Sexually transmitted infections (STIs)
One-in-five Men 'infected With Virus That Can Lead To Infertility' – Most Have No Idea
A new study suggests that one-in-five men has been infected with a virus that can cause fertility issues - and most have no idea.
Human papillomavirus (HPV) is the most common sexually transmitted infection in the UK. It's estimated that around 80 percent of us will be infected with at least one strain of HPV at some point in our lives.
Scientists have known for a long time that HPV can cause a range of cancers. It's also been believed it might be the cause of some cases of infertility.
However, previous research into HPV's effects on fertility has focused on women. But a new research study has found that high-risk HPV strains - thought to be carried by one in five men - can also affect sperm quality, reports The Sun.
It quotes a study, published in Frontiers in Cellular and Infection Microbiology which found high-risk HPV strains can suppress the immune system in the male genital tract. This could hinder the body's ability to get rid of the infection - a process that can take up to a year.
Now scientists believe this immune system suppression raises the risk of catching other diseases that can damage male fertility. Professor Virginia Rivero from the National University of Córdoba in Argentina is one of the study's authors.
She said: "Individuals often have no symptoms or signs, yet still carry HPV in the male genital tract."
Professor Virginia and her team examined the sperm samples of 205 men with an average age of 35 who had suffered fertility issues or treatment for urinary tract problems. They found that 39 of the men - 19 percent - tested positive for HPV.
The scientists identified 20 men among them who had high-risk strains - and seven with low-risk HPV. On closer examination of the semen, they found they found clues suggesting why high-risk HPV strains might impact male fertility.
Men with high-risk HPV strains had lower levels of specific immune cells in their semen. This suggests the virus had hampered the body's ability to fight it off, said the study.
It's thought this may have also raised the risk of other infections that could further reduce their fertility. There were also signs that the sperm of the men with high-risk HPV had been damaged by oxidative stress - a condition that occurs when the body has too many free radicals and not enough antioxidants to neutralize them.
Scientists say this could explain why these men had higher levels of dead sperm than men who didn't have the virus.
Most people don't know they have HPV. This is because it doesn't tend to cause symptoms or problems.
There are about 200 strains of the disease, most of which are harmless. However, some high-risk strains - including HPV16 and HPV18 - can cause cancers of the throat, neck, head, penis, vagina and anus.
Analysis published in The Lancet Global Health in 2023 suggested that 21 percent - or more than one-in-five - of men aged 15 and over in the UK are infected with at least one high-risk strain.
An HPV vaccine is offered to Year 8 school children in the UK. It is hoped this will reduce HPV-related cancer cases in the future.
It's The Most Common STI You've Never Heard Of. Will This Newly Developed Drug Provide The Cure?
Researchers at Tulane University are leading a groundbreaking study to seek a more effective treatment for trichomoniasis, an infection that, despite being the most common curable sexually transmitted infection (STI) worldwide, continues to fly under the radar.
The five-year, multi-center study is funded by a $9.2 million National Institutes of Health grant and will compare the effectiveness of a recently approved medication, secnidazole, against the current standard treatment, metronidazole, using a 1,200-person cohort across Louisiana, Alabama and Florida. Despite decades of use as the primary trichomoniasis medication, treatment by metronidazole continues to have a 10% breakthrough rate.
"More than 10 percent of people who take the recommended treatment still have it. That is just unacceptable. We need better options" said Dr. Patty Kissinger, professor of epidemiology at Tulane School of Public Health and Tropical Medicine. "The problem is trichomoniasis is the most common treatable STI, but there are often no symptoms, and the CDC has not recommended screening among asymptomatic people, so the public doesn't know about it."
Trichomoniasis, which infects about 156 million people annually worldwide, is caused by trichomonas vaginalis, a parasite that thrives in the genital tract of both men and women and causes inflammation. Those infected have a 1.5 times higher susceptibility to HIV. For expecting mothers, it can cause pre-term birth and increase risk for perinatal morbidity. African American women are also four times more likely to have trichomoniasis.
"Trichomoniasis affects millions but remains a highly neglected STI," Kissinger said. "We're hoping this study leads to better treatment options and increased awareness that we hope will encourage more screening."
Because of the lack of inclusion in STI screenings and scant symptoms, those infected can go years before realizing they have trichomoniasis.
This is the third in a series of studies funded by the NIH to refine treatment for trichomoniasis. This is the first study in the series to include men in its cohort and the first-ever study to compare the effectiveness of secnidazole with metronidazole.
Questions remain as to why metronidazole continues to have a high breakthrough rate. The prior NIH studies found that metronidazole is most effective when administered in multiple doses, but the breakthrough rate may be attributed to patients missing doses or having sex with partners before treatment is completed, creating a cycle of reinfection.
The secnidazole treatment would only require one dose, although some concerns remain about the cost of the medication, Kissinger said.
Trichomoniasis affects more than 3 million people in the United States and is particularly prevalent in the Deep South where the study is being conducted.
"We need better treatments for this STI," Kissinger said. "If this is successful, we could control it and encourage more screening that could reduce perinatal morbidity and maybe even reduce the chances of some people getting HIV."
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Simple Exercises That Could Cure The Embarrassing Pain That Is Endured By Nearly One In Ten Men - Who Are Often Told There's Nothing Wrong
Thousands of men are being left to suffer an embarrassing and debilitating condition – even though treatment could be as simple as a few minutes of daily exercises. Nearly one in ten men endure chronic testicular and penis pain at some point in their lives, which can make getting dressed uncomfortable and moving around an agony.
Experts say the condition is often mistaken for a sexually transmitted disease or dismissed as a symptom of depression or anxiety.
Growing research suggests these men could effectively be cured using a regime of pelvic floor exercises, similar to those recommended for women to combat urinary incontinence after childbirth.
But specialists have told The Mail on Sunday the NHS has a 'blind spot' for this area of men's health – meaning the condition, known as chronic pelvic pain syndrome (CPPS), often goes undiagnosed and untreated.
Jose Gonzalez Martinez began experiencing agonising pain after recovering from a prostate infection. Doctors and scans could find little clarity, until he was referred to Dr Boylan
Patients are sometimes forced to pay for private treatment because some NHS physiotherapists do not treat men for pelvic floor issues.
Instead, experts say, it is viewed as a 'women's issue'.
'Thousands of men suffer with these painful spasms in their pelvic area, but are repeatedly told there is nothing wrong,' says Dr Johnny Boylan, a genitourinary consultant who runs the CPPS clinic at Liverpool University Hospitals NHS Foundation Trust. 'Or they are given antibiotics for a potential infection or painkillers.
'But pain relief won't solve the problem unless you treat the underlying issue, which we know is rarely happening.
'Physiotherapy or simple daily exercises they can learn themselves could change the lives of many of these men but, too often, they cannot get this on the NHS. That needs to change.'
It is unclear how many men suffer from CPPS, but research published in the British Medical Journal this year suggested that as many as one in 12 men have been affected at some point.
The long-term pain often occurs in the testicles, the perineum (the area between the testicles and the anus) and the tip of the penis.
The sensation is often likened to a burning feeling or electric shocks that ripple through the affected area.
Patients report that the sensation can be so uncomfortable that putting on pants or trousers becomes unbearable because the pressure leads to flare-ups.
Pain in the genitals can also be a symptom of serious conditions such as sexually transmitted diseases, kidney stones, and even cancer.
This is why experts say it is important that patients who experience these issues always visit their GP.
However, many GPs are unaware of the symptoms of CPPS and are often unable to help men affected by it.
Studies suggest that, for some men, the condition can be triggered by an infection.
The pelvic floor is a group of muscles that support the spine, bladder and bowels
Other patients believe their CPPS was brought on by stress.
Doctors are also often unsure what causes the condition – or why it affects certain areas of the genitals but not others.
However, experts say that is becoming increasingly clear that CPPS is caused by a tightening of the pelvic floor muscles. Stretched like a hammock from the pubic bone at the front to the tailbone at the back, the pelvic floor is a group of muscles that support the spine, bladder and bowels.
It also allows us to control urine and bowel movements.
For women, it can be weakened by childbirth, leading to stress incontinence – peeing or pooing involuntarily when laughing, sneezing or exercising.
According to the NHS, one in three women experiences urinary incontinence in the first year after having a baby – and many continue to suffer for years afterwards. Women are advised to strengthen their pelvic floor by doing Kegel exercises – named after the 20th- century US gynaecologist Dr Arnold Kegel – which involve tightening the pelvic floor muscles for three to five seconds, then relaxing for three to five seconds, and repeating.
In June 2021, NHS England announced it was setting up specialist pelvic health clinics, staffed by physiotherapists, to treat tens of thousands of pregnant women and new mums with pelvic floor issues.
It is thought that men with CPPS have the opposite problem to women with stress incontinence. While, for these women, the muscles become too loose, for men, the muscles become constricted, and cannot relax.
Overtime, this leads to muscle spasms. Experts say CPPS patients should be offered 'reverse Kegel' exercises that loosen the muscles (see below for details).
However, there are no specialist pelvic health clinics available for men. In fact, experts say that many physiotherapists outright refuse to treat men for pelvic floor problems.
'Huge numbers of men suffer from chronic testicular pain,' says Bill Taylor, an Edinburgh-based physio, and a member of the Pelvic, Obstetric and Gynaecological Physiotherapy group, which campaigns for greater awareness around CPPS.
'It can be incredibly debilitating, can really impact their lives, even make them feel life isn't worth living.
'But when you're speaking to people about men's pelvic health, they tend to ask: 'Do men even have a pelvic floor?'
'There's this idea that only women have a pelvic floor, which even trickles down through GPs and doctors.
IT'S A FACTAround a fifth of men over 65 have urinary incontinence and may benefit from pelvic floor exercises, research shows
Advertisement'Historically, if you worked in pelvic health you were working in women's health.
'Most of the research has focused on women – there's really not been much research done on men.
'We need to educate doctors – GPs, sexual health consultants, urologists, incontinence specialists – so they understand the problem better and know what we as physiotherapists can offer, especially for men with chronic testicular pain.'
Dr Johnny Boylan says that, frequently, he has been unable to find NHS physiotherapists who will take on patients with CPPS.
'I've had to give them the names of a private physio who would help them instead,' he says.
One man who knows the agony of CPPS – and the frustration of trying to find treatment – is Jose Gonzalez Martinez, 37, a hotel worker, from Liverpool.
In October 2022, he developed an infection of the prostate, the gland that controls flow of urine.
Although a two-month course of antibiotics treated the infection, Mr Gonzalez Martinez was left with relentless pain in his testicles.
He said: 'It just kept getting worse. At first I thought it was a reaction to the infection or to the antibiotics.
'It was there all the time, although it was worse some days, and would get worse if I was moving around a lot.
'At times it would spread up into my groin and into my belly.'
Assuming the pain was caused by another infection, Mr Gonzalez Martinez's GP referred him to a sexual health clinic, where he was tested for sexually transmitted diseases including chlamydia, gonorrhoea and HIV.
Although he explained he was happily married and unlikely to have an STI, they repeated the tests a few weeks later.
He said: 'I don't think they believed me – even when all the tests, for both me and my wife, came back clear.'
An ultrasound failed to find any sign of physical damage, leaving Mr Gonzalez Martinez to struggle on.
He said: 'No one knew where the pain was coming from. I was still able to work. But it was constantly tiring and annoying. People told me they could see the pain in my face.'
Eventually he was referred to Dr Boylan.
Realising the problem was caused by over-tight muscles of the pelvic floor as result of the prostate infection, he prescribed daily exercises to release the tension – plus nortriptyline, an antidepressant also used for pain relief. Starting on 10mg a day, he later increased the dose to 20mg.
Mr Gonzalez Martinez said: 'There was an improvement, quite quickly. I was going two or three days without pain.
'For a time, if I was moving around a lot in my job, it was still sometimes painful. But with the exercises alongside the medication, the pain has completely disappeared.
'The exercises are very easy to do: just make the pelvic floor tense then relax. I do between one and three minutes and make sure I do it every day.'
Dr Boylan say it is crucial that more funding is made available for physiotherapists to take on men with CPPS and that GPs and specialists are educated about the symptoms so they can diagnose patients more speedily.
'It's a shame that it is so difficult to get diagnosed and treated for a condition that is so common,' he says.
'We are doing a disservice to these men by not providing that important part of their treatment.'
Relaxing and loosening the pelvic muscles regularly will teach the muscles how to move normally again and reduce muscle tension – and pain – according to Dr Johnny Boylan, a genitourinary consultant who runs the Chronic Pelvic Pain Syndrome clinic at Liverpool University Hospitals NHS Foundation Trust.
One pelvic exercise – known as 'down-training' – involves sitting in a chair and takes no longer than one minute.
It can be done at home, on public transport or at work.
Patients are told to uncross their knees and place their feet apart on the floor.
Then, let the jaw hang loose and teeth separate.
The belly is supposed to relax and the buttocks loosen.
Patients should then breathe deeply, gently expanding the stomach. This should be repeated five times in one sitting. Another option is to stand in front of a mirror without underwear and lift the testicles up towards the body by tightening the pelvic muscles. These are the muscles tightened or loosened to go to the toilet. When the pelvic floor is tightened, the anus should feel clenched.
Then, patients are told to relax again and let the testicles hang loose. Letting the belly hang loose will help the pelvic floor muscles relax too.
It is the loosening part of this exercise that is important. Regular practice makes it easier. So it is important patients do these exercises for several minutes every day. However, it is vital not to strain while tightening the pelvic muscles, as this can exacerbate pain.
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