INCIDENCE OF SEXUALLY TRANSMITTED DISEASES AMONGST POTENTIAL DONORS IN UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY, NIGERIA

*O.K Ibadin (M.Sc), ** I.O Enabulele (Ph.D) * Research Programme/Invitro Fertilization Unit, University of Benin Teaching Hospital, Benin City, Nigeria. **Department Of Microbiology, University of Benin, Nigeria.

Correspondence: Ibadin O.K. Human Reproduction Research Programme/IVF Unit Dept. of Obstetric & University of Benin Teaching Hospital, Benin City, Nigeria. E-mail: [email protected]

ABSTRACT The incidence of Sexually Transmitted INTRODUCTION Diseases in Prospective Semen Donors Therapeutic donor insemination where investigated using Standard has become well-established option in Laboratory Procedures. 30 Prospective the treatment of un-correctable male- Semen Donors were screened for factor . The use of donor semen common STDs/STI at the Human has increased dramatically in recent Reproductive Research Programme years and thousands of infants are /Invitro Fertilization Centre of the conceived worldwide by artificial University of Benin Teaching Hospital. insemination with the use of donor The incidence rates are Staphylococcus semen. Despite its wide acceptance aureus (20%), followed by Chlamydia among physicians and infertile couples, trachomatis (6.7%) while Klebsiellia spp, recent reports of contaminated semen Treponema pallidum, Human continue to cause considerable Immunodeficiency Virus (HIV), concern2,3. Many individuals presenting Escherichia coli and Hepatitis B Virus as potential semen donors, who are were detected with incidence rate of infected with several pathogens may 3.3% each respectively. Ten percent lack symptoms and signs of infection, or (10%) of the prospective semen donors may not have clinically detectable had evidence of polymicrobial infection evidence of infection, thereby placing excluding HIV. The risk of sexually the recipient at significant risk. Efforts to transmitted diseases or infection should reduce the risk of transmitting infection be of great concern to couples during with donor undergoing therapeutic artificial donor semen include adoption of the insemination. guidelines recommended by the Keywords: STDs/STI, Artificial American Society. These Insemination, Semen Donors) guidelines recommend rigorous

screening of Potential semen donors for The main focus of this study, and sexually transmitted disease (STDs) and focus is to ascertain the incidence of that the be frozen and Common Sexually Transmitted quarantined for a period of six to twelve Pathogens in male subjects Presenting months while the donor undergoes to our Clinic as Prospective Semen repeated testing for development of Donors using current screening antibodies to the human guidelines. immunodeficiency virus (HIV)4. Despite the comprehensive MATERIALS AND METHODS guidelines of several professional and 32 prospective semen donors, governmental agencies screening ranging in age from 30 to 40years were therapeutic insemination donors for recruited of the Human Reproduction sexually transmitted disease, available Research Programme/Invitro data suggest that the standard of Fertilization Centre of the Hospital from practice is highly variable7. Several January 2007 to August 2008. Semen, programmes appear to take inadequate urine, Urethral discharge and blood measures to prevent STD transmission were collected from each of the donor. by limiting screening to entry only All of the samples were rapidly without frequent retesting, while some transferred to Microbiology Lab of the continue to use fresh sperm and content Hospital and Standard Microbiology that the recommended screening Techniques was performed to detect the procedures are cumbersome and microbial agents (on Blood agar, expensive. The long-term sequela of MacConkey and Chocolate agar for infecting a healthy semen recipient with Bacteriogical culture incubated at STDs clearly justifies rigorous 370Celcius for 24-48hours. After screening, although this practice may Incubation Period, Specific diagnostic reduce the pool of suitable donors. tests according to microbiology These guidelines are not being references were performed to universally applied. Not only do some reorganize the known colonies8,10. In donor insemination programmes addition, Standard Serological Methods especially in developing countries, were applied for the detection of continue to use fresh semen5,6. Others Treponema palladum, Chlamydia use semen cultures as an alternative to trachomatis and Human urethral cultures inspite of the paucity of Immunodeficiency Virus in blood data on the reliability of semen cultures samples. Semen parameter was as a screening too7. performed according to World Health 14 Previous studies have reported Organization Guidelines . the Incidence of Sexually Transmitted Diseases among Potential Semen RESULTS Donors. From June 1986 through Demographic characteristic of the August 1987 in Houston Texas, for 48 Prospective Semen Donors, showed a healthy male volunteers presented as predominantly single male in potential semen donors. 10% of the heterosexual relationship and 30% gave donor had evidence of sexually a history of at least one previous 1,3,9 episode of Sexually Transmitted transmitted disease . Diseases (STDs). A total of 15(50%)

microbial agents were isolated from the Esacherichia coli and Hepalitis B Virus 30 Prospective Donors screened within had 3.3% incidence rate. 3(10%) had the period under study. Staphylococcus evidence of Polymicrobial Infection aureus had 6(20%) followed by excluding Human Immunodeficiency Chlamydia trachomatis 2(6.%), while Virus. Positive findings in this study Klebsielia spp, Treponema pallidum were predicted by history of more than Human Immunodeficiency Virus, one partner.

TABLE I: AGE CLASSIFICATION OF SEMEN DONORS WITH SEXUALLY TRANSMITTED DISEASES

Age (Yrs) Numb. Exam. Numb. Positive % Positive

20 - 24 10 4 40

25 – 29 14 10 71

30 – 34 3 1 33

35 – 39 2 0 0

> 40 1 0 0

Total 30 15 50

TABLE II: NUMBER OF MICROBIAL PATHOGEN PER SPECIMEN FROM PROSPECTIVE SEMEN DONORS IN UBTH

Microbial pathogen Processed specimen

Urethral discharge Urine Semen Blood Total

Staphylococcus aureus 5(16%) (0%) 3(10%) - 6(20%)

Klebsiellia Spp. 0(0%) (0%)) 1(3.3% - 1(3.3%)

Escherichia coli 0(0%) 1(3.3%) 0(0%) 1(3.3%)

Chlamydia trachomatis - - - 2(6.7%) 2(6.7%)

Treponema pallidum - - - 1(3.3%) 1(3.3%)

Human Immunodeficiency Virus - - - 1(3.3%) 1(3.3%)

Hepatitis B Virus - - - 1(3.3%) 1(3.3%)

Total 5(16.7%) 1(3.3%) 4(13.3%) 5(16.7%) 5(50%)

DISCUSSION whom are young, single, and are not Artificial insemination with donor always in monogamous relationships, semen has become a well established represent a high-risk population for STD alternative for couples with untreatable transmission. This predominantly- male factor infertility. Because of the student population requires rigorous widespread use of donor insemination, screening and frequent retesting for the and the increasing awareness and acquisition of new pathogens. prevalence of sexually transmitted Establishing a rapport and good diseases, It has become imperative to communication with this group of highly subject prospective semen donors for fertile donors, with emphasis on the sexually transmitted screening. importance of responsible, safe sexually behaviours is suggested. The incidence The incidence rate of sexually of Sexually Transmissible Infections in transmitted disease from this study was Prospective Semen Donors has been 50% which underscore the concern reported in some centres controversy often expressed by women undergoing remains concerning the extent of artificial inseminations with donor sperm screening that is appropriate for semen regarding the risk of being infected with donors. The major question is whether sexually transmitted pathogen. or not the benefit of reducing the risk of Chlamydia trachomatis ranked transmitting STDs compensates for the second in the incidence of STDs in this cost of vigorous screening. As screening study. Its manifestations are well methods continue to improve, and more acknowledged in women whom it is data accumulate on the outcome of responsible for majority of cases of frequent testing, it appears that such a 7 salpingitis . Prospective semen donors meticulous approach to screening is with seroevidence of HIV were rejected. appropriate. With such close In one of the study carried out by Mark surveillance and management, the 12 et al , the infection rate in 44 enlisted transmission of pathogens to semen semen donors in some fertility centres in recipients may hopefully be reduced to Canada is 13.6% as against 50% from the minimum. the 30 Semen Donors enlisted in this study. It should be noted that 3(10%) REFERENCES out of the total number enlisted in this 1. Stewart GJ, Tyler JPP, study had positive evidence of Cunningham AL et al. Polymicrobial infections particularly from Transmission of human T-Cell Urethral and Semen Samples from this Lymphotropic virus. Type III (HTL individuals. It was also observed that VIII) by artificial insemination by prospective donors in the age group of donor. Lancet 1981; 2:581-584. 25-29 had the highest incidence of STD of 10 (71%), which also underscore the 2. Monteiro EF, Spencer RC, need to educate and enlighten our Kinghorn GR et al, Sexually youths on the danger of acquiring these transmitted disease in potential pathogen. semen donors. Br. Med J. 1987; Consistent with previous studies 295:418. this finding strengthens the fact that Prospective Semen Donors, most of

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