Dear Anne, I've heard that chlamydia and gonorrhea can make you infertile ... Is that true? --Anonymous
Yes. Infections with gonorrhea and chlamydia can lead to a condition called pelvic inflammatory disease, which often has some very nasty repercussions. According to the Centers for Disease Control and Prevention, each year one million women in the United States suffer from PID, and 100,000 of these women become infertile each year from the disease. Even scarier, PID or PID-related complications cause the death of about 150 women each year.
Other long-term complications of PID include ovarian abscesses, pelvic scarring and pain during intercourse. In addition to these problems, PID is just plain uncomfortable. Women suffering from the disease often have tremendous pelvic and abdominal discomfort. Medical people even have a name for the pained, scuffling walk that women with PID tend to assume ... We call it the "PID Shuffle." In addition to their graceful gait, women with this condition often have high fevers and can look generally pretty ill. During a gynecologic exam, the tenderness of the reproductive tract becomes evident to the examiner when a woman with PID exhibits what we call the "Chandelier Sign"... which means even a gentle touch of her cervix causes her to practically jump off the table and go straight for the ceiling. (Whoever came up with this term obviously has not spent much time in Student Health, because last time I checked, we didn't have any chandeliers or fancy light fixtures of any kind).
Although some women clearly look sick when they have PID, one of the scariest things about the disease is that it can be totally asymptomatic. This means that it can silently sabotage a woman's reproductive health without giving her any indication that there is a problem. Often, these women have no idea that they've been exposed to infections like gonorrhea and chlamydia and have had no preceding gynecologic problems. This underscores the importance of screening for STIs if you have any reason to believe you might have had exposure. In the words of my supremely straightforward high school sex education counselor, "Just because it ain't drippin' don't mean it's clean."
So what causes PID? It's thought that bacteria from the lower genital tract ascend through the cervix, uterus and fallopian tubes to enter the pelvic space. The mucus in the cervix and uterine lining serve as "Interstate STI," allowing bacteria such as gonorrhea and chlamydia to cruise all the way from the vagina to the inside of the belly. Certain times of the month are risky for developing PID because the character of this mucus changes ... A woman is more susceptible, for example, around the time of her period. IUDs can also increase the risk of uphill spread of genital tract infections, making this method of contraception inadvisable for women who aren't in long-term, monogamous relationships.
Gonorrhea and chlamydia aren't the only bacteria associated with PID. Most cases of PID involve infections with multiple bacteria. Gardnerella, which is associated with bacterial vaginosis, has also been found in women with PID, as have a host of other bacteria including E. coli and Streptococcus species.
Prompt treatment of PID is essential in helping to prevent the development of scarring, abscesses and infertility. In severe cases, women may require hospitalization to receive treatment via IV, although most cases can be managed on an outpatient basis. Because confirming the infecting agent can take several days, women are treated presumptively with a combination of antibiotics to cover all possible perpetrators. Informing and treating all sexual partners is absolutely essential to prevent recurrent infections.
If you're sexually active, the best way to prevent PID is to always practice safe sex. If you use condoms appropriately, every time, it's highly unlikely that you will have to worry about developing PID. So, until next time, stay safe and stay away from the chandelier!
Anne Mills is a Cavalier Daily Health & Sexuality Columnist. She can be reached at mills@cavalierdaily.com or through the Sex & Balances submission page at cavalierdaily.com/sex.asp. This column should be used for educational purposes only and is not meant to substitute advice from your doctor.
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