For the then 22 year old Tina*, it was a thing of common sense for her to use protection whenever she had sex with her boyfriend, but after some months together, she relaxed her guard and agreed to do without it, as her man had always wanted. Besides, she felt that they had been steady for months, and thus had an exclusive relationship.
Unfortunately for her, she got the dreaded sexual infection Gonorrhoea. She had no idea what they were at that time, and after using some over- the-counter drugs that obviously just suppressed the disease, she basically went untreated for it. A year later, it re-emerged in the form of Pelvic Inflammatory Disease (PID).
During that bout of PID, she said, she was unable to do anything. She could not walk or hold anything, and had an incessant sharp pain in her pelvic area, as though she was being stabbed. She had to be rushed to the hospital in the dead of the night, where it was discovered that the untreated sexually transmitted disease she had a year ago was responsible for what she was now going through. She was again treated for both the infection, and the resulting PID.
Alas, like a lot of women, she was less than smart afterwards, and got back into a relationship with the same guy who had infected her earlier (who had, by the way, vehemently denied having the disease and had refused to be treated for it). Although she claimed not to have had unprotected sex with him again, a routine pap smear showed that she had Human Papillomavirus (HPV), the leading cause of cervical cancer. She was perplexed by this discovery. It was almost as if her so-called boyfriend was out for her blood…as if she had hurt him in some way, and he was seeking revenge.
She underwent treatment for that and the abnormal cells on her cervix were removed, but she was told there was a possibility that the procedure could impact her ability to conceive.
Years later, the boyfriend was (finally) history, and she was married to a wonderful man. However, four years into her marriage, Tina is still trying to conceive.
She said, “I cry sometimes thinking about it, thinking about how I have jeopardized my chances of becoming a mother by my carelessness and stupidity. I want a baby but given my history with STDs, there is a possibility it might not happen…but there is nothing God cannot do. I’m still waiting for it to happen naturally, but we will think of assisted reproduction, once we can afford it.”
The reality is this, sexually transmitted diseases are so common, in fact, it is one of the most frequent reasons people go to see a doctor. Although, there are no figures for women dealing with infertility in Nigeria, you can be sure that STDs account for a large percentage of the infertility numbers.
A survey carried out in Osun state showed that infertility caused by the aftermath of an STI was in the minority, as, out of 200 cases of infertility, cervical factors, Pelvic Infection Disease (PID), and endometriosis accounted for 3%, 5.5% and 2.5% of the cases respectively. But they didn’t take into account the fact that PID is often an outcome of an STD.
Internationally, the outcome of a study stated that, out of the nearly 2 million women in the United States who were infertile, there was a likelihood that at least some of them had had STDs, which led to PID, and which can take off between 10 to 20 percent of a woman’s fertility.
This is the reality of Bisi’s* life right now, as she shuttles between her business and the hospital for her cervical cancer treatments. She was a happy single mom, who was trying her best to raise her kids, and possibly get married some day, until the blip of a positive cervical testing showed up on her radar.
She got tested during a one-off medical fair in her church, during their women’s programme. It was discovered that she had the HPV and needed to undergo treatment. She followed up and for some time, it appeared to be clearing up, until a scan showed that there was really more cause for concern.
The doctors went for the jugular when they told her that they might have to remove her womb to save her life and stop the spread of the virus. Right there, she thought, “There goes my dream of being a wife, and having more children!!!”. But the bigger fear for her was not being able to see her children grow up.
You see, Bisi was not a promiscuous woman. Yes, she had had babies for two different men, both of whom had refused to marry her. Following that, she had kept to herself, and ensured that all her following relationships did not include sex. She just did her best to take care of her children and her business. But the way this HPV works is this; if a woman is sexually active, she is exposed to it. Once in the cervix, there is the possibility of the virus reproducing, and that is the real source of concern. Thankfully, there are vaccines to cure, and possibly prevent it.
While HPV can threaten a woman’s life, chlamydia bacteria is the silent killer of fertility, if left untreated or partially treated. More insidiously, doctor have revealed that, even when a woman no longer tests positive for an active infection, the chlamydia bacteria may have moved into her upper genital tract and set off PID, which may lead to pelvic pain (like Tina’s case), or could be without any symptoms. But, ultimately, it often leaves to inflammation and scar tissue that could block a woman’s fallopian tubes, thus preventing fertilization. It is also the most common cause of ectopic pregnancy, which can be fatal.
Other STDs that can impair fertility includes the Genital herpes which is most often a lifelong partner. It comes with sores in the genital area. You can only control the symptoms but it can be transferred to babies during child birth, if care is not taken. Although doctors cannot find a direct link between herpes and infertility in women, it is definitely a factor for male infertility.
There is also Gonorrhoea, which is a bacterial infection which doctor says primarily affects the vagina, cervix, uterus, and fallopian tubes in women and affects the urethra, epididymis, and testes in men. All the reproductive organs are practically invaded by these bacteria.
The major long-term effect of gonorrhoea infection for women is the development of tubal disease and damage. Although tubal surgery may help affected women achieve pregnancies, most will need IVF. Untreated or recurrent infection is associated with higher rates of later infertility.
Babies in the womb can also be affected by gonorrhoea, as during pregnancy, gonorrhoea is associated with miscarriage, low birth weight babies, premature delivery, and opthalmic (eye) infection of the baby, which, if untreated, can result in blindness. Just imagine saddling a child so longed for with all those issues, even before itâs got a fighting chance.
Untreated gonorrhoea in men can result in infection of the testes and surrounding tissues (epididymitis or orchitis). Occasionally this can lead to difficulty in transporting sperm, and thus male factor infertility. A Nigerian study suggested that male factor infertility rates may be as high as 50% following untreated gonorrhoea infection.
These facts might look bad, but it should instead be a call to action for us all. In order to improve our chances of getting the babies here on time, it will definitely be a smart move to get checked for sexually transmitted diseases early, and ensure they are not a factor in the TTC journey.
Food for thought!
Join the conversation with any of our TTC and Pregnancy Groups here.