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Can You Get Pregnant With a Sexually Transmitted Disease?

Past and present sexual health can play an important role in fertility. Some sexually transmitted diseases (STDs) can leave scarring and inflammation which make it more difficult to conceive, even after the infection has been treated.

For women, this scarring usually occurs as a side effect of Pelvic Inflammatory Disease (PID) which develops as a secondary infection after contracting an STD. Having an active STD while pregnant may also have consequences for the health of the baby. Increasingly, the term STD is being replaced with STI, or sexually transmitted infection. This is to underline that many people can be infected without showing symptoms or developing a disease. Someone with an asymptomatic STI may still be at risk of passing on the infection to a partner or baby, or may eventually develop symptoms later.

Discussing your sexual health status can be uncomfortable, but it is an essential part of planning for a baby. The good news is that if you do have a history of a sexually transmitted infection, there are treatments which can help. Understanding how an STI can affect your fertility and what to do about it is important for any patient who wants to get pregnant after an STI.

Here is a look at some of the STDs, their potential impact on fertility and how you and your doctors can overcome fertility challenges and minimize risk before you get pregnant.

Human Papillomavirus (HPV)

HPV, also known as genital warts, is an extremely common STI: almost 80 million people in the US have some form of HPV with another 14 million being infected each year. By some estimations, almost 75% of sexually active men and women in the US are affected by HPV. There are more than 100 different strains of HPV, with only 40 of those being sexually transmitted. Of those 40, only a few have the potential to cause visible genital warts. An even smaller percentage of HPV strains are dangerous with the potential to cause cancer. There is no medical cure for HPV but fortunately for most people, HPV is asymptomatic, and their bodies clear the infection on their own fairly quickly, within a few months to two years.

Most fertility issues arise when you are infected with one of the cancer-causing strains of HPV. Some women will develop pre-cancerous cells on their cervix which must be removed by a medical procedure. There are three techniques used to remove these cells.

• A cone biopsy is when a portion of the cervix is removed.
• Cryosurgery freezes and destroys abnormal tissue.
• Loop Electrosurgical Excision Procedure (LEEP) removes precancerous cells and superficial cervical tissue with an electrically charged wire loop.

All of these procedures carry the risk of making it more difficult to get pregnant or carry a baby to term if you do get pregnant. They may change or reduce cervical mucus, which makes it more difficult for sperm to reach the egg. This could also weaken your cervix, causing a condition known as cervical insufficiency or cervical incompetence, which can cause miscarriage or premature birth if your cervix opens while you are pregnant.

What can be done?

• IUI or IVF: If HPV treatment has caused a problem with your cervical mucus which is making it difficult to conceive, intrauterine insemination or in vitro fertilization can be good options, as they bypass the area altogether.

• Cervical monitoring: If you or your doctor are concerned about cervical insufficiency due to treatment for precancerous cells, you will be monitored very carefully during your pregnancy. Transvaginal scans are a type of ultrasound performed with a wand inserted into the vagina which can help doctors check the length of the cervix. Special vaginal swabs can also check for markers that indicate a risk of preterm birth. If signs of weakness are detected, you may be treated with supplemental progesterone, bedrest, and/or a procedure called a “cervical stitch” or cerclage, which can help keep your cervix closed for longer.

• Cesarean section: If you have active HPV warts while pregnant, pregnancy hormones can cause the warts to grow faster. If they are blocking the birth canal your doctor may recommend a C-section. This can also minimize the chance that your baby will come into contact with the virus during birth: in rare cases such exposure can lead to the baby developing warts on their vocal chords.

Genital Herpes

Genital herpes is another common STI, usually caused by the Herpes Simplex Virus type 2 (HSV-2), though HSV-1, which is known as oral herpes and causes cold sores, can also be transmitted to the genitals. Herpes usually causes painful sores on the genitals during an outbreak. Almost one in four women in the USA has been infected by HSV-2, compared to one in eight men. There is no cure for genital herpes, although outbreaks can usually be well-contained with medication. It does not affect your ability to conceive, but it does pose risks to the baby. In very rare cases, if the virus is present in the birth canal, it can be passed onto the infant, causing neonatal herpes, a potentially deadly infection.

The vast majority of women with genital herpes do not pass the infection onto their babies: less than 0.1% of babies born in the US each year contract neonatal herpes. The biggest risk of transmission happens when the mother acquires a genital herpes infection late in her pregnancy. This means that her body may not have time to create the antibodies which would normally be passed on to the baby. Women who contracted herpes before getting pregnant have a very low risk of transmitting the virus: antibodies from their immune system will cross the placenta and offer temporary protection during birth.

What can be done?

• Antiviral medication: Drugs such as Zovirax (acyclovir) or Valtrex (valacyclovir) can be taken during pregnancy, particularly in the last trimester or weeks, to cut down the chance of an outbreak before delivery. There is no evidence of these medications causing serious side effects in babies whose mothers were treated during pregnancy.

• Precautions in the delivery room: Your birth team can examine the birth canal in early labor for any signs of herpes lesions. They can avoid puncturing the bag of water, which may help to protect the baby from the virus. They can also use external monitors rather than scalp monitors for the baby and minimize the use of forceps or suction, all of which prevents creating tiny punctures in the baby’s scalp.

• Cesarean section: If your doctor feels there is significant risk of transmission during birth, they may recommend a C-section.

Chlamydia

Chlamydia is another very common sexually transmitted infection, with an estimated three million cases each year. Unlike HPV and herpes, however, chlamydia is not a virus but a bacterial infection. This is good news, because if caught early, it can usually be treated easily with antibiotics.

The trouble with chlamydia is that it is usually asymptomatic, so you could be carrying an untreated infection without knowing it. This is dangerous for several reasons. chlamydia is a serious cause of Pelvic Inflammatory Disease (PID) which leaves you at risk of inflammation, scarring, and blockage in your reproductive organs, particularly your fallopian tubes. This can make it difficult or impossible to get pregnant, because the sperm and egg are unable to meet. PID also puts you at risk for an ectopic pregnancy which can be deadly if the pregnancy is not removed in time. Untreated chlamydia can also cause serious health problems for a baby. About half of the babies born to mothers with untreated chlamydia infections contract pink eye. Also known as neonatal inclusion conjunctivitis when a newborn baby is affected, this infection causes swelling and the production of pus. If left untreated, it can cause corneal scarring.

Chlamydia in the male partner can also be a factor in a couple’s infertility, according to new research, though what role it plays is not yet understood.

What can be done?

• Antibiotics: If evidence of an active infection is found, a course of antibiotics will be ordered to clear the infection.

• Surgery: Blocked fallopian tubes or other pelvic scarring can sometimes be resolved with laparoscopic surgery.

• IVF: In vitro fertilization is often a very successful treatment for women who struggle to conceive because of a previous PID infection.

Gonorrhea

Approximately 820,000 cases of gonorrhea are reported in the US each year. Like chlamydia it is a bacterial infection which can usually be treated with antibiotics, though some strains are reportedly becoming resistant, which can make it more difficult to resolve. The risks of untreated infection are very similar to chlamydia as well: it is often asymptomatic, can cause PID and scarring, and can be passed on to a baby during birth. Similar to chlamydia, a baby infected with gonorrhea may develop pink eye: in this case it is called gonococcal conjunctivitis. Untreated, it can cause blindness.

Gonorrhea can also affect fertility in the male partner. The infection can result in a condition known as epididymitis, where the tube near the sperm ducts known as the epididymis becomes inflamed. When untreated, epididymitis can cause scarring which impacts the production and transport of sperm in the male body.

What can be done?

The treatments for gonorrhea and its related fertility problems are the same as chlamydia: antibiotics, surgery, or IVF.

Syphilis

Syphilis is a serious bacterial STI has unfortunately become more common in recent years. It is treatable with penicillin when it is detected at an early stage, but when undetected it can have tragic consequences. A woman who becomes pregnant while suffering from an untreated syphilis infection has a 50% chance of her pregnancy ending in miscarriage or stillbirth.

Unfortunately, syphilis is very easy to transmit to a baby at any stage during pregnancy (the infection can cross the placenta) or during childbirth. Congenital syphilis is extremely dangerous to a newborn baby, with a significant chance of fatality  when untreated. Getting tested for syphilis before getting pregnant or early in the first trimester is extremely important: the symptoms are not always obvious. Fortunately, treatment with penicillin can help protect both mother and baby throughout the pregnancy and beyond. When detected and treated early, transmission rates drop to 1 or 2% from the 50% transmission rate among untreated mothers.

Untreated syphilis can cause infertility in both women and men. Later stages of the disease cause damage to organs and nerves, which can affect all the systems of the body, including the reproductive system. For men, epididymitis causes most syphilis-related infertility.

What can be done?

Penicillin: Penicillin is the only approved treatment for syphilis, to the point where patients with penicillin allergy often go through a desensitization process so that they can take the medication. For women with a history of syphilis, ongoing monitoring and testing of themselves and their baby before and after birth are key to catching signs of congenital syphilis. 

HIV

Human Immunodeficiency Virus (HIV) doesn’t affect a woman’s ability to get pregnant, although if untreated HIV has progressed to AIDS, overall poor health and damage to internal organs can make sustaining a pregnancy very difficult. The main issue with HIV and pregnancy is preventing transmission from mother to baby. Knowing your HIV status before pregnancy is extremely important: with the right precautions, the risk of transmission can be lowered to about 1%.

What can be done?

HIV medications during pregnancy: Most HIV medications are safe to use while pregnant. By lowering the viral count (or how much HIV is present in the body) these medications can make it much less likely that HIV is passed through the placenta to the baby.

Cesarian section: In some cases, a scheduled C-section can help reduce the risk of transmission during delivery.

Not breastfeeding: HIV can be present in breast milk, so feeding the baby formula instead is important.

Postnatal medication for baby: Babies born to an HIV positive mother will take HIV medications for the first 6 to 8 weeks of life to help ensure that the virus does not have a chance to take hold in their systems.

When it comes to dealing with STIs and their impact on your fertility and the health of your future baby, knowledge is power. When you know your STI status, you and your medical practitioners can take steps to keep both you and your baby safe. Remember that you have a right to non-judgmental advice, guidance and treatment, and most problems of this type have a simple solution. If you think that a history of STI could be causing your fertility problems, don’t hesitate to speak to a doctor about it.

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Chlamydia and pregnancy

Their favorite habitat is the cervix (more precisely, the mucous membrane of the cervical canal). It is there that they are located in colonies, i.e. are not found throughout. Such frequent cases are associated with this fact, when one doctor takes a smear from the cervical canal and chlamydia is found in it, and the other one also takes a smear a day later, but chlamydia is not found again. That is why the diagnostic value of swabs for chlamydia is quite low - about 30%.

How chlamydia manifests itself

During an exacerbation of the infectious process, women's complaints may be different, depending on the level of chlamydia spread.

When chlamydia is found in the cervix, there may be slight discharge from the vagina, accompanied by moderate pulling pains in the lower abdomen, which is typical with local exacerbation of the process (there are practically no complaints in the chronic form). If the infection spreads higher (uterine cavity, tubes), then the complaints are more pronounced, because, for example, inflammation of the appendages may begin.

Exacerbation of chlamydial infection is especially dangerous during pregnancy, as it can lead to various complications.

Possible complications:

• early miscarriages are possible,
• late term premature amniotic fluid and preterm labor,
• in childbirth, there is a high probability of infection of the fetus (conjunctivitis, pharyngitis, otitis and even pneumonia).

Chlamydia diagnostics

The most informative method is a blood test for antibodies (immunoglobulins) to chlamydia. If a small concentration of these antibodies is detected, then they speak of a chronic carriage of chlamydia. If the concentration is high, there is an exacerbation of chlamydial infection.

The diagnosis of "chlamydia" is legitimate when it is confirmed by two fundamentally different diagnostic methods: smear (microscopy) and blood for antibodies to chlamydia (biochemical method). Only when the titer (concentration) of antibodies is high and / or in the presence of complaints specific to this infection, a course of treatment is indicated.

Digits must be multiples, i.e. more or less than twice, from the previous one (IgA 1:40 and IgG 1:80). Titers of 1:5 and less are doubtful and negative. Elevated IgG numbers indicate that the process is chronic. In this case, treatment is indicated if there are certain complaints, or if before that, the person has never been treated for this infection. High numbers of IgA are mainly found in an acute process (primary infection) or during an exacerbation of a chronic one that needs treatment.

What to do if the test is positive?

It must be remembered that today there are almost no 100% reliable methods, including the ELISA method (enzymatic immunoassay) is no exception. Quite often there are “false positive” results - you have to do either repeated tests or use other, fundamentally different methods.

These can be:

• taking smears for the PIF method (examination with a luminescent microscope) - where there may also be “false positive” answers,
• PCR blood test (based on the principle of genetic engineering, the study of DNA or its fragments) - today, its reliability is very high.

In the search for the truth of the diagnosis, quite often, everything can rest either on the financial capabilities of patients, or on the insufficient equipment of a particular laboratory. The better the body's defenses, the less likely it is to contract chlamydia. In which case, only “carriage” threatens you, it is not dangerous for you (only IgG, in low titers, will be determined in the blood test).

It is considered optimal if the whole family is examined at the same time (all interested persons, including children), because in this case, it is possible to identify who is at what stage and monitor the effectiveness of treatment.

In most cases, the pathogens of ureplasmosis and mycoplasmosis do not manifest themselves (hidden bacteriocarrier), and only when the process is exacerbated, they cause pregnancy complications similar to chlamydia and infection of the fetus. Therefore, when examining women who have had the above problems in the past, swabs and blood are taken at least immediately for these three pathogens. By the way, studies have shown that taking hormonal birth control pills reduces the risk of chlamydia infection, this effect is associated with an increase in the protective properties of cervical mucus (its permeability to bacteria decreases). As mentioned above, chlamydia is dangerous for pregnant women.

What to do?

But what to do if, after all, doctors found chlamydia in the acute stage in the expectant mother?

The placenta can be thought of as a mesh filter through which large molecules cannot pass (they remain in the mother's body). Therefore, in the treatment of a pregnant woman, antibiotics are used that are harmless to the fetus (i.e. those that do not pass through the placenta). These include drugs whose molecular weight is greater than the "capacity" of the capillaries. However, when taking these drugs, the effect on the fetus is still possible. The antibiotic acts primarily on the mother's body, however, during the period of treatment, it changes the metabolism in the body, which in turn affects the metabolism of the fetus. Antibiotics are always prescribed in short courses so that the effects are minimal.

References

• Zofkie AC., Fomina YY., Roberts SW., McIntire DD., Nelson DB., Adhikari EH. Effectiveness of Chlamydia Trachomatis expedited partner therapy in pregnancy. // Am J Obstet Gynecol - 2021 - Vol - NNULL - p.; PMID:33894150
• Zofkie AC., Fomina YY., Roberts SW., McIntire DD., Nelson DB., Adhikari EH. Effectiveness of Chlamydia Trachomatis expedited partner therapy in pregnancy. // Am J Obstet Gynecol - 2021 - Vol - NNULL - p.; PMID:33894147
• Shilling HS., Garland SM., Costa AM., Marceglia A., Fethers K., Danielewski J., Murray G., Bradshaw C., Vodstrcil L., Hocking JS., Kaldor J., Guy R., Machalek D.A. Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019. // Sex Transm Infect - 2021 - Vol - NNULL - p.; PMID:33782146
• Vercruysse J., Mekasha S., Stropp LM., Moroney J., He X., Liang Y., Vragovic O., Valle E., Ballard J., Pudney J., Kuohung W., Ingalls RR. Chlamydia trachomatis Infection, when Treated during Pregnancy, Is Not Associated with Preterm Birth in an Urban Safety-Net Hospital. // Infect Dis Obstet Gynecol - 2020 - Vol2020 - NNULL - p.8890619; PMID:33082702
• Olaleye AO., Babah OA., Osuagwu CS., Ogunsola FT., Afolabi BB. Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. // Eur J Obstet Gynecol Reprod Biol - 2020 - Vol255 - NNULL - p.1-12; PMID:33059307
• Hoenderboom BM., van Bergen JEAM., Dukers-Muijrers NHTM., Götz HM., Hoebe CJPA., de Vries HJC., van den Broek IVF., de Vries F., Land JA., van der Sande MAB., Morré SA., van Benthem BHB. Pregnancies and Time to Pregnancy in Women With and Without a Previous Chlamydia trachomatis Infection. // Sex Transm Dis - 2020 - Vol47 - N11 - p.739-747; PMID:32701764
• He W., Jin Y., Zhu H., Zheng Y., Qian J. Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis. // Arch Gynecol Obstet - 2020 - Vol302 - N3 - p.553-567; PMID:32643040
• Freeman J., Pettit J., Howe C. Chlamydia test-of-cure in pregnancy. // Can Fam Physician - 2020 - Vol66 - N6 - p.427-428; PMID:32532724
• Rajabpour M., Emamie AD., Pourmand MR., Goodarzi NN., Asbagh FA., Whiley DM. Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among women with genitourinary infection and pregnancy-related complications in Tehran: A cross-sectional study. // Int J STD AIDS - 2020 - Vol31 - N8 - p.773-780; PMID:32517577
• Goggins ER., Chamberlain AT., Kim TG., Young MR., Jamieson DJ., Haddad LB. Patterns of Screening, Infection, and Treatment of Chlamydia trachomatis and Neisseria gonorrhea in Pregnancy. // Obstet Gynecol - 2020 - Vol135 - N4 - p.799-807; PMID:32168225

Chlamydia - KVD №2

What is chlamydia?

Chlamydia is a common sexually transmitted infection (STI). The disease is caused by the bacterium Chlamydia trachomatis (Chlamydia trachomatis), which affects the female genital area and is the cause of non-gonococcal urethritis in men. Manifestations of chlamydia are usually minor or absent, but serious complications develop. Complications can cause irreparable damage to the body, including infertility - all this proceeds very secretly.

Chlamydia also causes penile discharge in infected men.

Ways of transmission of chlamydia

Chlamydia can be transmitted through:

• vaginal or anal contact with an infected partner;
• less common with oral sex;
• use of sex toys with an infected partner;
• infection of a newborn during childbirth from a sick mother.

Absolutely all sexually active people can get chlamydia. The greater the number of sexual partners, the greater the risk of infection. The risk of infection is especially high in girls, because their cervix is ​​not fully formed. About 75% of new cases occur in women under 25 years of age. By the age of 30, approximately 50% of sexually active women have had chlamydia. In sexually active men, the risk of infection is highest between the ages of 20 and 24.

You cannot get chlamydia through kisses, hugs, dishes, baths, towels.

Manifestations of chlamydia

Chlamydia is very secretive. About 75% of infected women and 50% of infected men are asymptomatic. If manifestations of the disease develop, then this occurs approximately 1 to 3 weeks after infection.

In women, chlamydia first affects the cervix and urethra (urinary canal).

Manifestations:

• unusual vaginal discharge;
• pain or discomfort when urinating;

If the infection penetrates to the appendages, manifestations are possible:

• pain in the lower abdomen;
• pain in the lumbar region;
• nausea;
• slight increase in temperature;
• pain during intercourse or bleeding after it;
• bleeding between periods.

Symptoms in men:

• clear or cloudy discharge from the penis;
• pain or discomfort when urinating;
• there may be burning and itching in the area of ​​the outlet of the urethra;
• rarely pain and/or swelling of the testicles.

Men or women who have anal sex with an infected partner can infect the rectum, resulting in inflammation, pain, discharge, or bleeding from the rectum.

Chlamydia can cause sore throat (pharyngitis) in men and women who have oral contact with an infected partner.

What complications can develop if chlamydia is not treated?

If the disease is not treated, serious short-term and persistent complications develop. Like the disease itself, complications often occur insidiously.

In women with untreated chlamydia, the infection can spread from the urethra to the fallopian tubes (the tubes that carry the egg from the ovaries to the uterus) - this causes (in 40% of cases) the development of pelvic inflammatory disease (PID). PID causes permanent damage to the fallopian tubes, uterus, and surrounding tissues. Chronic pelvic pain, infertility and ectopic pregnancy are the result of PID.

Women with chlamydia are more susceptible to HIV infection, the risk increases by almost 5 times.

To prevent serious consequences of chlamydia, an annual chlamydia screening is required for all sexually active women 25 years of age and younger. An annual examination is necessary for women over 25 who are at risk (new sexual partner, multiple sexual partners). All pregnant women should be screened for chlamydia.

Complications of chlamydia are rare in men. The infection sometimes extends to the epididymis and causes pain, fever, and, rarely, male infertility (sterility).

Rarely, chlamydial infection can cause inflammation of the joints in combination with skin lesions, inflammation of the eyes and urinary tract - this is the so-called Reiter's syndrome.

The effect of chlamydia on a pregnant woman and her child

Chlamydia in pregnant women increases the risk of miscarriage, premature detachment of the placenta. Newborns from infected mothers can get eye and lung infections. A lung infection (pneumonia) can be fatal to a newborn.

Diagnosis of chlamydia

Diagnosis includes observation of the patient's clinical symptoms, testing for chlamydia smears from the cervix, scraping from the urinary canal, the first morning portion of urine. Most often, the study is carried out by PCR (polymerase chain reaction). Swabs and scrapings may cause minor discomfort.

Additionally, a blood test is performed by ELISA (enzyme-linked immunosorbent assay) for the presence of immunity to chlamydia, this auxiliary test often helps to establish an accurate diagnosis.

Treatment of chlamydia

Treatment of chlamydia is with oral antibiotics. To prevent re-infection, all sexual partners must be found, examined and treated. Patients with chlamydia should refrain from unprotected sex during treatment, otherwise it is possible to re-infect the sexual partner. Unfortunately, after successful treatment, re-infection with chlamydia is possible, since a strong immunity to this microorganism does not develop. Repeated infection of women with chlamydia leads to a significant increase in the risk of serious complications, including infertility. A re-examination is carried out 4 weeks after treatment.

Chlamydia prevention

The best way to prevent sexually transmitted infections is through long-term sexual contact with one healthy sexual partner. Latex male condoms, when used correctly, drastically reduce the risk of transmission.

Annual chlamydia screening required for all sexually active women aged 25 and under. An annual examination is also necessary for women over 25 who are at risk (new sexual partner, multiple sexual partners). All pregnant women should be screened for chlamydia.

Any manifestations, such as pain or discomfort when urinating, unusual rash, discharge are a signal to stop sexual intercourse and immediately examine in a specialized clinic - KVD. If the patient is found to have chlamydia (or any other STI), he must inform his sexual partners so that they also undergo a full examination and appropriate treatment.

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