Being diagnosed with a sexually transmitted disease (STD) can be upsetting. Some take it as evidence that they’ve been cheated on; others wonder if they can ever have sex again. Some people who have long dreamed of having children might worry about what impact, if any, their STD could have on future fertility. The bad news is that certain STDs can make it difficult or impossible to have children. But the good news is that STDs are avoidable — and regular STD screening can ensure that infections are caught and treated before they have time to do damage.
It’s common for STDs not to have symptoms, and infections can cause tissue damage — unbeknownst to you!
Fertility can be impacted in several ways. The ability to become pregnant and bear children can be affected by a condition called pelvic inflammatory disease, which is usually caused by untreated gonorrhea or chlamydia infections. If you have a cervix, an infection with a high-risk strain of HPV can require invasive treatment, which in some cases might affect the ability to carry a pregnancy. If you have a penis, an untreated STD might lead to epididymitis, which in extreme cases can cause infertility.
Pelvic Inflammatory Disease (PID)
Many sexually transmitted infections are localized; for example, the bacteria that cause gonorrhea usually just hang out on the cervix. But untreated infections can spread on their own, and bacteria can also hitch a ride on sperm or the upward flow of a douche, which can take them into the cervix, through the uterus, down the fallopian tubes, and to the ovaries. At any of these locations, microbes can stake claim on your reproductive real estate, establishing colonies deep in your reproductive system. As these colonies grow, the bacterial infections become more widespread, and can cause scarring and other tissue damage. To keep these interlopers from getting through the front door, sexually active people can use barrier methods, such as latex condoms — especially with spermicides. There’s no need to host an open house for sexually transmitted bacteria in your uterus.
One result of a widespread STD, like chlamydia or gonorrhea, is pelvic inflammatory disease (PID), which can cause tissue damage to the uterus, cervix, fallopian tubes, ovaries, and other reproductive organs. About 10 percent of adults with this collection of reproductive organs suffer from PID at some point, and complications include infertility, ectopic pregnancy, and chronic pain. According to the Centers for Disease Control and Prevention, of the 750,000 annual cases of acute PID in the United States, up to 15 percent of these sufferers will become infertile as a result.
Cilia in fallopian tubes help transport eggs, but can be damaged by a gonorrhea infection. Image: Human Reproduction Update
The formation of scar tissue in the fallopian tubes can block the path that your eggs would otherwise be able to follow from your ovary to your uterus. A gonorrhea infection can also damage cilia, which are hairlike projections that help transport an egg down the fallopian tubes. Given such obstacles, it’s no surprise that PID increases risk for infertility or ectopic pregnancies. One large Swedish study found that the more often someone had PID, the greater their chances of infertility: One episode of acute PID led to an 8 percent infertility rate; two episodes led to a 19.5 percent infertility rate; three episodes led to a 40 percent infertility rate.
About 10 to 15 percent of the time, untreated chlamydia in females will progress to PID, possibly causing permanent damage to the fallopian tubes and uterus. If a gonorrhea infection progresses into PID, it can wreak similar havoc — in fact, before antibiotics, gonorrhea was incurable, and most ladies with gonorrhea saw their fertility affected as a result. Unfortunately, it’s very common not to experience symptoms of chlamydia or gonorrhea, so without regular STD screening, an infection can silently work its way up your reproductive tract, causing tissue damage that might not be reversible.
Cervical Cancer
The sexually transmitted virus human papillomavirus (HPV) can cause cervical cancer, but regular Pap testing usually catches it early enough to be treated before it can do significant harm. An abnormal Pap test might lead to colposcopy, with or without biopsy, which is more invasive than a Pap test but shouldn’t affect your ability to have children.
If your colposcopy results are abnormal, your health care provider might suggest followup procedures, including cryotherapy, loop electrosurgical excision procedure (LEEP), or a cone biopsy. Cryotherapy shouldn’t affect your fertility either, unless there is a very rare complication. LEEP might have some risks for future fertility, including increased chances of preterm birth. A cone biopsy can be performed either by LEEP or by treatment with a laser, and it comes with a few risks, including the possibility that your cervix will be unable to remain closed during pregnancy (incompetent cervix). It could also increase risk for miscarriage or preterm birth. Rarely, a cone biopsy can lead to infertility by causing narrowing of the cervix (cervical stenosis). In very rare cases, cervical cancer is treated by hysterectomy — the total removal of the uterus.
Luckily, there is now a vaccine (Gardasil) that can protect you from the strains of HPV that are together responsible for 70 percent of cervical cancers. Vaccination, the consistent use of latex condoms, limiting sex partners, and regular Pap testing can all combine to dramatically lower your risk of cervical cancer and invasive treatments that might compromise your fertility.
Epididymitis
Sometimes, an untreated STD can cause scarring that blocks sperm’s movement out of the testes, resulting in infertility. While this isn’t nearly as common (or as well studied) as other fertility-affecting conditions like pelvic inflammatory disease, it is a possibility.
An inflammation of the epididymis is called epididymitis. The epididymis is a tube that is connected to the testicle, and is where sperm are stored before ejaculation. When sperm enter the epididymis, they are “immature” — as they travel through the coiled tube, they gain the ability to swim. It is thought that epididymitis might affect sperm as they travel through the epididymis, possibly limiting their mobility and making them less able to swim toward an egg. It has also been shown that severe cases of epididymitis can cause enough scarring to block the sperm’s progress through the epididymis and the vas deferens (also called the ductus deferens). Lastly, it is postulated that acute epididymitis can affect sperm production.
An acute epididymitis case in which both testes have been affected (bilateral epididymitis) can lead to sterility in some. Chlamydia is the leading cause of epididymitis in heterosexuals 35 years old and younger, accounting for about 70 percent of epididymitis cases in that population. Because chlamydia is so often asymptomatic — half of men with chlamydia have no symptoms — it can be easy for an infection to spread undetected.
Planned Parenthood health centers offer STD screening, including urine tests for chlamydia and gonorrhea. If you are sexually active and have a cervix, we recommend regular Pap testing to catch cervical cancer before it starts. We also offer the preventive HPV vaccine, Gardasil, to decrease cervical-cancer risk. Furthermore, we can evaluate you for pelvic inflammatory disease or epipdidymitis. Finally, you can drop by any time to pick up condoms!
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