Apart from the negative health effects and the social stigma attached to STDs, your fertility may also be taking the brunt of such diseases. The figures quoted by the American Social Health Association are eye-opening. As many as 15% of infertile women can attribute tubal damage caused by pelvic inflammatory disease as a direct cause of an STD.
Whilst not applicable to all STDs, some do affect fertility in both men and women. In a recent conversation with Dr. Kecia Gaither, a woman’s health expert and perinatal consultant, Dreaming of Baby discussed Chlamydia and Gonorrhea and their effects on fertility.
What are Sexually Transmitted Diseases (STDs)?
Dr. KEciA GAITHER: ‘Sexually Transmitted Diseases are a group of diseases that affect the reproductive tract, transmitted via sexual contact. STDs, particularly chlamydia and gonorrhea, can affect tubal function. They can lead to tubal scarring, thus preventing normal fertility. They are a significant issue in terms of general public health and medical expenditures for addressing/correcting it’
Chlamydia and Gonorrhea, in particular, place quite the brunt on fertility. As one of the main causes of infertility worldwide, chlamydia is frequently asymptomatic, meaning that people are often unaware that they’ve been infected. Since it often goes undetected, it can easily spread, affecting fertility in both men and women. Likewise, untreated gonorrhea can also lead to infertility. Bacteria can spread to the reproductive organs, leading to pelvic inflammatory disease (PID). Dr. Gaither explains further:
Dr. Kecia Gaither: ‘Chlamydia and Gonorrhea are the two primary entities that directly damage the Fallopian tubes, resulting in infertility. The diseases cause tubal damage by setting up an inflammatory response within the genital tract system. This response leads to scar formation which effectively blocks the patency of the Fallopian tubes, blunts the fine hairs, or cilia on the ends of the tube. When an egg is released by the ovary, the little feather-like ends of the Fallopian tube “sway” to guide the egg into the tube. A two-fold effect occurs: the feather like ends are blunted, so they can’t effectively guide the egg accordingly, and then the tube itself is blocked due to the scarring from the inflammatory response. The symptoms of Chlamydia and Gonorrhea include thick yellowish discharge and vague lower abdominal pain. Sometimes there may be no symptoms.’
Dr. Kecia Gaither: ‘There are times when a woman can develop “PID” or pelvic inflammatory disease. This is an infection that is caused by the presence of multiple bacterial species or a polymicrobial infection. This can cause abscesses to develop on the ovaries, fever is seen. This infection requires hospitalization and IV antibiotic therapy. The sequelae of PID additionally results in tubal damage and infertility.’
Diagnosing Chlamydia and Gonorrhea
Testing is a must in order to find out if you have been infected with chlamydia or gonorrhea. Testing becomes even more imperative if you think you have symptoms of either disease, if you’ve had unprotected sex or a condom broke, if a sexual partner tells you they have an infection, or if you’re pregnant or planning to conceive. Dr. Kecia Gaither provides us with an overview of testing and the diagnosis process:
Dr. Kecia Gaither: ‘The US Preventative Services Task Force and ACOG recommends annual screening for chlamydia in all sexually active women 24 and younger, and older women with risk factors (such as multiple sexual partners).
Dr. Kecia Gaither: ‘[Testing involves] a visit to your physician, where a pelvic exam by speculum will occur. The health provider will then swab the cervix with a culturette specific to identifying the disease. Likely, the cervix may be” friable”, meaning that when touched by the culturette, it will bleed easily. It also may be very reddish in appearance. After the speculum is removed, the health provider will do a digital exam, feeling the uterus, and adnexa (the area of the tubes and ovaries). What is generally found is that when the cervix is manipulated, it will elicit pain known as “cervical motion tenderness”. Additionally, there may be pain observed when the adnexa are touched.
Dr. Kecia Gaither: ‘You can be re-infected, which is why it’s important for partners to be tested and treated. Otherwise, you will have a perpetual cycle of re-infection after treatment. During pregnancy, the woman is screened at the beginning of her prenatal care, and again in the third trimester, close to her due date.’
With the right treatment, curing Gonorrhea is possible. In order to prevent any long-term effects, treating Gonorrhea early on and before the development of any complications, is a must. Dr. Gaither explains the treatment process following diagnosis:
Dr. Kecia Gaither: ‘A discussion is had concerning the nature of the disease, that it’s sexually transmitted. The patient is treated with antibiotics, both an antibiotic injection, and oral antibiotics are prescribed. The patient is advised that her partner needs to be tested/treated accordingly. It is advised that the patient comes back to the office for re-testing or a “test of cure” to ensure that the infection is gone. It is advised that if sexual contact occurs during this interval between diagnosis and cure, condoms be utilized.’
Gonorrhea and Trying for Baby
If the infection progresses to PID, chances of infertility or an ectopic pregnancy increase. We’ve asked Dr. Gaither if the effects of PID can be reversed:
Dr. Kecia Gaither: ‘If diagnostic testing confirms tubal blockage, depending on the extent severity, the patient may be offered surgical options such as tuboplasty, or if damage to the tubes is extensive perhaps assisted reproductive technologies may be an option. [These options include] IVF, and surrogacy, if uterine issues are present additionally.’
Gonorrhea during pregnancy places you at greater risk of miscarriage, infections, and premature delivery. In this regard, we also asked Dr. Gaither how long one should wait before trying to conceive after being diagnosed with Gonorrhea:
Dr. Kecia Gaither: ‘Once diagnosed and treated, typically the “TOC” or test of cure occurs within a few weeks. One should wait until both partners have tested negative before attempting conception.’
Dr Kecia Gaither: ‘Keep those annual screenings. Any unusual symptoms of pelvic pain or abnormal discharge, see your health provider. If diagnosed, ensure your partner is tested and treated accordingly, with follow up for test of cure. Finally, in pregnancy, make sure you keep your appointments for your screenings for STD’s.’