April is STD (Sexually Transmitted Diseases) Awareness Month, and unfortunately, sexually transmitted infections (STI), which can be the result of unprotected sex, are frighteningly common. The Centers for Disease Control and Prevention (CDC) estimates that 19 million new STIs occur each year, almost half of them among young people ages 15 to 24.  It has also been reported that by the age of 24, one in three sexually active people will have one or more STIs, and over the course of a lifetime up to 75 percent of sexually active women and men will get an STI of some kind. 

The magnitude of the problem is worsened by the fact that the impact of STIs on an individual can be devastating.  Short-term, STIs may not cause any symptoms or they can cause pain, vaginal or penile discharge, genital sores or blisters, and fever.  In some, STIs can result in chronic pain, an increased risk of certain cancers, neurological difficulty, liver failure, and even death. STIs can also cause infertility, in part because they often display few, if any visible symptoms. Because women and men are frequently unaware that they have an STI, they do not to seek treatment, which further threatens their fertility.

Common STIs include chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), genital warts (human papilloma virus, HPV), herpes simplex virus (genital herpes, HSV), and hepatitis. Chlamydia remains the most reported infections disease in the United States. It is estimated that there are approximately 2.8 million new cases of Chlamydia in the United States each year.  Gonorrhea is the second most commonly reported infectious disease in the United States, with over 300,000 cases reported in annually.  Like chlamydia, gonorrhea is substantially under diagnosed and under reported, and approximately twice as many new infections are estimated to occur each year as are reported.  Though other STIs can impair fertility, chlamydia and gonorrhea are most likely to do so.

In women, chlamydia and gonorrhea, as well as other bacteria, can cause pelvic inflammatory disease (PID), which is an infection that travels upward from the vagina through the cervix to the uterus and fallopian tubes.  This infection can lead to scarring and blockage of the fallopian tubes.  PID can occur in up to almost half of untreated chlamydia and gonorrhea infections.  Over one million women each year seek treatment for PID in the United States; more than 100,000 women become infertile because of this disease, and the vast majority are unaware of the that it is happening.

In men, chlamydia and gonorrhea can travel upwards from the urethra all the way to the testicles. This can cause permanent sterility in men in a number of ways.  The scarring from the infection can block the passage of sperm.  In addition, injury to the testicles from an infection can interfere with sperm production and function.  Approximately 15% of male infertility is from STIs.

As we know, STIs can result from unprotected sex.  If one is engaging in sexual activity, the best way to reduce the transmission is to practice “safe” sex.  Condoms should always be used; they definitely reduce the transmission of STIs, but condom use does not prevent them all.  It is important for sexual partners to communicate about safe sex practices.  However, rely on yourself to stay safe.  It is OK to ask to see test results before you engage in sexual activity with a new partner. This is important, because according to Planned Parenthood, more than one in three people will lie about their STI status and sexual history in order to have sex. 

If any symptoms, such as pelvic pain or vaginal or penile discharge, are present, evaluation by a medical provider should be sought promptly, as timely treatment reduces the risk of long term complications.  Finally, a routine gynecologic examination does not necessarily detect STIs and may not even screen for them.  It is important to have an honest and open relationship with your medical provider, and ask for STI screening if you are sexually active.