Gonorrhoea and infertility

The World Health Organisation (WHO) has plenty to say about sexually transmitted infections (STIs). Thanks to them, we know that there are eight different bacteria, viruses and parasites that can be transmitted through unprotected sexual contact. We also know they are linked to the greatest incidence of STIs.

Of these, only four bacterial infections are currently curable:

  • Syphilis (130,000 cases in US in 2019)
  • Gonorrhoea (616,000 cases in US in 2019)
  • Chlamydia (1 in 20 sexually active women in US – estimate)
  • Trichomoniasis (2.1% of sexually active women in US – estimate)

The other four are viral infections, which are incurable such as hepatitis B, herpes simplex virus (HSV or herpes), HIV and human papillomavirus but they are treatable.

An unfashionable STI 

Nowadays, gonorrhoea is publicly regarded as a disease of the past. A shameful and unpleasant pest of a disease that WW2 soldiers caught after dalliances with ladies of the night. These days it is swept under the carpet, with more focus on chlamydia, herpes and HIV/AIDS.

However, there is a problem and the 616,000 cases in the US don’t tell the whole story. Firstly, gonorrhoea, as well as being very unpleasant. if not terminal causes infertility. Secondly, it is a growing issue.

Neisseria gonorrhoeae: the bacterium responsible for gonorrhoea. The gonorrhoea bacteria are most often passed from one person to another during unprotected sexual contact, including oral, anal or vaginal intercourse.

In terms of infertility, gonorrhoea affects both women and men:

  • Infertility in women: Gonorrhoea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). PID can result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID requires immediate treatment
  • Infertility in men: Gonorrhoea can cause a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis) to become inflamed (epididymitis). Untreated epididymitis can lead to infertility.

The number of cases doesn’t tell the whole story. This is because rates of reported gonorrhoea in the US have increased 92% since the historic low in 2009. And during 2018–2019, the overall rate of reported gonorrhoea increased 5.7%. It is a growing problem.

Why is it growing?

Firstly, it has been swept under the radar by a focus on other STIs, which have caught the public attention for various reasons. Secondly, there is an issue with antibiotic resistance. The Center for Disease Control said, “Gonorrhoea can quickly develop resistance to antibiotics used to treat infection. In 2019, more than half of all infections were estimated to be resistant to at least one antibiotic.”

The current recommended antibiotic for treatment, ceftriaxone, is now beginning to be susceptible to resistance, with WHO stating, “An international spreading ceftriaxone-resistant gonococcal strain has been reported in Denmark, France, Japan and United Kingdom”.

This is not great news and heightens the need for people to take steps to ensure that they do not catch the disease in the first place.

Avoiding risk

In terms of risk, sexually active women younger than 25 who have unprotected sex are statistically at increased risk of getting gonorrhoea. Other factors that can increase risk include:

  • Having a new sex partner
  • Having a sex partner who has other partners
  • Having more than one sex partner
  • Having a sex partner who has had another (different) sexually transmitted infection.

The risk outlined above can, however, be greatly reduced by using a condom during vaginal sex. It is worth mentioning that using condoms and practicing safe sex also provides a degree of protection against other STDs, including HIV and chlamydia.

New antibiotics are already being tested for use against gonorrhoea. However, in the meantime it is worthwhile highlighting the new problem of this old adversary. It’s good reminder that it can cause long-term problems like infertility, and we mustn’t let this issue slip below the radar.