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June, 1993 |
Complications and SequelaeSome sexually transmitted diseases threaten the fertility of both men and women. In women STD pathogens migrate up from the lower reproductive tract, causing pelvic inflammatory disease (inflammation of the uterus, fallopian tubes, ovaries, or other pelvic structures), chronic pelvic pain, and infertility (See Figure 2). Sexually transmitted diseases, mainly chlamydia and gonorrhea, cause most cases of pelvic inflammatory disease (249, 321). An estimated 8% to 20% of women with untreated cervical gonorrhea develop pelvic inflammatory disease (79, 145, 320). In a Swedish study begun in 1960, one of the largest studies of pelvic inflammatory disease, 18% of women with pelvic inflammatory disease had chronic pelvic pain compared with about 5% of women who had not had pelvic inflammatory disease (321). Often the first symptom that women with chlamydial infection notice is the pain of pelvic inflammatory disease. At that point any damage to the fallopian tubes is irreversible. Pelvic inflammatory disease can cause infertility. Without treatment 55% to 85% of women with pelvic inflammatory disease may become infertile (321). In some areas pelvic inflammatory disease is a common cause of women's infertility. In a study in Zimbabwe 84% of 135 infertile women with abnormal fallopian tubes had a history of pelvic inflammatory disease (67). Many women may lose their fertility without ever realizing that they had pelvic inflammatory disease. For example, in 14 studies of women with blocked fallopian tubes, 40% to 80% did not report that they had had pelvic inflammatory disease (197). STDs also can increase a woman's risk of ectopic pregnancy, a condition that can kill from sudden and severe internal bleeding when the out-of-place pregnancy ruptures the fallopian tube. Studies in the 1980s in developing countries found that ectopic pregnancy caused 1% to 15% of all maternal deaths (189). Pelvic inflammatory disease, by permanently scarring and narrowing the fallopian tubes, increases the risk that a pregnancy will be ectopic by 7- to 10-fold (321). A US study found that genital chlamydial infection more than doubled a woman's risk of having an ectopic pregnancy (52). In men infertility may follow an infection that spreads from the urethra (where it is described as urethritis) to the epididymis (epididymitis) (see Figure 2). In men under age 35 the most common cause of epididymitis is gonorrheal or chlamydial infection (26). Before antibiotics became available, 10% to 30% of men who had gonorrhea developed epididymitis, and 20% to 40% of men with epididymitis became infertile (220). Some STDs attack the fetus and infant. In two-thirds or more of pregnant women with syphilis, the infection spreads to the amniotic sac and infects the fetus (334). About 40% of infected pregnancies end in spontaneous abortion, stillbirth, or perinatal death (68). Gonorrhea or chlamydia may spread to the eyes of babies as they pass through the cervix and vagina. Without preventive therapy 2% to 50% of infants exposed to the gonorrhea-causing bacteria Neisseria gonorrhoeae during birth develop eye infections (ophthalmia neonatorum) (109, 151, 255). In a number of developing countries ophthalmia neonatorum afflicts 5% of newborns (191). Without treatment ophthalmia neonatorum permanently damages the vision of 1% to 6% of affected infants (88, 229). Chlamydia also may spread to the lungs of newborns and lead to chlamydial pneumonia. |