The concerning link between STIs and infertility

Posted 19 February 2018 in Men's Health, Sexual Health, Womens health

A couple in a romantic sunsetInfertility 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, 12)

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. (12)

Avoid sharing sex toys, or wash and cover them with a fresh condom after each use. (12)

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

  1. NHS Choices. Infertility – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/infertility/

  2. NHS Choices. Chlamydia – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/

  3. NHS Choices. Chlamydia – Complications [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/complications/

  4. NHS Choices. Gonorrhoea – Overview [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/

  5. NHS Choices. Gonorrhoea – Complications [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/complications/

  6. NHS Choices. Sexually transmitted infections (STIs) [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/

  7. 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

  8. NHS Choices. Chlamydia – Treatment [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/chlamydia/treatment/

  9. British National Formulary (version 1.3.4) [Mobile application software]. Retrieved from: www.bnf.org

  10. NHS Choices. Gonorrhoea – Treatment [cited 2 February 2018]. Available at: https://www.nhs.uk/conditions/gonorrhoea/treatment/

  11. FPA. Condoms (male and female) [cited 2 February 2018]. Available at: https://www.fpa.org.uk/contraception-help/condoms-male-and-female

  12. Central Manchester Foundation Trust. Chlamydia [cited 2 February 2018]. Available at: http://www.cmft.nhs.uk/health-a-to-z?letter=C&path=articles/chlamydia/introduction

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