STIs and Pre-Conception Health: An Overview of Risks & Prevention

This report discusses the impact of sexually transmitted infections (STIs) such as chlamydia, gonorrhoea, HIV, genital herpes, syphilis, and Mycoplasma genitalium on fertility and neonatal health. It highlights the rising rates of STIs in Australia, particularly chlamydia and gonorrhoea, and their potential adverse effects on reproductive health, including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in both men and women. The report emphasizes the importance of screening and safer sex practices to prevent the spread of STIs and minimize the risk of transmission from mother to baby. It also references guidelines for testing donors in assisted reproduction clinics to prevent STI transmission. For more information on pre-conception health, readers are directed to www.yourfertility.org.au. Desklib provides access to similar reports and solved assignments for students.

Sexually transmitted infections (ST
Sexually transmitted infections (STIs) are prevalent across Australia and the incid
some STIs is rising. STIs can impact fertility in both men and women, affect a wom
ability to carry a pregnancy, and influence child health outcomes. The STIs that c
fertility and/or neonatal health include chlamydia, gonorrhoea, human immunode
virus (HIV), genital herpes, syphilis and Mycoplasma genitalium.
Pre-Conception Health Special Interest Gro
1
Your Fertility is a national public education campaign funded by the Australian
Government Department of Health and Ageing under the Family Planning Grants Program.
Updated October 2015

Syphilis (Treponema pallidum)
Syphilis can be transmitted from mother to foetus during pregna
This is known as congenital syphilis and can result in health prob
the child at birth and later in life.
Notifications for syphilis in Australia have increased in recent yea
mostly among men who have sex with men. However, notificatio
congenital syphilis remain low. This is likely to be due to screenin
treatment of pregnant women [1].
Mycoplasma genitalium
Mycoplasma genitalium is an increasingly common bacterial STI
which can result in vaginal discharge, urethritis, cervicitis and PID
women. PID can lead to other reproductive complications and inf
[14]. Studies have shown a strong association between Mycoplas
genitalium and infertility [14].
Summary
STIs such as chlamydia, gonorrhoea, HIV, genital herpes, syphilis
and Mycoplasma genitalium can adversely affect fertility and/or
health. Notifications of some STIs continue to rise. In particular, d
of chlamydia and gonorrhoea more than doubled in Australia bet
2008 and 2012.
Recommendations
Screening is an important tool in preventing the spread of chlam
infection. Opportunistic screening may decrease infection rates a
detection rates, allowing for earlier treatment of the infection. Bo
. [5] recommend opportunistic screening of sexually active youn
attending their doctor for other reproductive health matters such
smears, contraceptive advice, antenatal care or termination of p
Transmission of STIs can be reduced or even prevented by use o
sex practices including the use of condoms. Screening of both m
women prior to pregnancy can detect STIs and allow for treatme
pregnancy occurs. This would minimise the risk of transmission f
mother to baby and prevent health problems in the unborn child
The Department of Health and Ageing have produced helpful STI
symptoms and treatment tools for health professionals [15,16].
Guidelines for testing of donors
In Australia, assisted reproduction clinics are required to minimis
of donor gametes transmitting STIs to recipients. Guidelines prod
by the National Health and Medical Research Council state that c
should not accept gamete donations from people at increased ris
transmissible infections and that potential donors should underg
for such conditions [17].
The Code of Practice for reproductive technology units issued by
Reproductive Technology Accreditation Committee of the Fertility
of Australia also requires that clinics minimise the risk of “transm
infectious agents” between gamete/embryo donors and recipien
For more information about pre-conception hea
www.yourfertility.org.au
Evidence review
Chlamydia (Chlamydia trachomatis)
Chlamydia is the most commonly notified infectious disease in Australia
[1] and worldwide [2]. In 2012 there were 82,707 new diagnoses of
chlamydia in Australia, which is an increase of 17% since 2009 [1].
The population rate of reported diagnoses more than doubled in both
the male and female populations, from 125 in 2003 to 307 per 100 000
male population in 2012, and from 181 in 2003 to 419 per 100 000
female population in 2012 [1]. Infections are most common in the 15
to 29 years age-group, which accounts for 80% of cases [3]. The risk of
infection is higher for women than men and in those aged 15-24 years
than in those who are older [2,4]
Chlamydia is often asymptomatic so people can have the infection
for some time without being diagnosed or treated [2]. In women,
undetected or multiple chlamydia infections can cause pelvic inflammatory
disease (PID), which in turn can lead to ectopic pregnancy and tubal
infertility [2,4,5]. In men, chlamydia can affect sperm quality and
function and cause urethritis, prostatitis and epididymitis [4,5]. It is
thought that the immune response to the infection rather than the
infection itself causes the damage [6].
Gonorrhoea (Neisseria gonorrhoea)
Gonorrhoea infection can cause similar adverse effects on fertility as
chlamydia but is more commonly symptomatic. If left untreated it can
lead to PID in women and infertility in both men and women. In 2011,
infection rates for gonorrhoea were second only to chlamydia with over
11,000 notifications [7]. The rate of diagnosis of gonorrhoea increased by
67%, from 35.1 per 100 000 population in 2008 to 58.9 in 2012 [1].
While chlamydia is more common in females, gonorrhoea is more common
in males [5]. The groups most commonly affected are men who have sex
with men, Indigenous Australians in remote areas and people who have
had heterosexual contact overseas [5].
HIV (human immunodeficiency virus)
HIV can be transmitted through sexual intercourse and can also be
transmitted to a baby during pregnancy and through breastfeeding. HIV
cannot be cured and there is currently no vaccine to prevent it, but safer
sex practices can prevent transmission. With effective antiviral medications,
many people are able to survive and live relatively normal lives. HIV can
impair female fertility [8]. Use of assisted reproductive technology can
minimise the risk of transmission in HIV discordant couples wishing
to have children [8,10,11].
HIV is most common in men who have sex with men. In 2008, there were
almost 1000 new cases of HIV in Australia [3]. Of these cases, 66% were
men who have sex with men and 24% were through heterosexual contact [3].
Of 1 364 cases of HIV infection newly diagnosed in 2008 – 2012, for which
exposure to HIV was attributed to heterosexual contact, 58% were in people
from high prevalence countries or their partners [1].
Genital herpes
Genital herpes, caused by the herpes simplex virus (HSV), is not a
notifiable STI but is common among sexually active people. Genital symptoms
include small, painful blisters, painful urination and vaginal discharge.
Nearly 75% of women with herpes can expect at least one flare‐up during
pregnancy. HSV can be transmitted to the baby through direct contact
with the virus during birth. To reduce the risk of transmission, it is often
recommended that a cesarean be offered to women with active lesions [12].
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Pre-Conception Health Special Interest Group
Sexually transmitted infections (STIs)
Updated October 2015
Written by Karin Hammarberg on behalf of the PCHSIG
[e-mail]

References
1. The Kirby Institute, 2013. “HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2013”. The K
South Wales, Sydney, NSW.
2. Akande, V., et al., 2010. “Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for Practice.”
13(3): 115-125.
3. National Centre in HIV Epidemiology and Clinical Research, 2009 “HIV/AIDS, viral hepatitis and sexually transmissible infections in Austr
report, NCHECR, The University of New South Wales: Sydney.
4. Carey, A.J. and Beagley, K.W., 2010. “Chlamydia trachomatis, a hidden epidemic: effects on female reproduction and options for treatm
Reproductive Immunology. 63: 576-586.
5. Bowden, F.J., et al., 2002. “Sexually transmitted infections: new diagnostic approaches and treatments.” Medical Journal of Australia. 17
6. Hogan, R.J., Mathews, S.A., Mukhopadhyay, S., Summersgill, J.T., Timms, P., 2004. “Chlamydial Persistence: beyond the Biphasic Paradig
Immunity 72: 1843-1855.
7. Australian Bureau of Statistics, Sexually transmissible infections, 4102.0 - Australian Social Trends, Jun 2012.
8. an Leeuwen, E., Prins, J.M., Jurriaans, S., Boer, K., Reiss, P., Repping, S., van der Veen, F., 2007. “Reproduction and fertility in human imm
type-1 infection.” Human Reproduction Update 13:197-206.
9. Ochsendorf, F.R., 2008. “Sexually transmitted infections: impact on male fertility.” Andrologia, 40(2): 72-75.
10. Baker, HWG., Mijch, A., Garland, S., Crowe, S., Edgar, D., Clarke, G., Foster, P., Blood, J., 2003. “Use of assisted reproductive technolog
sion of HIV in discordant couples wishing to have their own children where the male partner is seropositive with an undetectable viral loa
11. Delvaux, T. and Nostlinger, C., 2007. “Reproductive choices for women and men living with HIV: contraception, abortion and fertility.” Re
15 (29 supplement): 46-66.
12. Cochrane Database of Systematic Reviews: Plain Language Summaries. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013130/
13. Schmid, G.P., Stoner, B.P., Hawkes, S., Broutet, N., 2007. “The need and plan for global elimination of congenital syphilis”. Sex Transm
14. McGowin, C.L. and Anderson-Smits, C., 2011. “Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women.” P
e1001324, 10.1371/journal.ppat.1001324.
15. Department of Health and Ageing, STI Symptoms Tool
http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-sti-tools/$File/sti-symptoms-tool.pdf
16. Department of Health and Ageing, STI Treatment Tool
http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-sti-tools/$File/sti-treatment-tool.pdf
17. National Health and Medical Research Council, 2007. “Ethical guidelines on the use of assisted reproductive technology in clinical pract
Australian Government: Canberra.
18. Reproductive Technology Accreditation Committee, 2010. “Code of practice for assisted reproductive technology units.” Available from
http://www.fertilitysociety.com.au/rtac/.
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Pre-Conception Health Special Interest Group
Sexually transmitted infections (STIs)
Updated October 2015