Untreated chlamydia or gonorrhoea infections can lead to infertility

Medical Director

Dr Mireia Galian

IVI London

According to a report published last June by the UK Health Security Agency (UKHSA), in 2022, the highest number of diagnosed cases of gonorrhoea was recorded since records began in 1918, with a total of 82,592 new cases. The report also notes that chlamydia is the most commonly registered sexually transmitted infection, with nearly 200,000 cases in 2022 alone. In addition to the known health implications of contracting an STI, these infections can also complicate or prevent conception due to Pelvic Inflammatory Disease (PID).

What is Pelvic Inflammatory Disease (PID)?

Pelvic Inflammatory Disease is one of the consequences of an infection by Neisseria gonorrhoeae and Chlamydia. These sexually transmitted bacteria spread from the vagina to the uterus, fallopian tubes, or ovaries. The consequences include inflammation, scarring, or even blockage of the fallopian tubes, which hinders fertilization or the proper passage of the embryo, potentially leading to an ectopic pregnancy. In acute forms, PID can result in an abscess in the tube and the ovary (tubo-ovarian abscess) or become established in the endometrium (chronic endometritis).

How do STIs affect female fertility?

An obstruction in the fallopian tubes due to an infection prevents the transport of eggs from the ovaries, making it impossible for sperm to find an egg to fertilize and generate an embryo. In some cases, the fallopian tubes may be partially blocked, and even if fertilization occurs, the embryo may not be able to implant in the uterus due to the STI. In this regard, chronic endometrial infection often does not present symptoms, making it difficult to suspect its existence. Only on occasion does it lead to scarring of the uterus, resulting in Asherman’s syndrome, which prevents embryo implantation and placenta formation during pregnancy.

Symptoms and treatment of STIs

There may be occasions when a patient suffers from both chlamydia and gonorrhoea infections simultaneously. However, these infections can be asymptomatic or manifest with very mild symptoms that make detection challenging. Regarding treatment, chlamydia usually responds well to antibiotic medications, while gonorrhoea is more resistant to antibacterials. In any case, early detection is crucial to prevent future problems.

Symptoms such as lower abdominal pain, abnormal vaginal discharge, pain during sexual intercourse, bleeding between periods, or a burning sensation when urinating should be consulted with a specialist who can treat a possible PID as soon as possible. However, in other cases, this condition may not be accompanied by symptoms, especially in its chronic forms, and the diagnosis may arise from difficulties in achieving conception. This is common in the case of hydrosalpinx, the dilation of the fallopian tube with thinning and irregularity of the wall, along with fluid accumulation. All of this leads to tubal infertility.

How does Human Papillomavirus (HPV) affect fertility?

HPV can affect fertility indirectly, particularly in women. It may lead to cervical dysplasia or precancerous changes, which alter the cervix’s structure and disrupt cervical mucus production, hindering sperm transport. Severe cases often require treatments like cervical conization or LEEP, potentially causing scarring that further obstructs sperm passage and can increase the risk of a late miscarriage or pre-term birth. In extreme situations where cervical cancer develops due to long-term HPV infection, a hysterectomy may be necessary, resulting in permanent infertility.     

Do STIs also affect male fertility?

Despite the greater impact on women, STIs can also cause infertility in men. As a result of gonorrhoea or chlamydia infection, the epididymis, which are the ducts located at the back of the testicles that store and mature sperm for fertilization, can become blocked. In the case of HPV, this infection can hinder the free movement of sperm, negatively impacting the chances of pregnancy.

A blocked epididymis would hinder the proper maturation of sperm, preventing them from acquiring the necessary mobility to reach the egg and achieve natural fertilization. Another gland frequently affected by STIs is the prostate, which provides nutrients to sperm as they pass through the seminal pathways. Its inflammation, often becoming chronic, hampers the proper function of sperm. However, if we start with the premise of transmitting the STI to a female partner, the chances of encountering many more difficulties in conceiving are greatly increased.