Chlamydia & Fertility

I remember being told that if I got chlamydia, didn’t know about it and it didn’t get treated, then I would  be infertile. That scared me. I never knew why or how it would impact my fertility, how long it might take to have an impact, or if there was any scope for fixing that. Sexually transmitted infections are still quite a taboo topic, so here  is the low down: 

What is chlamydia?
Chlamydia is a bacterial infection that is passed on in semen or vaginal fluid, and is one of the most common sexually transmitted infections in the UK: there were 87,905 cases in 2021 in people between ages 15 and 24. It is recommended that you get tested for it every year if you are sexually active and under the age of 25, or any time you have a new partner. Tests for chlamydia are simple and easy, and in most areas of the UK you can get home test kits for free, so you may not even need to go to the GP or health centre. Chlamydia is mostly asymptomatic, though in some cases will present with pain or bleeding during sex, bleeding between periods for women, unusual discharge or pelvic pain, or testicular pain in men. When diagnosed, chlamydia is easily  treatable with a short course of antibiotics. 

What happens if left untreated?
If Chlamydia is left untreated it can develop into inflammation that affects the urethra in both men and women. In women the cervix and endometrium (uterus lining) can be affected too. This in turn can lead to Pelvic Inflammatory Disease, which causes damage to the ovaries, fallopian tubes and endometrium. Fibrosis or occlusion (blocking) of the fallopian tubes makes it difficult for an egg to travel to the uterus to be fertilised. Therefore it is more likely to not be fertilised at all (leading to Tubal Factor Infertility) or be fertilised in the fallopian tube, leading to ectopic pregnancy. Each time a woman is re-infected and  inflammation develops, the  risk to  fertility increases. 

In men, untreated chlamydia is thought to affect sperm health. Though there is a limited pool of evidence  about chlamydia itself, it is well understood that infection in the testicles and worsening sperm health go hand in hand. Testicular infection and inflammation leaves sperm less motile, higher in physical abnormalities and less in quantity. Some studies in infertile men found higher instances of chlamydia antibodies, and those who had more chlamydia antibodies had a lower sperm count.  Fortunately a study has shown that 30  days after diagnosis, when treated immediately with 7 days of antibiotics, there was significant improvement in sperm health parameters.

What should  you  do about it?
If you have any concerns that you have symptoms of chlamydia, or have changed partners recently, you should  get tested. The testing is minimal effort and cost compared to the repercussions of untreated infection.  Sexually  transmitted infections have been taboo for a long time, but it is time that comes to an end. Get tested, talk to your  partner and friends about it, and encourage  them to get tested too. 

References -
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GOV UK, 2022
DOI:10.1111/and.12944
DOI: 10.1093/humupd/5.5.433
DOI: 10.1016/j.fertnstert.2008.06.051
DOI: 10.1016/j.contraception.2015.01.004