OBGYN Dr. Mare discusses sexually transmitted infections (STIs), how they can affect your fertility, and how to prevent them.

 

By Dr. Mare Mbaye

Sexually transmitted infections (STIs) are very common in the US, affecting over two million people every year. The CDC estimates that these infections cause infertility in at least 24,000 women each year. With cases on the rise, it’s more important than ever to know how STIs can affect you and how to prevent them. This is especially true given that many STIs are easily spread because they don’t cause symptoms. 

STIs include HPV (human papillomavirus), chlamydia, gonorrhea, syphilis, certain hepatitises, as well as a few lesser known and uncommon infections. While HPV is very common, it is not a significant or direct cause of infertility so I won’t focus on it here. Yeast infections and bacterial vaginosis are not considered to be STIs. 

STIs, pelvic inflammatory disease, and infertility

In most cases, STIs are linked to infertility primarily when they are left untreated. These infections can travel up the reproductive tract and lead to pelvic inflammatory disease (PID) in women and epididymitis in men—both of which are causes of infertility. The main culprits here? Chlamydia, gonorrhea, and syphilis. We’ll talk more about these guys, but first, why is PID such a problem? 

STIs are linked to infertility primarily when they are left untreated.

In women, PID is the result of inflammation of the fallopian tubes (salpingitis) which leads to damage, scarring, and eventually tubal factor infertility (infertility due to a problem with the fallopian tubes). Epididymitis is a result of the same thing, but within the tubes that contain and transport sperm. 

Approximately 15% of women with PID end up developing tubal factor infertility, regardless of what initially caused the PID. Additionally, the number of episodes of PID a woman has is directly proportional to her risk of infertility. Infertility from STIs is much more common in women than men—in the largest study to date on this subject, less than 1% of men with infertility had a history of chlamydia or gonorrhea. 

PID also increases the risk for an ectopic pregnancy. An ectopic pregnancy is a pregnancy that implants outside the uterus. These pregnancies are not viable and can pose a severe, life-threatening risk to women if not treated promptly. The risk is highest for women with a history of a prior ectopic or PID. Lastly, it can be the cause of long term pelvic and/or abdominal pain.

Given all these complications, it’s no wonder PID and the STIs that cause them are something we take very seriously in treating promptly. 

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Chlamydia, gonorrhea, and infertility

Chlamydia is by far the leading STI in America and therefore the leading cause of PID. If left untreated, about 10-15% of women with chlamydia will develop PID. The same is true with gonorrhea, which is less common.  

Chlamydia and gonorrhea rarely cause symptoms. When they do, it is typically postcoital spotting, a change in vaginal discharge, or pelvic or abdominal pain. As a result, the majority of women with tubal factor infertility don’t actually have a history of clinically-diagnosed PID in the past. Instead, they develop asymptomatic or minimally-symptomatic salpingitis as a result of one of these “silent” upper genital tract infections. 

Syphilis and infertility

Syphilis has now become another important contributor to infertility as cases have resurged in the last several years. Untreated syphilis can cause infertility in anyone who has had it. There are multiple predictable stages to the disease and the later stages cause damage to multiple organs and nerves and affect all systems of the body, including the reproductive system. Due to lack of awareness, those who contract it often don’t realize what it is and therefore don’t get treated as promptly as they should. The CDC provides excellent information on the phases of syphilis and how they progress.

And if you need any more reasons to protect yourself, all three of these infections can increase your risk of contracting HIV.

So, what can you do to protect yourself and prevent any long-term issues?

  • First and foremost, practice safe sex with all new partners. ALWAYS use a condom. It is the only contraception that also protects against STIs. 
  • If you or your partner don’t use condoms, then be thorough in making sure you are both STI-free. 
  • Get checked! The CDC, ACOG, and USPSTF all recommend annual STI screening for all sexually active women under 25 because 15-24 year olds account for more than half of new STIs. This is also recommended for older women with risk factors such as new or multiple sex partners, or a sex partner who has an STI.
  • If you are diagnosed with an STI, get prompt treatment, and make sure to follow up for a test of cure (a repeat test to confirm that the infection is gone).

Tubal-factor infertility from an STI

What happens if you do have tubal-factor infertility? Part of the infertility workup includes a procedure called a hysterosalpingogram (HSG) where an x-ray is used to confirm that fluid inserted into the uterus through the vagina and cervix makes it out of both tubal ends. If this test shows that one or both tubes are blocked, your REI will discuss with you whether or not the tube(s) need to come out. If both tubes are blocked, typically the only option is in vitro fertilization (IVF) if the pregnancy is to be carried by the partner with the blockage. 

If you’re concerned about a history of STIs or PID, talk to your doctor about your situation and review your options.