Reproductive System Disorders

By Abdulla Israr & Simran Rani

Reproductive System Disorders

Introduction

·        The reproductive system is essential for the continuation of life and species survival.

·        It ensures the production of gametes, fertilization, pregnancy, and childbirth.

·        Disorders of the reproductive system can affect fertility, sexual health, and overall well-being. Among these, sexually transmitted diseases (STDs) and Pelvic Inflammatory Disease (PID) are highly significant due to their prevalence, impact on fertility, and public health burden.

  • STDs: Caused by infectious agents (bacteria, viruses, protozoa, fungi, parasites) transmitted primarily through sexual contact.
  • PID: A serious infection of the female upper genital tract, often a complication of untreated STDs (mainly gonorrhea and chlamydia), causing chronic pain, infertility, and increased risk of ectopic pregnancy.

Sexually Transmitted Diseases (STDs)

Definition

STDs are infections transmitted through sexual contact (vaginal, anal, or oral) as well as through blood transfusion, sharing of needles, or vertical transmission (mother to child during pregnancy, delivery, or breastfeeding).

Common Causative Agents

  • Bacterial STDs: Gonorrhea (Neisseria gonorrhoeae), Syphilis (Treponema pallidum), Chlamydia (Chlamydia trachomatis), Chancroid (Haemophilus ducreyi).
  • Viral STDs: HIV/AIDS, Genital Herpes (HSV-2), Human Papillomavirus (HPV), Hepatitis B and C.
  • Protozoal STDs: Trichomoniasis (Trichomonas vaginalis).
  • Fungal STDs: Candidiasis (Candida albicans).
  • Parasitic infestations: Pubic lice (Phthirus pubis), Scabies (Sarcoptes scabiei).

Major STDs

1. Gonorrhea

  • Cause: Neisseria gonorrhoeae (Gram-negative diplococcus).
  • Transmission: Sexual contact, perinatal (mother to newborn → ophthalmia neonatorum).
  • Symptoms:
    • Males: Urethritis, dysuria, purulent urethral discharge.
    • Females: Often asymptomatic; cervicitis, vaginal discharge, pelvic pain.
  • Complications: Epididymitis, prostatitis, infertility, PID in women, neonatal blindness.
  • Diagnosis: Gram stain (Gram-negative intracellular diplococci), culture, NAAT (Nucleic Acid Amplification Test).
  • Treatment: Ceftriaxone (IM) + Azithromycin (oral).

2. Syphilis

  • Cause: Treponema pallidum (spirochete).
  • Stages:
    • Primary: Painless chancre at infection site.
    • Secondary: Rash on palms/soles, mucocutaneous lesions, condyloma lata.
    • Latent: Asymptomatic phase.
    • Tertiary: Cardiovascular syphilis, neurosyphilis, gummas.
  • Congenital Syphilis: Stillbirth, Hutchinson’s teeth, saddle nose deformity.
  • Diagnosis: VDRL, RPR (screening); FTA-ABS, TPHA (confirmatory).
  • Treatment: Benzathine Penicillin G.

3. Chlamydia

  • Cause: Chlamydia trachomatis (obligate intracellular bacterium).
  • Symptoms:
    • Men: Urethritis, epididymitis.
    • Women: Cervicitis, mucopurulent discharge, pelvic pain.
  • Complications: PID, infertility, ectopic pregnancy, neonatal conjunctivitis/pneumonia.
  • Diagnosis: NAAT, culture, ELISA.
  • Treatment: Azithromycin (single dose) or Doxycycline (7 days).

4. Genital Herpes

  • Cause: Herpes Simplex Virus (HSV-2, occasionally HSV-1).
  • Symptoms: Painful vesicular eruptions on genitalia, burning sensation, fever, lymphadenopathy.
  • Recurrence: Virus remains latent in nerve ganglia → reactivation.
  • Diagnosis: Viral culture, PCR, Tzanck smear.
  • Treatment: Acyclovir, Valacyclovir (reduces severity, not curative).

5. Human Papillomavirus (HPV) Infection

  • Cause: HPV types 6, 11 (genital warts), types 16, 18 (oncogenic → cervical cancer).
  • Symptoms: Condyloma acuminata (cauliflower-like warts), precancerous cervical lesions.
  • Complications: Cervical cancer, anal cancer, penile cancer.
  • Prevention: HPV vaccination (Gardasil, Cervarix).
  • Treatment: Cryotherapy, laser therapy, podophyllin application.

6. HIV/AIDS

  • Cause: Human Immunodeficiency Virus (retrovirus).
  • Transmission: Sexual contact, blood transfusion, sharing needles, mother-to-child.
  • Clinical Features:
    • Acute HIV: Flu-like illness.
    • Chronic: Opportunistic infections, weight loss, oral candidiasis, Kaposi’s sarcoma.
  • Diagnosis: ELISA (screening), Western blot/RT-PCR (confirmatory).
  • Treatment: Antiretroviral therapy (ART) – combination drugs (HAART).

7. Trichomoniasis

  • Cause: Trichomonas vaginalis (protozoa).
  • Symptoms: Frothy, greenish-yellow vaginal discharge, foul odor, vulvar irritation, strawberry cervix.
  • Diagnosis: Wet mount microscopy, culture.
  • Treatment: Metronidazole (oral).

8. Candidiasis (Vulvovaginal Thrush)

  • Cause: Candida albicans.
  • Symptoms: Thick curdy white discharge, pruritus, erythema.
  • Risk Factors: Diabetes, antibiotic use, immunosuppression.
  • Treatment: Fluconazole, clotrimazole.

Prevention of STDs

  • Safe sexual practices (condom use, mutual monogamy).
  • Health education and awareness.
  • Screening and early treatment.
  • Vaccination (Hepatitis B, HPV).
  • Prenatal screening to prevent congenital infections.

Pelvic Inflammatory Disease (PID)

Definition

PID is an infection and inflammation of the female upper genital tract (uterus, fallopian tubes, ovaries, pelvic peritoneum).

Etiology

  • Infectious agents:
    • Neisseria gonorrhoeae, Chlamydia trachomatis.
    • Anaerobes (Bacteroides), Mycoplasma genitalium, Gardnerella vaginalis.
  • Risk factors: Multiple sexual partners, unprotected sex, prior history of STDs, IUD insertion, poor hygiene.

Pathophysiology

  • Pathogens ascend from the vagina and cervix → infect endometrium (endometritis) → fallopian tubes (salpingitis) → ovaries (oophoritis) → pelvic peritoneum (peritonitis).
  • Inflammation → scarring and adhesions → infertility, chronic pain, risk of ectopic pregnancy.

Clinical Features

  • Lower abdominal/pelvic pain.
  • Fever, chills, malaise.
  • Abnormal vaginal discharge (purulent).
  • Dyspareunia (painful intercourse).
  • Irregular menstrual bleeding.
  • Cervical motion tenderness (Chandelier sign).

Complications

  • Chronic pelvic pain.
  • Infertility due to tubal scarring.
  • Ectopic pregnancy.
  • Tubo-ovarian abscess.
  • Peritonitis, sepsis if untreated.

Diagnosis

  • Clinical diagnosis is most important.
  • Investigations:
    • Pelvic exam (tenderness).
    • Lab tests: Leukocytosis, ESR, CRP.
    • Cervical/vaginal swabs for NAAT (gonorrhea, chlamydia).
    • Ultrasound: Tubo-ovarian abscess.
    • Laparoscopy: Gold standard.

Treatment

  • Empirical broad-spectrum antibiotics (covering gonorrhea, chlamydia, anaerobes):
    • Ceftriaxone + Doxycycline ± Metronidazole.
  • Hospitalization for severe cases.
  • Drainage of abscess if present.
  • Partner treatment to prevent reinfection.

Prevention

  • Early treatment of STDs.
  • Safe sex practices.
  • Regular gynecological check-ups.
  • Avoid unnecessary IUD insertion in high-risk women.

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