Common Infections of Pelvis Leading Onto InfertilityDr Asha S Vijay

Infectious agents can impair various critical human functions, including reproduction. Bacteria, fungi, viruses, and parasites can interfere with the reproductive process in both sexes, most of which are sexually transmitted.

Infections of the male genito-urinary tract account for about 15% of male infertility cases. The disease affects different sites of the male reproductive tract, such as the testis, epididymis, and male accessory sex glands. Subsequently, spermatozoa can be affected by urogenital infections at different levels of their development, maturation, and transport.

Infections affecting reproductive organs in women are collectively referred to as Pelvic inflammatory disease (PID). Infections are a primary significant number of women who are trying to conceive. Many genital tract infections can cause infertility by blocking fallopian tubes. Infection of the endometrium (endometritis) creates a hostile environment for embryos to implant causing infertility. Infection of the ovaries (oophoritis) can eggs’ quality, leading to infertility.

Common infections causing infertility are:

Chlamydia is the most common sexually transmitted bacterial infection (STI) associated with male infertility, affecting millions of people every year. Symptoms of active disease may include a burning sensation during urination, a light-coloured discharge from the penis, and tender/swollen testicles. It is important to note that up to half of infections do not produce noticeable symptoms. An uncontrolled disease, Chlamydia can cause permanent scarring and blockages of the ejaculatory duct (epididymitis) or impair sperm production (orchitis).

In women, chlamydia can spread to the upper genital tract (uterus, fallopian tubes, and ovaries), resulting in PID and the possibility of ectopic pregnancy or infertility. It can also cause inflammation of the cervix, resulting in challenges in conceiving by affecting the cervical mucus. It is often asymptomatic and causes damage to the tubes much before diagnosis.

Gonorrhoea is an STI commonly associated with male infertility. Symptoms of an active infection may include a burning sensation during urination and a darker-coloured discharge from the penis. Like Chlamydia, gonorrhoea may also cause permanent scarring and blockage of the ejaculatory duct or damage sperm production.

Females infected with this bacterial infection have a 10 – 20% risk of developing infertility. Symptoms include dysuria, dyspareunia, lower abdominal pain and purulent and foul-smelling discharge from the vagina. Gonorrhoea damages tubes and causes sloughing, thereby infertility.

Common childhood infection presents as swollen lymph nodes under the jaw jawline to an airborne virus. Men infected with mumps after puberty can suffer from the painfully swollen testis and permanently impaired sperm production.

Tuberculosis is a significant cause of infertility in developing countries, particularly India. It’s a bacterial infection known to attack the reproductive system and cause permanent tubal blockages in men and women. Genital TB is usually secondary to TB elsewhere in the body. Genital TB is often symptomless, presenting as only infertility. The cause of infertility is usually due to damaged/ blocked tubes, tube-ovarian mass, endometritis, and adhesions in the pelvic cavity.

Mycoplasma is a sexually transmitted bacteria that can latch onto sperm cells and reduce their motility. Infection with Mycoplasma typically does not produce noticeable outward symptoms but may be diagnosed by culturing the semen.

In women, it causes non-specific tubal changes causing salpingitis. Due to inflammation of tubes, sperm motility in line is affected and creates a hostile environment for the gametes.

Non-sexually transmitted urinary tract infections are relatively rare in men but can occur. In these cases, most of the damage to fertility is caused by entering white blood cells or “leukocytes” to fight the bacteria. The leukocytes release toxic substances to kill the bacteria that can cause collateral damage to sperm. Large numbers of leukocytes often discover these infections during a semen analysis. If treated with antibiotics, total fertility can typically be restored.

Early diagnosis and treatment are the keys to preventing damage to reproductive organs. Since many of these infections damage much before diagnosis, prevention is the best approach to avoid fertility-related issues.