Can STDs Cause Infertility In Males?

A young man with an STD discussing his fertility with a doctor

Sexually transmitted diseases (STDs) are a significant public health concern, affecting millions of people worldwide. While the impact of STDs on female fertility is well-known, their role in male infertility is often overlooked.

STDs like chlamydia and gonorrhea, which are among the most prevalent sexually transmitted infections, have been shown to directly impact male fertility by damaging the reproductive tract and compromising sperm quality. Understanding this link is crucial for both individual and public health, as it underscores the importance of STD prevention, early detection, and prompt treatment.

This article will explore the connection between STDs and male infertility, shedding light on the most common culprits and the mechanisms by which they can impair a man’s reproductive health.

Which STDs Can Impact Male Fertility?


Chlamydia trachomatis is one of the most common sexually transmitted bacterial infections, and it can affect various parts of the male reproductive tract, including the urethra, epididymis, and testicles.

There are several reasons why chlamydia infection has been has been linked to male infertility:

  1. Damage to sperm DNA: Chlamydia infection has been associated with increased sperm DNA fragmentation in infertile men. The degree of DNA damage in sperm from chlamydia-infected men was found to be three times higher compared to healthy controls. This DNA fragmentation can significantly impair sperm function and fertility potential.
  2. Impairment of sperm parameters: Studies have shown that chlamydia infection can negatively impact key sperm parameters. Infected men have been found to have reduced sperm motility, abnormal sperm morphology, and lower sperm counts compared to uninfected men. These alterations in sperm quality can decrease the chances of successful fertilization.
  3. Induction of inflammatory responses: Chlamydia can trigger inflammation in the male genital tract, leading to conditions like urethritis, epididymitis, and prostatitis. The resulting inflammatory environment may be toxic to sperm and impair their function. Chronic inflammation can also lead to scarring and obstruction of the reproductive tract over time.
  4. Interference with sperm function: In addition to affecting sperm parameters, chlamydia has been shown to directly impair sperm function. Infection can decrease the ability of sperm to undergo the acrosome reaction, a crucial step in fertilization. Chlamydia can also attach directly to sperm, potentially affecting their motility and interactions with the egg.

However, prompt antibiotic treatment of chlamydia has been found to improve fertility outcomes in many cases. Several studies have reported that treating infected men with antibiotics like azithromycin or doxycycline can lead to significant improvements in sperm DNA integrity, motility, and morphology. In some cases, previously infertile couples were able to conceive after the male partner received treatment for chlamydia.

These findings underscore the importance of early detection and treatment of chlamydia infections in men to prevent or reverse fertility impairment. Screening of men, especially in couples seeking fertility treatment, can identify asymptomatic infections.

Antibiotic therapy should be promptly initiated in infected men, with a test of cure to confirm clearance of the pathogen. Treating chlamydia in its early stages, before chronic inflammation and tissue scarring occur, offers the best chances of restoring fertility potential in affected men.


Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is another common sexually transmitted infection that can lead to male infertility. Like chlamydia, gonorrhea can infect multiple sites within the male reproductive tract and cause damage:

  1. Epididymitis and urethritis: Gonorrhea is a major cause of epididymitis, which is inflammation of the epididymis, the coiled tube that stores and transports sperm from the testicles. Untreated epididymitis can lead to scarring and obstruction of the epididymis, preventing sperm from being ejaculated. Gonorrhea can also cause urethritis (inflammation of the urethra), potentially resulting in urethral strictures that impede the passage of sperm.
  2. Orchitis: In some cases, gonorrhea infection can ascend to the testicles themselves, causing orchitis (testicular inflammation). Orchitis can directly damage the sperm-producing tissues of the testes and lead to reduced sperm counts and quality. Rarely, severe untreated orchitis may cause testicular atrophy and permanent fertility impairment.
  3. Increased susceptibility to other STDs: Having gonorrhea can increase a man’s risk of contracting other STDs like chlamydia, which can compound the negative effects on fertility. Co-infection with multiple STDs has been associated with greater impairments in semen parameters and higher rates of infertility.
  4. Inflammatory damage to sperm: The inflammatory response triggered by gonorrhea infection can expose sperm to elevated levels of reactive oxygen species (ROS) and inflammatory cytokines. This oxidative stress can cause direct damage to sperm DNA, induce sperm apoptosis, and impair sperm motility and morphology. The resulting increase in abnormal sperm parameters reduces fertility potential.

Prompt treatment of gonorrhea with antibiotics is crucial for preventing these complications and preserving fertility. However, the emergence of antibiotic-resistant strains of N. gonorrhoeae is making the infection harder to cure and increasing the risks of long-term reproductive tract damage.

Screening for gonorrhea, especially among men in high-risk groups or those experiencing infertility, allows early detection and treatment. Preventive measures like consistent condom use and limiting sexual partners can reduce the chances of contracting gonorrhea and other STDs that threaten male fertility.

Other STDs

Several other sexually transmitted infections beyond chlamydia and gonorrhea have also been linked to male infertility:

  1. Syphilis: Although a direct toxic effect of syphilis on male fertility has not been definitively established, complications of untreated syphilis can affect fertility. Syphilitic epididymitis can cause epididymal obstruction, while syphilitic orchitis can damage the seminiferous tubules. Tertiary syphilis can also lead to erectile dysfunction.
  2. Herpes simplex virus (HSV): Studies have found that HSV infection, especially HSV-2, can result in decreased sperm count, motility, and viability. HSV particles have been shown to directly bind to and damage sperm cells. The inflammatory response triggered by HSV infection may also expose sperm to oxidative stress, causing DNA fragmentation and impaired function.
  3. Human immunodeficiency virus (HIV): Men with HIV may experience reduced sperm counts, impaired sperm motility, and abnormal sperm morphology. Both the virus itself and antiretroviral medications used to treat it can negatively impact semen parameters and fertility. Untreated HIV also increases the risk of acquiring other STDs that can further impair fertility.
  4. Hepatitis B and C viruses (HBV and HCV): Some studies suggest HBV infection is associated with reduced sperm motility, concentration, and normal morphology compared to uninfected men. HBV-positive men may have decreased fertility and pregnancy rates with assisted reproduction. HCV has also been linked to sperm abnormalities and infertility.
  5. Mycoplasma genitalium: This emerging STD pathogen has been detected in the semen of a significant proportion of infertile men. M. genitalium can directly attach to and damage sperm, causing reduced motility. It is also associated with increased seminal inflammation in infertile males.
  6. Trichomonas vaginalis: While the impact of this protozoan STD on male fertility remains controversial, some studies have found T. vaginalis is more common in infertile men and may be associated with altered semen parameters. The parasite’s secretory products can decrease sperm fertilizing capacity.

While more research is needed on some of these STDs, the evidence suggests they may impair male fertility through direct damage to sperm, induction of inflammatory responses in the male reproductive tract, and increasing the risk of contracting other STDs. Screening, prevention, and prompt treatment are important to mitigate the potential fertility impacts of these infections in men.

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How Common is Infertility in Men Who Have Had STDs?

Studies have consistently shown that sexually transmitted diseases (STDs) are more prevalent in infertile men compared to the general male population. This higher prevalence suggests a potential link between STDs and male infertility.

  • Chlamydia: The prevalence of Chlamydia trachomatis infection in infertile men ranges from 0.4% to 42.3%, depending on the study population and diagnostic methods used. These rates are significantly higher than the estimated prevalence of 1.1% to 1.9% in the general male population aged 30-44 years.
  • Gonorrhea: While data on gonorrhea prevalence in infertile men is limited, some studies have found rates ranging from 0% to 6.5%. This is still higher than the estimated global incidence of 0.24% in men aged 15-49 years.
  • Other STDs: Prevalence rates of other STDs in infertile men include 1.0% for herpes simplex virus-2 (HSV-2), 2.7% for Mycoplasma genitalium, and 10-12% for Ureaplasma urealyticum.

Futhermore, men with secondary infertility (inability to conceive after previously fathering a child) have been found to have higher rates of STDs compared to those with primary infertility. One study reported chlamydia prevalence of 2.5% in men with secondary infertility versus 0.5% in those with primary infertility.

Additionally, women with tubal factor infertility, often caused by pelvic inflammatory disease due to STDs, are more likely to have partners with current or past STD infections. A study found 3.6% prevalence of gonorrhea in partners of women with tubal factor infertility, compared to 0.1% in partners of women with other infertility causes.

These findings highlight the importance of STD screening in infertile couples, especially in cases of secondary infertility or tubal damage in the female partner. Early detection and treatment of STDs in both partners may help prevent further reproductive tract damage and potentially improve fertility outcomes. However, more research is needed to fully understand the complex relationships between STDs, male reproductive health, and couple infertility.

Treatment of STDs

Prompt and appropriate treatment of sexually transmitted diseases (STDs) is crucial for preventing or reversing their negative effects on male fertility. The specific treatment depends on the type of STD identified.


Chlamydia can be effectively treated with oral antibiotics such as azithromycin (single dose) or doxycycline (7-day course). Antibiotic treatment can potentially improve sperm parameters and restore fertility in many cases if the infection is caught early.

Gonorrhea is typically treated with a combination of two antibiotics, such as ceftriaxone (injection) and azithromycin (oral), to address the increasing problem of antibiotic resistance. Prompt treatment is essential to prevent complications like epididymitis and reduce the risk of infertility.

Antivirals and other treatments

:While there is no cure for Herpes simplex virus (HSV), antiviral medications like acyclovir, valacyclovir, and famciclovir can help manage symptoms, reduce outbreaks, and decrease the risk of transmission to partners. Suppressive therapy may be recommended for men with frequent recurrences.

Antiretroviral therapy (ART) is used to control HIV infection, prevent disease progression, and reduce the risk of transmission. ART may also help improve semen parameters in HIV-positive men, although fertility may still be impaired compared to uninfected men.

Treatment for chronic Hepatitis B virus (HBV) infection typically involves antiviral medications like entecavir or tenofovir. These drugs can help suppress viral replication, reduce liver damage, and potentially improve fertility outcomes.

Assisted Reproductive Technologies (ART)

In some cases, STDs may cause irreversible damage to the male reproductive tract, leading to persistent infertility even after the infection has been treated. In such situations, assisted reproductive technologies (ART) may be necessary to achieve pregnancy:

  1. Intrauterine insemination (IUI): Washed and concentrated sperm are directly inserted into the uterus to increase the chances of fertilization. IUI may be an option for mild to moderate male factor infertility.
  2. In vitro fertilization (IVF): Eggs are retrieved from the female partner and fertilized with sperm in a laboratory setting, with the resulting embryos transferred back into the uterus. IVF can help overcome more severe forms of male infertility.
  3. Intracytoplasmic sperm injection (ICSI): A single sperm is directly injected into an egg to achieve fertilization. ICSI is often used in cases of very low sperm count or motility, or when IVF has been unsuccessful.

While STD treatment can often restore or improve fertility, it is important for couples to undergo a comprehensive fertility evaluation to identify any additional factors that may be contributing to infertility. A combination of lifestyle changes, medical interventions, and ART may be necessary to optimize the chances of achieving a successful pregnancy in couples affected by STD-related male infertility.

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Prevention of STDs

Preventing sexually transmitted diseases (STDs) is crucial for maintaining male reproductive health and fertility. Several strategies can help reduce the risk of contracting STDs and their potential impact on fertility.

Safe Sex Practices

  1. Condom use: Consistent and correct use of male latex condoms is highly effective in reducing the transmission of STDs, including chlamydia, gonorrhea, HIV, and hepatitis B. Condoms provide a physical barrier that prevents exposure to infected secretions and reduces the risk of STD acquisition and transmission.
  2. Dental dams: These thin, square pieces of latex can be used during oral-vaginal or oral-anal sex to reduce the risk of STD transmission. Dental dams act as a barrier to prevent direct contact with potentially infected areas.
  3. Limiting sexual partners: Reducing the number of sexual partners can decrease the risk of exposure to STDs. Engaging in mutual monogamy with an uninfected partner is one of the most reliable ways to avoid STDs.

Regular STD Screening

The CDC recommends yearly screening for sexually active women under 25 and older women with risk factors like new or multiple sex partners. Regular screening allows for early detection and treatment of these common STDs, which can help prevent complications like pelvic inflammatory disease and infertility.

Individuals at high risk for HIV and syphilis, such as men who have sex with men, should be tested more frequently. Early diagnosis and treatment can prevent the spread of these infections and reduce the risk of long-term complications.

Depending on individual risk factors, screening for other STDs like hepatitis B, hepatitis C, and HPV may be recommended. Discussing sexual history and risk factors with a healthcare provider can help determine appropriate screening tests.

Other Prevention Methods

In addition to these strategies, vaccination against hepatitis B and HPV can provide long-term protection against these viral STDs. Comprehensive sexual education and open communication with sexual partners are also important for promoting sexual health and reducing STD risk.

By implementing a combination of safe sex practices, regular screening, and preventive measures like vaccination, men can significantly lower their risk of contracting STDs and the potential impact on their fertility. Healthcare providers play a key role in educating patients, encouraging screening, and providing timely treatment to help preserve male reproductive health.

Can Fertility Be Restored if STDs Are Caught and Treated Early?

Prompt diagnosis and treatment of sexually transmitted diseases (STDs) can significantly improve the long-term reproductive outlook for affected men. When infections like chlamydia and gonorrhea are detected and treated with antibiotics in their early stages, before they cause significant damage to the reproductive tract, fertility can often be preserved or restored.

Studies have shown that treating men with chlamydia using antibiotics like azithromycin or doxycycline can lead to improvements in sperm parameters such as motility, morphology, and DNA integrity.. In some cases, previously infertile men were able to successfully conceive with their partners after receiving treatment for chlamydial infections.

However, when STDs are left untreated, they can lead to serious complications and irreversible damage to the male reproductive system over time. Chronic infections with chlamydia or gonorrhea can cause scarring and obstruction of the epididymis and vas deferens, potentially resulting in permanent infertility.

Untreated STDs can also increase a man’s risk of developing other conditions that impact fertility, such as:

  • Epididymitis and orchitis: Inflammation of the epididymis and testicles, which can lead to scarring, obstruction, and impaired sperm production and transport.
  • Urethral strictures: Narrowing of the urethra due to inflammation and scarring, which can impede the passage of semen.
  • Prostatitis: Infection and inflammation of the prostate gland, which may contribute to fertility issues.

In addition, untreated STDs can be transmitted to female partners, potentially causing pelvic inflammatory disease, tubal damage, and infertility. This can further compound the reproductive difficulties faced by affected couples.

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