Sexually Transmitted Diseases can be disconcerting to think about and scary to discuss, especially when you consider the potential they have to impact your fertility. However, an understanding of the STDs that the capacity to increase the risk of both male and female infertility can be empowering and reassuring. It'll equip you with the knowledge you need to help you identify which signs you should ignore and which symptoms may be cause for concern. In this article, we'll discuss the various STDs that can impact both male and female fertility, how they do so, and the signs and symptoms of each one.

Which STDs can cause male infertility? 

The following STDs can all increase the risk of infertility in people born male:

Gonorrhea

Untreated gonorrhea can lead to epididymitis, a condition where the coiled tube at the back of the testicles becomes inflamed. This can impact the body in the following ways:

• Inflammation and scarring: Gonorrhea is an infection that causes inflammation in the epididymis, leading to swelling and potential scarring. This scarring can obstruct the epididymal ducts, which are responsible for transporting sperm, blocking the normal flow of sperm during ejaculation, and therefore reducing the chances of them reaching and fertilising an egg
• Motility and quality of sperm: Gonorrhea-induced inflammation and scarring can impair the production of healthy sperm in the epididymis, leading to a reduced sperm count, decreased sperm motility, and abnormal morphology (sperm). When the health of sperm is compromised, and these parameters are not what they should be, the sperm cells are unlikely to travel fluidly to the egg.

Chlamydia

A common bacterial infection, chlamydia can too lead to epididymitis when left untreated, causing scarring and blockages that can disrupt the passage of sperm. Chlamydial infections can also cause:

• Reactive arthritis: In some cases, chlamydia can trigger reactive arthritis, a type of joint inflammation that occurs as a response to an infection. Reactive arthritis can affect joints in the reproductive system, leading to complications such as pain, swelling, and potential damage to both the testes and in turn the sperm they produce. 
• Sperm abnormalities: Chlamydia infection can also affect sperm quality and function. It may lead to changes in sperm motility (movement), morphology (shape), and overall sperm count, lowering the probability of a successful fertilisation. 

Genital herpes

Although it is rare for herpes to directly cause infertility in men, it can lead to complications including:

• Epididymitis: Like gonorrhea, Genital herpes can lead to an inflammation of the epididymis, often causing discomfort, swelling, and potential scarring. In severe cases, this scarring may potentially affect sperm movement or lead to blockages.
• Coinfection with other STDs: Genital herpes can increase the risk of contracting other STDs such as gonorrhea and chlamydia which, as previously touched on, have the potential to cause infertility in men. Therefore, if genital herpes is present alongside other STDs, the risk of fertility issues may increase.

Which STDs can cause female infertility?

Commonly contracted STDs can lead to female infertility in different ways. Here's an outline of which STDs can cause infertility in people born female and how. 

Pelvic Inflammatory Disease (PID)

Occasionally the result of untreated chlamydia or gonorrhea, pelvic or "acute" pelvic inflammatory disease is an infection and inflammation in certain reproductive organs, most commonly the uterus, fallopian tubes, and ovaries. When left untreated, PID can lead to complications that affect fertility in the following ways:

1. Fallopian tube damage and blockage: Inflammation caused by PID can lead to swelling, scarring and adhesions (bands of scar tissue) in the fallopian tubes which, when left untreated, can lead to blockages, permanent damage, and eventually what is called 'tubal factor infertility.' The fallopian tubes play a crucial role in egg fertilisation, transporting them from the ovaries to the uterus, and so blockages can either prevent sperm from reaching the egg, or the egg from reaching the uterus, causing tubal factor infertility.
2. Ectopic pregnancy: In addition to tubal factor infertility, PID increases the risk of ectopic pregnancy: when a fertilised egg implants and grows outside the uterus, usually in the fallopian tubes. As mentioned above, scarring and damage can disrupt the journey of the fertilised egg through the fallopian tubes. However, this blockage also increases the likelihood of the egg being implanted in an abnormal and potentially harmful place, resulting in ectopic pregnancy. 
3. Chronic pelvic and abdominal pain: PID can have some distressing, painful symptoms.  Chronic pelvic pain and pain during intercourse can discourage women from sex, reducing the frequency of intercourse and therefore their chances of conception.

Chlamydia and Gonorrhea

Just like PID, chlamydia and gonorrhea can cause inflammation, scarring, and blockages in the fallopian tubes. Unsurprisingly therefore, the NHS advises sexually active women under 25 to get tested at least once a year.

1. In the case of chlamydia, the bacteria can trigger inflammation and scarring in the reproductive organs. Over time, this scarring can cause damage to the fallopian tubes, making it difficult for the egg to pass through them, or for sperm to reach the egg. This can result in infertility or increase the risk of ectopic pregnancy (one that occurs outside the uterus, usually in the fallopian tubes). Chlamydia can also cause premature delivery in pregnant women and be passed onto newborn babies, so it's important to get tested regularly. 
2. Gonorrhea thrives in a woman's reproductive tract. The infection can trigger inflammation in the reproductive organs, leading to the development of PID and damage to the fallopian tubes. Symptoms which can signify the presence of gonorrhea include abnormal discharge (unusual discharge from the vagina), burning or painful urination and pain during sex.  

Human Papillomavirus (HPV)

A viral infection, HPV does not typically cause female infertility in itself. However, certain high-risk strains of HPV can lead to cervical changes that, if left untreated or undetected, can increase the risk of cervical cancer. 

Here's how HPV-related cervical cancer can affect fertility in women:

1. Cervical tissue damage: HPV infection can cause cellular changes in the cervix, including the development of lesions (organ or tissue damage) or abnormal cells around the cervix. These conditions may require specific surgical interventions that can remove or damage cervical tissue, potentially impacting fertility.
2. Treatment-related effects: The treatments for cervical cancer, such as surgery, radiation therapy, or chemotherapy, can also affect reproductive organs. Surgical removal of the cervix or uterus, radiation damage to the ovaries, or chemotherapy's impact on ovarian function can all have implications for a woman's fertility.

Mycoplasma Genitalium

A lesser known bacteria discovered in 1981, a buildup of mycoplasma genitalium can create a genital tract infection in both male and female reproductive organs.. One of the symptoms of MG is pelvic inflammatory disease which, as discussed earlier, can lead to female infertility through scarring and blockages.

As this article has shown, STDs can contribute to both male and female infertility, and so if you are diagnosed positive with any of the above, be sure to inform any sexual partners who may also be infected.

Remember, it's completely normal to feel concerned or overwhelmed by all the information we've discussed above. However, it's worth mentioning that early detection, quick treatment and practicing safe sex will significantly reduce the risks of infertility associated with these STDs. Regular screening and communication with healthcare providers are crucial to maintaining sexual and reproductive health, and keeping the chances of infertility to a minimum.

If you have any concerns or believe you may have been exposed to an STD, speak to a healthcare professional or your Fertifa Patient Advisor, who will always be happy to reassure you and talk through STDs in more detail 💜