By-Dr Sandhya Mishra, Consultant – Reproductive Medicine & Gynecologist, Milann Fertility Centre, Indiranagar, Bengaluru

Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are major global health issues, impacting quality of life, causing infertility, cancers, and pregnancy complications, and playing a key role in HIV transmission.

Infertility affects one in six people globally, impacting about 15% of couples, or 48.5 million couples worldwide. Men account for 50% of all infertility cases, with 20-30% being solely male-related. This profound issue affects millions of people of reproductive age, along with their families and communities. According to the WHO, 48 million couples and 186 million individuals globally struggle with infertility. In India, a diverse nation, the impact of STIs and HIV/AIDS on fertility is a critical issue that demands urgent attention.

Understanding HIV/AIDS and its Symptoms

HIV weakens the body’s defenses by targeting CD4 cells in the immune system. If left untreated, it can be transmitted through blood, unprotected sex, or mother-to-child. It can also result in AIDS.

HIV affects fertility in both men and women through biological and psychosocial factors. In men, HIV can impair sperm quality, and motility, and decrease testosterone levels, making conception difficult. Women with HIV may experience irregular menstrual cycles, reduced egg quality, and lower birth rates. Additionally, HIV can lead to conditions like pelvic inflammatory disease (PID), damaging the fallopian tubes, ovaries, and uterus. Psychosocial factors, such as fear, stress, and stigma, can further impact fertility and the decision to have children.

HIV starts with flu-like symptoms weeks after exposure, may then remain asymptomatic while weakening the immune system, and progresses to AIDS with severe symptoms like weight loss, persistent fever, and frequent infections.

STIs and Their Impact on Fertility

Chlamydia, gonorrhea, and syphilis are prominent sexually transmitted infections (STIs) that significantly contribute to infertility in both men and women. Chlamydia, for example, can inflict severe damage on reproductive organs, leading to blocked fallopian tubes in women and reduced sperm production in men. If left untreated, these infections can progress to pelvic inflammatory disease (PID), impacting 10–20% of Indian women with untreated chlamydia or gonorrhea.

Symptoms of Common STIs

Chlamydia: Often no symptoms, but can include abnormal discharge, burning during urination, and pelvic pain.

Gonorrhea: Painful urination, abnormal discharge, and pelvic pain.

Syphilis: Sores at the injection site, skin rashes, and mucous membrane lesions.

Herpes: Painful blisters or sores, itching, and discomfort.

HPV: Often no symptoms but can cause genital warts and increase cancer risk.

Trichomoniasis: Itching, discharge, and discomfort in the genital area.

Treatments for HIV/AIDS

Testing and Minimizing Risk: Before treatment, an HIV viral load test and CD4 count assess infection levels and immunity. To reduce infection risk, antiretroviral drugs, neonatal prophylaxis, elective Caesarean delivery, and avoiding breastfeeding are used during pregnancy.

Antiretroviral Therapy and Fertility Management: ART manages HIV, supports healthy living, and reduces transmission risk. For HIV-positive women, ART with fertility treatments can lead to a healthy pregnancy, with medication to minimize infection risk to the child.

For HIV-positive men, sperm is washed to separate motile sperm and tested for HIV RNA before insemination. A dedicated area for HIV-positive couples during ART treatments helps prevent contamination, though the risk is very low.

Assisted Reproduction and Medical Advancements: Assisted reproduction methods like IUI, IVF, and ICSI offer safe fertility solutions for couples with one HIV-positive partner, thanks to advancements in medical care.

Treatments for STIs

Diagnosis involves reviewing history and symptoms and conducting urine, blood, or swab tests. Treatments include antibiotics for bacterial STIs, antivirals for viral STIs, and antifungals for fungal STIs. Follow-up includes re-testing and notifying partners to prevent reinfection.

Prevention Strategies for STIs and HIV/AIDS

1. Safe Practices: Consistent condom use during sexual activity significantly reduces the risk of HIV and STIs.

2. Regular Screenings: Routine check-ups and screenings are vital for early detection and treatment of infections, particularly for couples planning to conceive.

3. Vaccinations: Vaccines such as the HPV vaccine can prevent specific STIs. The HPV vaccine is included in India’s national immunization program to help lower cervical cancer rates.

4. Sexual Health Education: Providing education on safe sex practices and STI prevention helps individuals make informed decisions.

Counseling: Offering support and counseling addresses the psychological and emotional impacts of STIs.