Gonorrhea: Could it Explain Some Cases of Infertility?

Gonorrhoea is one of the most common infections that can be passed on from man to woman or from woman to man during sexual intercourse. As with most sexually transmitted diseases (STDs), it is difficult to know who has it just by looking at them. Infection often does not cause any obvious symptoms in either men or women, which makes it more likely to spread and it means that the people who have it are more likely to develop long term problems as a result of the infection. Gonorrhoea, which is caused by the bacterium, Neisseria gonorrhoeae, is a common cause of infertility in both sexes.

What Symptoms Does Gonorrhoea Cause?

If you do get symptoms if you have gonorrhoea they are not very specific – the same symptoms can arise with other sexually transmitted diseases. In men, symptoms can appear within days, or they can take a month to show themselves, if they appear at all. Occasionally the testicles feel sore and swollen but the most common signs are a feeling of burning when trying to pass water, or a pus-like discharge from the end of the penis. Diagnosis is confirmed when this discharge is tested and live Neisseria bacteria are identified.

Women are even more likely to have no symptoms at all even if they have quite a serious infection. The bacteria live inside the cells of the mucosal surface of the genital tract – so they stay hidden from the immune system and don’t cause obvious damage. If there are symptoms, they are mild and are the same as any bladder or vaginal infection. The bacteria that causes gonorrhoea can also infect the throat and eyes if it is introduced there.

Gonorrhoea and Infertility

In men, whether or not they have symptoms of soreness in the testicles, the bacteria that causes gonorrhoea can damage the epididymis, the tubes that lead from the testicles to the penis, causing epididymitis. This causes a lot of inflammation and, because these are fairly narrow tubes, the swelling can easily block them up so that sperm can no longer travel from the testicles to the semen, resulting in male infertility or reduce fertility.

In women, gonorrhoea that is left untreated because the woman herself does not suspect that she has it, chronic infection can lead to pelvic inflammatory disease. This is a serious complication that can cause pus-filled abscesses in the pelvis, around or in the uterus, ovaries and fallopian tubes. As the infection becomes worse, this leads to quite severe pain in the abdomen in some cases, and a general feeling of being unwell, with fever, tiredness and nausea.

The fallopian tubes are very prone to being seriously damaged by the abscesses and this can block them, causing infertility and also making it more likely that any pregnancy that does occur will implant outside the uterus. Ectopic pregnancies can occur in any woman but they are more likely in women with chronic gonorrhoea. As there is little space on the end of the fallopian tube, the pregnancy ends early and the fallopian tube can rupture, leading to a medical emergency.

Getting a Test for Gonorrhoea

If you think you may have been exposed to gonorrhoea by having had unprotected sex (sex without condoms) with someone who might be infected with gonorrhoea, it makes sense to get tested. A urine sample can be used to see if the bacteria that cause gonorrhoea are present in the cervix or urethra in men. Women who are suspected of having pelvic inflammatory disease may need to have an ultrasound scan to see the scale of the problem.

If gonorrhoea is diagnosed, you will be started on a course of antibiotics that should clear up the problem but pelvic inflammatory disease can take weeks to treat, and longer for the damage to heal. Even after the infection has gone, the scar tissue that has formed can still affect the fallopian tubes, causing long-term infertility.