Infertility affects around 3.5 million UK people, but did
you know that as many as one in four cases of infertility are caused by
sexually transmitted infections (STIs)? The longer STIs are left untreated, the
greater the risk of infertility, which is why it’s crucial to diagnose and
treat STIs promptly to maintain the health and wellbeing of individuals and
couples wishing to conceive. (1)
Which STIs can cause
infertility?
Chlamydia and gonorrhoea are the two most common STIs in the
UK, and also happen to be potential causes of infertility if left untreated.
Chlamydia
Chlamydia is the most common STI in the UK, with approximately
70% of cases being under 25 years of age. It is caused by a type of bacteria
called Chlamydia trachomatis. Worryingly,
it usually doesn’t cause any symptoms, meaning that people don’t know they’re
infected unless they have a test. For under 25s it is recommended to have a
test for chlamydia yearly or upon getting a new sexual partner. (2)
If a person with chlamydia does experience symptoms, they
may include painful urination, unexpected or discoloured discharge from the
vagina, penis or back passage, abdominal pain or unusual vaginal bleeding
(after sex or when not on your period) in women, and painful inflamed testicles
in men. (2)
If you catch chlamydia and it is left untreated, it could
eventually cause infertility. In women, this is because the infection can lead
to pelvic inflammatory disease (PID), a condition in which the higher portion
of the reproductive system becomes inflamed, including the ovaries, fallopian
tubes and uterus. PID can cause scarring of these areas, which can make it hard
or sometimes impossible for an egg to be released and to reach the uterus. In
men, a condition called epididymo-orchitis can develop, which is inflammation
of the testicles and sperm ducts. If left untreated, it can damage these areas
to the extent of causing infertility. (3)
Gonorrhoea
Gonorrhoea is another very common STI in the UK caused by
the bacterium Neisseria gonorrhoeae.
Symptoms are usually a thick, yellow or green, unpleasant-smelling discharge
from the vagina or penis, painful urination and unusual vaginal bleeding. But,
as with chlamydia, some people don’t get symptoms – this is the case for approximately
10% of men and 50% of women infected. (4)
Untreated gonorrhoea may also lead to PID in women, which in
turn may lead to infertility. The infection may spread to the testicles and
prostate gland in men, occasionally causing a drop in fertility or even
infertility. (5)
If you think you may be at risk of having chlamydia or
gonorrhoea, you have had any of the above symptoms, or you have had a recent
change of sexual partner, you can arrange a test at your GP surgery, a
genitourinary medicine (GUM) clinic or a sexual health clinic. Certain
pharmacies, contraception clinics and young people’s services may also offer
testing. (6, 7)
You can also order testing kits and treatments for a range
of STIs including chlamydia and gonorrhoea from Webmed Pharmacy here.
What happens if I
test positive for chlamydia or gonorrhoea?
If you have chlamydia, you’ll receive antibiotic treatment.
The antibiotics usually used are azithromycin,
taken as a single dose, or doxycycline,
taken for a week. Other antibiotics can be used if you are allergic to the
usual choices, pregnant or breastfeeding. Don’t have sex until you’ve finished
the course, or for a week after taking the azithromycin single dose, as the
infection may not have fully cleared up within this time. If you take the
antibiotics as directed and follow the aforementioned advice, you probably
won’t need to have another test to confirm whether the treatment has worked,
unless your symptoms persist. (8)
For gonorrhoea, the usual choice of antibiotic treatment is
a single dose of azithromycin alongside a ceftriaxone
injection. You’ll most likely have a repeat test a couple of weeks later to
make sure the infection has cleared – avoid sex until you’ve had a negative
result from this test. (9, 10)
If you’ve tested positive for chlamydia or gonorrhoea, then
any sexual partners you’ve had within the last 6 months will need to be tested
and potentially treated too. If you don’t want to or can’t contact them
yourself, you can seek the help of a GUM or sexual health clinic who may be
able to find their details and send them a letter advising them to be tested.
The letter won’t contain your name. (8, 10)
How can I protect
myself from STIs?
Condoms are widely available and highly effective at
protecting against STIs. Free male or female condoms are available from
contraception clinics, young people’s services and sexual health clinics.
Certain GUM clinics and GP surgeries may also supply free condoms. They can be
used for vaginal or anal sex, or to cover the penis during oral sex. (11)
Dams are square-shaped barriers made from latex or
polyurethane (also used to make condoms). They can be used during oral sex to
cover the vagina or anus, or to cover the vulva during skin-to-skin contact
with a partner’s vulva.
Avoid sharing sex toys, or wash and cover them with a fresh
condom after each use.
Forms of contraception such as the oral contraceptive pill,
copper intrauterine devices (IUDs) and spermicides are designed to protect
against pregnancy only and will not
offer protection from STIs.
References
NHS Choices. Infertility – Overview [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/infertility/
NHS Choices. Chlamydia – Overview [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/
NHS Choices. Chlamydia – Complications [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/complications/
NHS Choices. Gonorrhoea – Overview [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/
NHS Choices. Gonorrhoea – Complications [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/complications/
NHS Choices. Sexually transmitted infections
(STIs) [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/
FPA. Sexually transmitted infections (STIs) help
[cited 2 February 2018]. Available at: https://www.fpa.org.uk/help-and-advice/sexually-transmitted-infections-stis-help
NHS Choices. Chlamydia – Treatment [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/treatment/
British National Formulary (version 1.3.4)
[Mobile application software]. Retrieved from: www.bnf.org
NHS Choices. Gonorrhoea – Treatment [cited 2
February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/treatment/
FPA. Condoms (male and female) [cited 2 February
2018]. Available at: https://www.fpa.org.uk/contraception-help/condoms-male-and-female
Author: Gabby Gallagher MPharm
Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/02/18