HSV-2 Positivity and Primary Infertility Among Young Women in Mysore, India

Background: The WHO estimates 70 million couples worldwide suffer from infertility, with the highest prevalence in countries with elevated fertility rates. Sexually transmitted infections (STIs) are considered the major preventable cause of female infertility. Our study investigated the prevalence and correlates of primary infertility among young women in Mysore, India.

Methods: Sexually active women, aged 15-30 years, were recruited into a cohort study. Sociodemographic characteristics were collected and participants underwent a physical examination and laboratory testing for STIs. Primary infertility (PI) was defined as having been married for longer than two years, not using contraception, and without a child. Multivariate logistic regression was used to estimate adjusted Odds Ratios (aOR).

Results: Of the 897 participating women, 113 were identified as PI cases (12.6%, 95% Confidence Interval [95% CI], 10.5-15.0%). PI was highly associated with the presence of Herpes Simplex Virus-2 (HSV-2) antibodies (aOR:3.41; 95% CI:1.86, 6.26). Age (aOR:0.79; 95% CI:0.73, 0.85), number of unprotected sexual acts (aOR for every ten acts:1.71; 95% CI:1.23, 2.37), and having post-secondary education (aOR:3.01; 95% CI:0.98, 9.29) were also associated with PI.

Conclusions: The prevalence of infertility within this cohort was similar to estimates from other regions of India, and the data show a strong association between HSV-2 infection and PI. HSV-2 infection may cause tubal infertility in women by increasing inflammation in the genital tract, or by increasing susceptibility to other pathogens. Screening and treatment for HSV-2 should be a priority at reproductive health clinics, in order to curb STI transmission and prevent infertility.