Gonorrhea is a common bacterial infection transmitted through sexual contact that can significantly impact a woman’s ability to become pregnant. Caused by the bacterium Neisseria gonorrhoeae, it is a leading preventable cause of fertility issues worldwide. The risk of developing long-term reproductive complications increases substantially when the infection is not diagnosed and treated promptly. The primary mechanism linking gonorrhea to infertility involves the infection progressing into the upper reproductive tract.
How Gonorrhea Leads to Infertility: The Role of PID
Untreated gonorrhea initially infects the cervix. However, the bacteria can ascend into the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID). This upward migration triggers an inflammatory response in the upper genital tract. While the body’s immune reaction fights the infection, it causes collateral damage to the delicate reproductive structures.
PID leads to inflammation and subsequent scarring, primarily within the fallopian tubes, a condition known as salpingitis. The fallopian tubes are lined with cilia, which move the egg toward the uterus. The inflammation and resulting scar tissue destroy these cilia and can partially or completely block the tubes. This damage prevents the sperm and egg from meeting for fertilization, causing tubal factor infertility.
Impaired movement within the tubes can also lead to ectopic pregnancy. If the tube is only partially damaged, a fertilized egg may implant within the fallopian tube instead of traveling to the uterus. Ectopic pregnancy is a life-threatening medical emergency, as the fallopian tube can rupture and cause severe internal bleeding. Women who have had PID face a risk of ectopic pregnancy that is seven to ten times higher than those who have not.
Recognizing Symptoms and Seeking Prompt Treatment
A major challenge in preventing PID and subsequent infertility is that gonorrhea often produces no noticeable symptoms in women. Up to half of infected women may be completely asymptomatic, allowing the infection to progress silently and cause irreparable damage. This lack of early warning signs is why screening is important for sexually active women.
When symptoms are present, they are often non-specific. They may include a change in vaginal discharge (white or yellow), pain or a burning sensation during urination, bleeding between menstrual periods, or pain during sexual intercourse. Lower abdominal or pelvic pain can indicate that the infection has already ascended and caused PID.
The standard of care for treating uncomplicated gonorrhea involves a single, high-dose intramuscular injection of the antibiotic ceftriaxone. In many cases, a second antibiotic, such as doxycycline, is also prescribed, particularly if co-infection with chlamydia has not been ruled out. While this antibiotic regimen is effective at eliminating the bacterial infection and preventing further damage, it cannot reverse any scarring or tubal damage already caused by PID. This underscores the importance of early diagnosis and treatment before the infection ascends.
Testing, Screening, and Preventing Future Infections
Proactive screening is the most effective tool to prevent the long-term reproductive consequences of gonorrhea. Annual screening is recommended for all sexually active women under the age of 25. Women aged 25 and older should also be screened if they have risk factors. These include having a new sex partner, multiple sex partners, or a partner who has other partners.
Testing typically involves a nucleic acid amplification test (NAAT) performed on a urine sample or a swab taken from the cervix or vagina. Consistent use of barrier methods, specifically male latex condoms, reduces the risk of acquiring the infection. Limiting the number of sex partners also decreases the risk of exposure.
If a diagnosis is confirmed, it is necessary to notify all recent sex partners so they can be tested and treated. Partner notification and treatment prevent reinfection, which would increase the woman’s risk of developing PID and further tubal damage. Following treatment, women should be retested approximately three months later to confirm the infection is cured and reinfection has not occurred.