalis. The 2

organisms increase the risk of PID and therefore cause infertility by 50% and 30% respectively.

The authors went on to find a meta-analysis that determined vaginal microbiome variation is

present in at least 20% of infertility cases. However, more studies do not show solid correlation

between tubal damage and variations such as bacterial vaginosis. These results can be applied

locally as infertility is a common problem seen in gynae clinics and testing for STI’s can be easy,

however, the cost burden needs to be considered as tests for Chlamydia are not done in house.

A cross sectional from India looked at correlates of primary infertility in women done in 2011.

Adamson et al looked to find out the correlates and prevalence of primary infertility among

young women in Mysore, India. Using the AXIS tool for appraisal of cross sectional studies, this

cross sectional study was of appropriate design as the authors wanted prevalence data of causes

of infertility at a specific time from the specific population (women with infertility). The

selection process allowed for nonpregnant women that engaged in unprotected sex leading to a

sample size of 897. Risk factors and outcome variables were considered such as vaginal pH and

STI infections. Confidence intervals were calculated for the major risk factor at 95%. All women

were treated using appropriate clinical guidelines.

The study used trained personnel to interview participants on behavior and reproductive health.

The women were then given a pelvic exam and samples for STI screening were done. The

2
Rahil Prasad
A00071199

authors concluded that herpes simplex 2 was associated with infertility in this group at 3.13% of

the women. Of the seropositive women for HSV 2 11.5 had T vaginalis and Bacterial Vaginosis.

However, the authors found no link between infertility and Candida infections. The authors

recommend that future reproductive health programs use this data on HSV 2 to drive work on

infertility. The data can be applied locally as it gives another STI for us to test when treating

women with infertility. It is common for HSV 2 infections to not manifest in many women and if

data suggests that it can be the cause of infertility and PID, we should test for it.

Therefore, the 2 papers reinforce the role of STI for infertility and it is important to consider it in

women with infertility. Personally, I believe that unprotected sex is common in Fiji and sexual

behaviors are often dangerous. This has been supported by anecdotal data from health

professionals and also when speaking to patients. The most common reason for high risk

behavior such as unprotected sex by patients is convenience and simply not being bothered.

Moreover, a public health approach is needed to tackle this issue but it seems harder to achieve

now given the higher rates of STI’s and teenage pregnancy. Furthermore, when treating

infertility, we must test for STI’s and counsel women on the importance of safe sexual practices.

However, it must be acknowledged that many women simply do not have a choice for family

planning as they are barred by their husbands and partners and the patriarchal nature of our

society leads to many men simply not initiating condom use.

In conclusion, women and girls should be widely counseled on the dangers of STI’s and treated

for STI’s if infertility is a persistent problem. My recommendation is to use the Fiji Guidelines of

STI treatment and administer a stat dose of ceftriaxone or a combination of stat amoxicillin,

3
Rahil Prasad
A00071199

probenecid, augmentin and azithromycin as it can be cheap, it's easy to take and the impact on

antibiotic resistance will be low given the high prevalence of STI in women with persistent

infertility.

4
Rahil Prasad
A00071199

Reference

Adamson, P. C., Krupp, K., Freeman, A. H., Klausner, J. D., Reingold, A. L., & Madhivanan, P.

(2011). Prevalence & correlates of primary infertility among young women in Mysore, India.

The Indian journal of medical research, 134(4), 440–446.

Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted

diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1-9.

doi:10.1016/j.ajog.2016.08.008

Ministry of Health and Medical Services Publishing Team. (2016, January 08). Sexually

transmitted infections – MHMS. Retrieved May 7, 2023, from

https://www.health.gov.fj/what-you-need-to-know/