Will Chlamydia Destroy Your Fertility?

Chlamydia is a sexually transmitted disease (STD) often caught by young people and generally considered an easily remedied, harmless infection. However, chlamydia has some hidden long-term risks that should not be ignored.

Chlamydia is the most frequently reported bacterial STD in the United States: There were an estimated 4 million new chlamydial infections in 2018, according to the Centers for Disease Control and Prevention (CDC). Globally, the World Health Organization estimated there were 129 million new cases of chlamydia in 2020, even in the midst of a global pandemic.

Alongside being easily transmittable, this STD poses a threat to long-term fertility for people assigned female at birth, with some research suggesting people assigned male at birth are also at risk of fertility issues following infection.

"Chlamydia trachomatis is a bacteria that affects the reproductive tract," explained Jeff Foster, M.D., a general practitioner in the United Kingdom. "Chlamydial infection can spread to the uterus and/or fallopian tubes in women."

It's spread through sex or contact with infected genital fluids, such as semen or vaginal fluid. Despite common misconceptions surrounding them, STDs can be passed to someone via oral and anal sex, as well as vaginal sex. Sharing sex toys that have not been washed or covered with a new condom for each user may transmit the infection between partners.

Chlamydia can be transmitted simply through genital contact, which means penetration, ejaculation or orgasm are not necessary for transmission. Although rare, you can contract chlamydia by semen or vaginal fluid getting into your eye. It is also possible for chlamydia to pass from a pregnant woman to her baby.

Internet "experts" and school rumors alike insist STDs are transmittable by sitting on a public toilet seat, but this is a myth. Chlamydia cannot be passed through any casual contact, which includes sharing baths or towels, swimming in public pools or even kissing.

The majority of women do not experience symptoms of chlamydia, but the most common signs include pain when urinating, unusual vaginal discharge, pain in the pelvis, pain during sex, bleeding after sex and bleeding between periods. Men may also be asymptomatic or they may experience pain when urinating, white, cloudy or watery discharge from the tip of the penis, burning or itching in the urethra or pain in the testicles.

Healthcare providers test for chlamydia by using a urine test or swab test, and results are usually swift. If treated quickly with a short course or a singular large dose of antibiotics, the disease is unlikely to have any serious repercussions.

"If not treated, chlamydia can lead to damage to the reproductive system," explained Lora Shahine, M.D., a physician at Pacific Northwest Fertility and a clinical associate professor at the University of Washington. "In women, chlamydial infection can spread to the uterus or fallopian tubes and cause pelvic inflammatory disease, according to the CDC. PID can damage the fallopian tubes and uterus and cause chronic pain, infertility and ectopic pregnancy."

Research into chlamydia and infertility is limited, but it is clear the scarring and blocking of fallopian tubes caused by the infection are irreversible. People with blocked fallopian tubes may need to use additional fertility remedies, such as in vitro fertilization, to conceive.

For men, the research is even more limited, but some studies indicate chlamydia threatens the fertility of all the sexes. A 2007 study showed a higher DNA fragmentation rate in sperm, which is associated with infertility, among men diagnosed with chlamydia. A 2019 study indicated chlamydia was found in fixed testicular biopsies from 43 of 95 men (45.3 percent) with unexplained infertility.

The CDC advises that all sexually active women age 25 and younger be screened annually for chlamydia. For women older than 25, the CDC suggests they get screened every year if they have multiple partners or a new partner. They also recommend men who have sex with men get tested every year.

Although the CDC states, "there is insufficient evidence for screening among heterosexual men who are at low risk for infection," regular screening is important for everyone to prevent the spread of STDs and to protect people's health. Damage to fertility is far more difficult to undo than it is to prevent.

To encourage more people to get tested and to limit the spread of chlamydia, the stigma associated with sexually transmitted infections needs to be shattered to foster a sense of comfort around discussing the health of our most intimate body parts.

"Increasing awareness of how common STIs are, increasing access and use of screening, and encouraging access and use of treatment can help decrease stigma," Shahine said.