Sharon Perkins - Getting Pregnant For Dummies

You may not even know that you have a sexually transmitted disease. Some STDs cause a vaginal or penile discharge, others cause itching or small sores, but some cause no symptoms at all. Most are easily treated with antibiotics. The problem is that many women don’t realize they have an infection because most have no clear symptoms. The following sections describe a few of the most damaging STDs and provide some statistics about the diseases in the United States.

Human papilloma virus (HPV) is the most common STD in the United States, now surpassing chlamydia and gonorrhea. HPV is different from human immunodeficiency virus (HIV). HPV is transmitted through vaginal, oral, or anal sex. Most often, HPV will go away because the immune system eradicates the virus. However, certain variations of HPV can cause genital warts or cancer. The cancers associated with HPV infection include cervical, vaginal, anal, penile, and throat cancers.

Like the situation with many viruses, there is no cure — but there is a vaccine. Beyond that, safe sex limits the risk of transmission. While cancer is the major concern with a positive HPV test, newer studies suggest that HPV may also affect fertility. A recent study evaluated the incidence of HPV in couples undergoing IVF. The study detected HPV in 19 percent of the females and 20 percent of the males. For the males who tested positive, there was a reduction in semen concentration, motility, and shape. The authors did not comment about whether this results in a lower pregnancy rate.

Currently, the gold test standard for HPV in women is the PAP smear (a swab of your cervix), as HPV can cause cervical cancer. Cervical cancer develops slowly in the cells that mark the border between the vagina and the inside of the cervix. The initial infection causes cells to change their appearance, and this can be seen by taking cells from this region of the cervix, staining them, and looking at them under the microscope.

Treatment for PAP smears where a number of cells look abnormal includes further investigating the cervix with a device called a colposcope. This device (and the colposcopy procedure) is just a way to magnify the area of the cervix where cervical cancers start. The areas identified by the colposcope can be biopsied, and potential cervical cancer cells identified through this early detection method can be removed. (The removal procedure is commonly called a LEEP procedure, Loop Electrosurgical Excision Procedure).

Prior to knowing that HPV causes cervical cancer, the PAP was the best way to identify these early precancerous changes. But now, it is known that certain variations of the HPV, called serotypes, can identify which people are at risk for developing cervical cancer. So, the more modern PAP is done so that the HPV can be typed and the risk assessed. The use of serotyping has allowed those people who are either HPV negative or have one of the safer variants of HPV to have less frequent PAP smears, such as every three years. Early treatment and more frequent screening can reduce the risk for developing cancer.

There is little data to suggest that HPV has a huge impact on your ability to conceive and, even if you were treated for HPV, the cervical procedures themselves should not increase your infertility risk. So, cancer is a concern with HPV — but impact on fertility, not so much.

A note about the HPV vaccine: While there is a vaccine for HPV, only about 40 percent of females and 28 percent of males who are in the age range where the vaccine is recommended (ages 11–26) actually have been vaccinated. Optimally, the vaccines should be given to all males and females at age 11–12. There are three different vaccines as of this writing, and for the 9-valent vaccine, the upper age for immunization has been increased to 45 years old for both men and women. As of 2019, the CDC did not recommend vaccinating adults over age 45.

Chlamydia is the most reported sexually transmitted infection in the United States — meaning we more often test for it than the other infections. The bacterium Chlamydia trachomatis is responsible for the infection. Both men and women can be infected, and both male and female fertility can be damaged. Chlamydia is easily tested by swabbing the penis or vagina and sending the swab to a lab for testing. A new test using urine is also being developed. Chlamydia is easily treated with antibiotics.

Here are some facts about the disease:

About 2 million new cases of chlamydia are diagnosed every year.

Almost two-thirds of new chlamydia infections occur in 14- to 24-year-olds.

Of those women who develop pelvic inflammatory disease (PID), 30 percent will have chlamydia. Each occurrence of PID reduces the chance of achieving a pregnancy by 25 percent due to the damage the infection does to the fallopian tubes.

Women with PID are seven to ten times more likely to have an ectopic pregnancy, a pregnancy that grows outside the uterus, usually in the tubes. (For more about ectopic pregnancies, see Chapter 13.)

Most women (75 percent) have no symptoms of infection; symptoms include lower abdominal pain, burning with urination, and vaginal irritation.

Twenty-five percent of men have no symptoms from chlamydia; the rest may have a discharge from the urethra, or pain and burning on urination.

Men with untreated chlamydia can develop epididymitis, an infection in the testicles, where sperm are developed. This condition can lead to low sperm counts.

Each year, 100,000 women become infertile from chlamydia. With a first episode of PID from chlamydia, 12 percent of women become infertile; a second episode of PID increases infertility to 40 percent. Eighty percent of women who have had PID from chlamydia three or more times are infertile.

Chlamydia is largely a silent disease. Only about 10 percent of men become symptomatic, and anywhere from 5–30 percent of women become symptomatic.

It is important to know that symptoms of a chlamydia infection, if any, may not appear until weeks after the person becomes infected. Diagnosis is made using vaginal swabs (for a woman) and penile swabs (for a man).

Chlamydia is treated with oral antibiotics: either a single dose of azithromycin or a seven-day course of doxycycline.

Having been treated once does not mean you can’t get reinfected — in fact reinfection is common. Annual testing for all sexually active women and men is recommended.

Untreated chlamydia when you’re pregnant can lead to miscarriage, preterm labor, or chlamydial conjunctivitis (eye infections) or chlamydial pneumonia (respiratory infections) in the child. Pregnant women with untreated chlamydia are also at a much higher risk for stillbirth.

Cytomegalovirus (CMV) is caused by a virus — unlike chlamydia, which is caused by a bacterium. The difference is that bacteria do their damage outside of cells while viruses invade cells and do their damage by hijacking part of the DNA machinery. CMV is present in over half of the people by age 40 and one in three children are infected by age 5. Most people have no symptoms when they become infected, but CMV may cause mild symptoms of cough, fatigue, swollen glands, and sore throat. People infected with CMV are infected for life. CMV is spread through human fluids: direct contact through saliva or urine, sexual contact/semen, transplanted organs, blood transfusions, and breast milk (which, along with direct contact, is how many little ones contract the infection).