While syphilis and HIV can pose serious and life-threatening effects if untreated, infertility is another major damage caused by untreated chlamydia and gonorrhea. Two of the most common STDs both in the US and Singapore, untreated chlamydia and gonorrhea can permanently damage a woman’s reproductive system. However, the good news is the fact that chlamydia and gonorrhea are two causes of preventable infertility, meaning that it is actually in our power to prevent these health conditions from progressing into pelvic inflammatory disease (PID) which affects the reproductive organs by causing scarrings, inflammation and blockage.
Chlamydia and infertility
Chlamydia is one of the most-known STDs caused by a bacterium called Chlamydia trachomatis. Every sexually active person can be exposed to chlamydia and another risk factor in the transmission of this STD is having multiple sexual partners.
As STDs are often asymptomatic, people with chlamydia can go on for years feeling fine without knowing that they have it. Young women under the age of 25 are especially prone to this STD. Therefore, annual STD screening is encouraged by the Centers for Disease Control and Prevention (CDC) for this age group. Untreated chlamydia can cause PID. According to the CDC, around 10-15% women develop PID from untreated chlamydia. PID occurs as the bacteria travels upwards from the vagina or cervix to the reproductive organs. Not only does PID lead to fever and lower abdominal pain, this serious complication can result in the development of scar tissues which eventually block the fallopian tubes. The blockage of the fallopian tubes is referred to as hydrosalpinx. The formation of scar tissues also makes it harder for the tube to ‘retrieve’ the eggs during ovulation. There is no clear timeline on how long it takes for chlamydia to cause infertility, but the National Health Service (NHS) approximated that 1 in 10 women with untreated chlamydia will develop PID within a year.
To prevent chlamydia from progressing into PID, the two things people can take is to get screened for STDs. If a person is diagnosed with chlamydia, immediate treatment such as taking antibiotics (doxycycline and azithromycin) and finishing them according to the prescribed amount. If consumed correctly, the success rate for curing chlamydia is up to 95%.
Gonorrhea and infertility
Neisseria gonorrhoeae is the bacterium responsible for gonorrhea. Tending to target warm and moist areas, gonorrhea usually attacks the rectum, throat or mouth. The cervix can also be affected in females. Similar to chlamydia, people with gonorrhea may not realize it. The telltale symptom is burning sensation when urinating. In men, other symptoms can include white, green or yellow discharge, swelling of the testicles, and foreskin inflammation. On the other hand, females might experience bleeding between periods and abnormal vaginal discharge.
Gonorrhea, if left untreated, can lead to pelvic inflammatory disease (PID). PID is the main cause of tubal factor infertility along with other health conditions such as endometriosis. As we know, fallopian tubes are crucial because of their very function of connecting the two ovaries to the uterus. These tubes act as the path for the released eggs to move towards the uterus. Not limited to that, sperm also travels through them and this is the place where fertilization takes place. Given this fact, any scarrings/blockage/damages of fallopian tubes will hinder sperm from swimming to the eggs for fertilization. Sometimes, fertilization can still take place, but these damages prevent embryos from getting to the uterus. This occurrence can lead to ectopic or tubal pregnancy, where the fertilized egg grows out of the main cavity of the uterus. A good 25 to 35% of female infertility is due to tubal factor, according to the American Society for Reproductive Medicine (ASRM).
Like most bacterial infections, gonorrhea cannot go away on its own. One way to minimize the chances of infertility is to get screened and treated. Unlike STDs such as herpes and HIV, gonorrhea can be completely cured. To prevent gonorrhea from worsening to PID, doctors usually prescribe antibiotics such as ceftriaxone and azithromycin. Due to the emergence of drug-resistant strains of gonorrhea, sometimes these antibiotics can be administered orally or intramuscularly through injections.
Diagnosing and mitigating infertility
According to the World Health Organization (WHO), infertility is defined as a disease of the male or female reproductive system indicated by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Many women are not aware that their fallopian tubes are damaged until a consultation with an infertility doctor. With the presence of PID, infertility is also accompanied by other problems such as chronic lower abdominal pain. Diagnosing infertility can be done through hysterosalpingogram and laparoscopy.
Hysterosalpingogram utilizes X-ray where a dye is passed through the cervix to the uterus. This dye can trace the fallopian tubes and this step can determine whether or not the tubes are open. However, even when the fallopian tubes are open, it does not guarantee that there is no damage or scarrings in the tubes. Scarrings or other damages of the tubes cannot be diagnosed with this method.
Laparoscopy is a small surgical procedure that includes minimal incisions and insertion of laparoscope (a small surgical instrument) to look into the fallopian tubes. This way, scar tissues can be detected.
Sometimes, it is possible to repair the fallopian tubes through surgery, but this ultimately depends on the extent of the damage. If the degree of the damage is severe and the tubes cannot be surgically repaired, in vitro fertilization (IVF) is a method couples can consider to achieve pregnancy.
Getting regularly tested for STDs is imperative for sexually-active people. Shim Clinic is a sexual health clinic based in Singapore providing STD testing, diagnosis and treatment. We also cater to STD prevention methods such as HIV PEP (best taken within 72 hours after a possible exposure), HIV PrEP and HPV vaccination (Gardasil-9).