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IN THE FACE OF RELENTLESSLY MOUNTING EVIDENCE THAT EVEN ONE UNPROTECTED SEXUAL ENCOUNTER COULD LEAD TO A LIFETIME OF COMPLICATIONS, SICKNESS ANDSOMETIMES DEATH, IT’S NOW CONVENTIONAL WISDOM TO TAKE PRECAUTIONS. That’s a good thing because there’s another, often overlooked piece of the unprotected sex story: the connection between sexually transmitted diseases or infections (STDs/STIs) and infertility.

Every year, people trying to create families make the awful discovery that their ability to achieve or sustain a pregnancy is compromised by the effects of an STD or STI. And as anyone who has wrestled with reproductive difficulties will tell you, it’s one miserable experience to want to make a baby and not be able to. At least not without medical interventions—if luck is smiling. The worst part is, it didn’t have to happen.

That makes education about the undeniable link between STDs and infertility a potent motivator to practice safe sex. While young people might not grasp the concept of their own mortality, they do get that what they do today may thwart their expectations, their one-day, someday dream of becoming mothers and fathers.

Every year at least 111 million new cases of curable sexually transmitted infections (STIs) and half of all new HIV infections occur among young people, according to recent studies. STIs affect human fertility primarily through infections of the female upper genital tract and, less frequently, through obstructions of the male vas deferens. STI’s and STDs are equal opportunity afflictions. Too often, kids who have unprotected sex think that the worst that could happen is getting pregnant or contracting some kind of treatable disease. Even more frightening, they often don’t know when they are engaging in risky sexual behaviors. We need to open up our informational initiatives to make everyone aware of what’s at stake and what to do about it.

Fertility problems are common. According to a recent epidemiological study in Human Reproduction, one in six couples around the world have experienced difficulties at some point in their reproductive lives. (The standard definition is when people are unable to conceive after a year of unprotected sex. On average it takes six months for a 30-year-old couple to achieve pregnancy.) Frequencies vary from country to country. For example, STD-related infertility occurs three times more often in Africa than in other parts of the world, while one in ten U. S. couples are affected. But what all countries have in common is the dual rise in infertility due to delayed childbearing and, significantly, sexually transmitted infections.

STIS: PREVENTABLE INFERTILITY

Responsible family planning really means making fully informed decisions about all aspects of reproduction. The knowledge gap about the links between STDs and fertility leaves us all vulnerable. Misinformation about what constitutes appropriate prevention is rampant. In the first-ever global survey about basic fertility facts conducted by The American Fertility Association and Dr. Richard Scott of Reproductive Medicine Associates of New Jersey, out of 17,500 respondents nearly half answered that general health is a good indicator of fertility. It is not.

It’s important to know that a normal gynecological check-up does not include routine testing for the top four STDs that are most likely to affect fertility. Passing a general physical with flying colors isn’t a reliable pregnancy prognosticator, even though a healthy lifestyle can help preserve fertility. Women (and men) ages 19 to 26 are the most vulnerable population because they are the most sexually active as a group. Yet early intervention is also critical for teens, since they are sexually active too.

Many young people don’t seek treatment because even the idea of STIs feels shameful. They fear public disclosure, ruined reputations, and repercussions from angry parents and community elders. We have to understand and find appropriate ways to help people overcome these barriers to reproductive health. Young people must be encouraged to seek medical treatment and advice as soon as they suspect they may have contracted an infection. Repeated testing is also critical, since STIs can be asymptomatic for long periods.

DOES SAFER SEX HELP?

What actually is sexual contact? Do you really know when you’re having sex? In a society where “Friends with Benefits” is a commonplace description of sexual relationships without obligations, many people erroneously think that anal penetration, oral sex, or mutual masturbation doesn’t “count” as sex. But all of these are sex and do count!

Sex is not just whatever gets you pregnant. It also includes acts that can cause potential health risks from sexual and sexualized activity, including some types of foreplay and even kissing. We have to insure that the real answer to the question: “How could I get an STD? We didn’t even have sex?”—is fully understood. And we have to clarify the full spectrum of what encompasses sexual behavior. In truth, even the term “safe sex” is a misnomer. The reality is that one can only have “safer sex.” We don’t want to spread fear and anxiety, but we must alert sexually active people to take proactive steps on their own behalf.

LET’S START TALKING

Differences in religion, culture, and ethnic history affect sexual behavior and how we teach reproductive health, but not the reasons why. Protecting reproductive fertility is critical to all societies.

WHAT ARE STIS AND STDS?

Sexually transmitted infections are synonymous with sexually transmitted diseases, although STI is the currently preferred terminology.

Up to 75 percent of sexually active women and men will get an STI of some kind.

According to NYU Medical Center infertility and teen reproductive health specialist Dr. Nicole Noyes, “It is estimated that 19 million new cases of sexually transmitted infections occur each year in the United States, half of these occurring in young people aged 15 to 24 years….” In fact, 25 percent of sexually active teens acquire one or more sexually transmitted infections. [But] all individuals (adults and teenagers) who engage in sexual activities are at risk…”.

HOW CAN I GET ONE?:

Very simply, unprotected sex can lead to STIs. Untreated STIs can cause infertility. STI symptoms are often undetectable until long after infection.

• The top five STD’s that affect fertility are Chlamydia, Gonorrhea, PID (pelvic inflammatory disease), Syphilis, and HPV.
• People the world over understand that HIV/AIDS is transmitted sexually, yet we are woefully behind in helping them understand the more-than-20 other viral and bacterial diseases that can infect people through oral, anal, or vaginal sex. Some, like HPV, don’t even require an exchange of bodily fluids. Research is still being done into the lesser-known effects of these diseases on fertility. For example, cervical abnormalities have been found to be common in HIV-infected girls. Even women who have had premature delivery in the past are now recommended by some doctors for screening and treatment of bacterial vaginosis to avoid further complications that could lead to secondary infertility.
• Pelvic Inflammatory Disease (PID) is the most common cause of infertility, and often asymptomatic. Again, Dr. Noyes: “PID is a term used to describe an upward traveling infection in the female body that results from vaginal intercourse with an infected partner. This infection causes fallopian tube, ovarian and/or pelvic damage. The primary bacteria responsible for PID are Chlamydia and Gonorrhea [although most are polymicrobial.] Left untreated, almost half of Chlamydia and Gonorrhea infections progress to PID. In the U.S., more than one million women each year seek treatment for PID, and more than 100,000 become infertile because of this disease. Gonorrhea is thought to account for 40% of all PID cases.” Chlamydia can also spread from the urethra to the testicles and cause permanent disability and sterility in men if left untreated.
• HPV, the most common STI in the U.S., while only indirectly linked to infertility, causes cervical cancer (the second most common type, after breast cancer , among women worldwide). Twenty-five million women now have HPV (a figure far higher than previously believed), including nearly half of those between 20 and 24. Approximtely11,000 American women are diagnosed each year and 3,700 will die of the disease. HPV can also compromise fertility down the road, since treatments for HPV include chemotherapy, which can affect fertility, and obviously, hysterectomies.
• HPV virus is so ubiquitous that scientists compare it to the common cold. It can metastasize years after transmission, often affecting women in their late 30’s. Mouth-to-mouth transmission is possible, so kissing can spread it. Oral sex, hand-to-genital contact, wet toilet seats, and sweat, in addition to other kinds of body fluid exchange, make this STI harder to prevent than any other kind through safer sex.
• Luckily, there are new vaccines that can prevent the spread of this quiet, but fertility-compromising disease. Their long-range efficacy and side-effects are still being studied, but everyone who is sexually active should carefully consider the possible benefits prophylactic vaccination. Additionally, since the current vaccinations only last five years, the need for continued screening is critical.

HOW CAN I PREVENT STDS?

What are common misconceptions about what behaviors to avoid? People want clear answers to questions about what is safe/safer sex, even if the “right” questions aren’t asked. When discussing these issues:

• Talk frankly about how to protect against the top threats to fertility. Using condoms each and every time definitely lowers transmission of STIs, but does not prevent them all;
• Emphasize the importance of seeking treatment early;
• Be aware of cultural, psychological, or economic barriers to following through or finding the proper advice or treatments; and,
• Accept the reality that young kids will have sex, regardless of what their parents, elders, teachers, or government officials will say.

ENCOURAGING PERSONAL RESPONSIBILITY AND SAFER SEXUAL BEHAVIOR

Understanding one’s sexuality is a lifelong process. Again, according to Dr. Noyes, “Many teens use contraception only sporadically. Consistency is critical.” Most importantly, we need to teach people how to advocate for themselves with medical practitioners and with their sex partners.

We need to find the most effective means to communicate key concepts:

• Don’t give into pressure (self-imposed or other generated) to participate in sexually-risky behaviors.
• Understand the importance of testing and the need to get tested regularly.
• Keep yourself safe. Don’t allow body fluids, including blood, semen, or seminal fluids, vaginal fluids, and the discharge from sores caused by STIs to get into your or your partner’s body (vagina, anus, or mouth).
• Know your partner and talk to them about these issues, but rely on yourself to stay safe.
• Tell partners that you care about protecting your fertility now and in the future. Ask to see test results before you engage in sexually risky behaviors. (According to Planned Parenthood, more than one in three people will lie about their STD/STI status and sexual history—including whether or not they have HIV!— to have sex with someone else.)
• Even though most medical providers don’t volunteer to do so, or even ask about sexual behavior, everyone needs to ask to be tested routinely for the four top fertility-affecting diseases.
• Seek medical care as soon as you suspect an STI because of symptoms or known exposure to a carrier. Don’t keep secrets from your medical provider and don’t wait!

EDUCATING OURSELVES, EDUCATING THE WORLD

By encouraging healthy sexual behaviors and helping people understand how to avoid risky behaviors that might compromise fertility in the future, we can begin to ensure that those who want to have babies biologically can do so, without enduring the heartbreak and burdens—the real economic, psychological, and social costs—infertility can bring to individuals and communities the world over. If we are to fight for people’s reproductive health we must work to insure that all who want to conceive receive better education about STDs. This one big step will lower infertility rates dramatically. Information, open talk, and education are crucial for us all.

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