Sterility in women is a major problem encountered in reproductive medicine these days. STDs are one of the most important causes of female infertility. The common diseases that cause sterility in women are gonorrheal and chlamydia infections.
What is sterility?
Sterility is defined as the inability to get pregnant after 1 year or more of having sexual intercourse without protection. It is a major public health concern. Approximately 1/3rd of sterility cases are due to fertility issues in women, 1/3rd is due to fertility issues in men and 1/3rd is due to the factors relating to both of the partners.
A significant number of female sterility cases are caused by untreated sexually transmitted diseases (STDs) which are most commonly caused by causative agents such as Neisseria Gonorrhoeae and chlamydia trachomatis. Roughly, about 2.86 million cases of chlamydia and 820,000 cases of gonorrhea occur every year in the US.
The infection of these organisms can move up along the reproductive tract and cause inflammation, scarring, and damage to the fallopian tubes, which are essential to getting pregnant. Such movement of bacteria along the mucus membrane of the cervix to the endometrium and finally to the tubes is clinically known as Pelvic Inflammatory Disease (PID) and this type of infertility is known as Tubal Factor Infertility (TFI) which is the most common form of female infertility.
Some studies also suggest that apart from the aforementioned organisms, Trichomonas Vaginalis and Mycoplasma Genitalium may also damage the tubes and contribute to female infertility but the evidence is not substantial, and further research on these is needed to find their correlation with female infertility.
Chlamydia Trachomatis is the most common cause of female infertility in the US but it is usually missed and untreated because most patients of Chlamydia infections don’t have symptoms. Chlamydia infection accounts for approximately 50% of acute cases of PID in the developed world.
Those patients who had Chlamydia infection before are more likely to have subsequent sterility as well as unsuccessful IVF than those who didn’t have it. Hence, it is very important to notice and treat Chlamydia infections on time. Patients can be screened for Chlamydia by testing for Chlamydia antibodies.
The common symptoms of Chlamydia infection when they do occur (usually several weeks after having sex) include abnormal foul-smelling vaginal discharge, pain and burning sensation during urination, pain while having sexual intercourse, lower abdominal pain, nausea, and fever.
Although less prevalent than Chlamydia, it is still the second most common infectious agent that affects tubal patency in women. It first causes plasma cell endometritis and travels up along the reproductive tract and damages the epithelial cells of the fallopian tubes by attacking the mucosal cells. This irrevocable damage affects the ability of the fallopian tubes to transfer the eggs for fertilization in the tubes and subsequent implantation in the uterus.
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Thus, Neiserria Gonorrhea infection increases the risk of TFI and ectopic pregnancy (egg implantation in places other than the uterus). Like Chlamydia, most patients suffering from N. gonorrhea are also asymptomatic making it extremely difficult to notice and treat this disease on time.
The common symptoms of N. Gonorrhea include greenish-yellow or whitish discharge from the genitals, bleeding between periods, small drops of blood (spotting) during sex, irregular and painful menses, pain while urinating, swollen glands in the neck, conjunctivitis, abdominal pain, and fever.
Mode of transmission
Women can get STDs by engaging in oral, vaginal, or anal sex without protection. Women can also pass these infections while giving birth to a baby. Chances of reinfection are also there if women have unprotected sexual intercourse.
Young women of reproductive age are highly susceptible to STDs that can cause sterility.
The diagnosis of STDs can be done by blood tests and vaginal swab tests. All sexual partners need to be tested.
Significance of testing on time
As mentioned above, most cases of Chlamydia and N. Gonorrhea infections go unnoticed and may cause irreparable damage to the reproductive tracts, especially the fallopian tubes. Women who have Chlamydia also have a greater risk of catching HIV. Therefore, it is of utmost importance for women who want to conceive to get screened for these bacteria on time.
Both of the aforementioned infections can be treated easily with antibiotics if caught on time and damage to the tubes can be prevented. In the modern era, where the non-barrier methods of contraception are gaining popularity, the importance of screening has increased even more.
Moreover, the aforementioned infections can lead to complications like the infection of other reproductive organs such as the ovaries, infection of the peritoneum, and adnexal destruction decreasing the chance of future pregnancy. Hence, the best method to reduce the occurrence of infertility is to detect the infections in asymptomatic individuals and treat them and their partners on time.
The current recommendation is that all sexually active females 25 and younger should be screened yearly for chlamydia. Women older than 25 with multiple sex partners or a new sex partner should also be screened every year. Pregnant women should be screened, as well.
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Most patients with the aforementioned infections can be treated in the outpatient department and there is no need for hospitalization except in special circumstances. Sex especially unprotected is prohibited during the treatment period. The treatment should be started earlier in the disease course in order to get better results which also shows the importance of getting tested.
It is important to take the whole course of prescribed antibiotics even if you are feeling better in order to reduce the chance of recurrence.
Chlamydia infections are usually treated with oral or pessary antibiotics such as azithromycin and doxycycline. Gonorrhea is treated with ceftriaxone or oral azithromycin. The partners also need to be treated concomitantly. Most patients feel relief within days of treatment.
NB: Antibiotics can treat PID caused by STDs but they can’t repair the permanent damage caused by scarring. Hence, it is very crucial to get tested on time.
Treatment of TFI
TFI is harder to treat than early infections with the above agents. It is usually treated with surgical intervention and IVF if surgery fails.
Prevention of sterility
In conclusion, the most important factor to prevent sterility in females is to practice safe sex using a barrier method such as condoms in order to remain safe from STDs, maintain monogamy, get tested on time if one has had unprotected sex, and get treated on time along with their sexual partner.
Tsevat DG, Wiesenfeld HC, Parks C, Peipert JF. Sexually transmitted diseases and infertility. Am J Obstet Gynecol. 2017;216(1):1-9. doi:10.1016/j.ajog.2016.08.008 https://pubmed.ncbi.nlm.nih.gov/28007229/