Mrs. T. informs you that she had had Chlamydia in the
past.  Could this affect her fertility?  

Chlamydia is the most common bacterial STI in the United
States, and is the leading cause of preventable
infertility (Morgan, 2006).  The risk factors for
infertility include the number of Chlamydia infections a
woman has had, as well as the length and severity of the
infection (Morgan, 2006).

Chlamydia is the generic name for infections that are
caused by Chlamydia trachomatis (Public Health Agency of
Canada, 2007).  C. trachomatis (CT) is responsible for
numerous syndromes, including urethritis and pelvic
inflammatory disease (Morgan, 2006).  Infected
individuals are often asymptomatic, leading to
under-diagnosis.  Despite this, over 65,000 cases were
reported in Canada in 2006 (202 cases per 100,000
population, Public Health Agency of Canada, 2006).  In
Canada, Chlamydia is a reportable infection

CT is a gram-negative obligate intracellular bacterium
that has an incubation period of one to 3 weeks, and the
ability to infect only human epithelial cells (Currie &
Bowden, 2007).  Currently, 18 different serotypes have
been identified, 11 of which are predominantly isolated
from the urogenital tract (Currie & Bowden, 2007).

A key issue in the discussion of Chlamydia and
infertility is the lack of symptoms in many infected
individuals.  Due to the lack of symptoms, a large
number of individuals go untreated, leaving chlamydial
infection present for prolonged periods.  This may lead
to pelvic inflammatory disease (PID), which can result
in ectopic pregnancy, infertility, and chronic pelvic
pain (Manavi, 2006).  It has been estimated that
untreated chlamydial infection leads to PID in 20-40% of
infected women (Paavonen & Eggert-Kruse, 1999).

PID is the result of postinfectious inflammation of the
female upper genital tract that may include salpingitis,
endometritis, and inflammation of the fallopian tubes
(Manavi, 2006).  It originates from the upward spread of
infectious organisms through the cervix and into the
uterus, fallopian tubes, or peritoneal cavity (Crossman,
2006).  Prolonged or repeated infection may result in
tubal scarring or obstruction, with infertility as the
result if both fallopian tubes are affected (Scott,
204).  

The clinical symptoms of PID are non-specific, and may
be missed in an infected woman if the symptoms are mild.
 The severity of the symptoms does not always correlate
with the severity of the disease however.  The spectrum
of disease ranges from subclinical, asymptomatic
infection to severe, life-threatening illness.  The most
common symptoms of PID include lower abdominal pain,
dyspareunia, abnormal vaginal discharge, bleeding, back
pain, and occasionally chills or fever (Crossman, 2006;
Manavi, 2006).  As indicated, many women with PID may
never experience any symptoms.

In men, chlamydial infection is associated with
epididymitis, non-gonococcal urethritis, and
prostatitis; however males are also frequently
asymptomatic, therefore do not seek treatment (Pacey &
Eley, 2004).  Evidence is accumulating that CT infection
negatively impacts the function of the sperm and the
quality of the semen (Pacey & Eley, 2004; Scott, 2004).

So, to take a short story and make it long, having
Chlamydia in the past could in fact be currently
impacting Ms. T.’s attempts to get pregnant.  The
difference with Ms. T. however, is that as she is aware
of having been infected, it is more likely that she
received treatment.  However, if she experienced damage
to her internal gynecological organs at the time of
infection, she may still have fertility issues.

Lisa and Nadine

References Crossman, S. H. (2006). The challenge of
pelvic inflammatory disease. American Family Physician,
73, 859-864. Currie, M. J., & Bowden, F. J. (2007). The
importance of Chlamydial infections in obstetrics and
gynaecology: An update. Australian and New Zealand
Journal of Obstetrics and Bynaecology, 47, 2-8. Manavi,
K. (2006). A review on infection with Chlamydia
trachomatis. Best Practice and Research in Clinical
Obstetrics and Gynaecology, 20(6), 941-951. Morgan, K.
(2006). Sexually transmitted infections.  In McCance, K.
 L., & Huether, S. E. (Eds.), Pathophysiology: The
biologic basis for disease in adults and children (5th
edition, pp. 875-878). St. Louis: Elsevier Mosby.
Paavonen, J., & Eggert-Kruse, W. (1999). Chlamydia
trachomatis: Impact on human reproduction. Human
Reproduction Update, 5, 433-447. Pacey, A. A., & Eley,
A. (2004). Chlamydia trachomatis and male fertility.
Human Fertility, 7(4), 271-276. Public Health Agency of
Canada. (2007). Canadian guidelines on sexually
transmitted infections 2006: Chlamydial infection
(Updated 2007). Ottawa: Public Health Agency of Canada.
Scott, G. (2004). Chlamydia and male fertility. The
Journal of the Royal Society for the Promotion of
Health, 124, 211-212.