The effects of sexually transmitted infections and sexual function on male fertility, "Beyond the Abstract," by Claire Brookings

BERKELEY, CA (UroToday.com) - This review article looks at the relationship between sexually transmitted infections (STIs), male sexual functioning, and male fertility. Possibly the most important conclusion made is there is a desperate need to clarify some key areas, and that further studies are warranted before we can fully understand this relationship.

Some STIs clearly have a direct effect on fertility and these mechanisms are understood. These are rare complications such as testicular atrophy with syphilis, or obliteration of the epididymal canal with gonorrhea. Other STIs have been implicated in male infertility and show effects on sperm parameters, but the mechanism behind this remains unclear. Perhaps a better understanding of the pathogenesis behind male infertility would help clarify the role of STIs. In some studies, treatment of infections has improved sperm parameters but not in other studies. This does not alter the fact that STIs may well affect male fertility but makes us ask the question, is it the infection itself causing the problem or the subsequent inflammatory response or does the infection trigger a continuing autoimmune dysfunction/dysregulation? If infertility is due to such a secondary effect then it is understandable why treatment of the infection does not always show improvement in sperm quality.

Over the last 10 years there has been a great improvement in diagnostic testing with the roll out of PCR (polymerase chain reaction) and NAATS (nucleic acid amplification tests). These tests are now extremely sensitive and specific for the presence of the causative agent. In some cases it is clear that the virus/bacteria isolated is a pathogen such as herpes simplex virus or chlamydia. In other cases, such as the presence of ureaplasma species, these are felt, by some, to be commensal bacterial flora, particularly in women. How long after sexual contact would these infections be picked up on NAATS testing in males and does a positive test imply an infection or pathogenesis in otherwise asymptomatic males?

Finally with social development there has been a dramatic change in the last 50 years regarding many aspects of sex and relationships. The role of the male and his subsequent psychosocial pressures have shifted. In the US today, in 40.4% of households, the female partner is the primary provider, with only 6.7% of households having the male as the sole provider. There has been sexual liberation of women and development of convenient female-controlled contraceptive methods. Both men and women are living in a media-dominated sexualized world, though there is still much cultural and religious pressure to abstain. This pressure may in fact impact further on sexual functioning if a STI is diagnosed. Pornography-induced sexual dysfunction in now recognised, too. To what extent have these factors added to the pressure on the male to perform nature’s basic male requirement?

As clinicians managing couples with infertility today, we should be taking a holistic approach, investigating fully each partner and treating any underlying infections found but also considering the psychosocial impact on sexual function of infertility per se and also of the diagnosis of an STI in this particular situation.

Written by:
Claire Brookings as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK

Sexually transmitted infections and sexual function in relation to male fertility - Abstract

email news signup