Healthcare provider discussing with telehealth patient whether chlamydia can make you infertile

Can Chlamydia Make You Infertile?

Written on November 24, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Chlamydia is the most commonly reported sexually transmitted disease (STD) caused by bacteria in the United States.[1] Unfortunately, chlamydia does not always cause symptoms when it infects either men or women. Chlamydia is easy to treat and cure as long as it is diagnosed early on in the infection.

You may have wondered, “Can chlamydia make you infertile?” When left untreated, chlamydial infections are a significant source of both male and female infertility.[1] The World Health Organization (WHO) defines infertility as “the inability of a sexually active, non-contraceptive couple to achieve pregnancy in one year.”[2] Infertility affects about 15 out of every 100 couples.[3]

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Chlamydia’s Silent Symptoms (Usually)

One of the main reasons why so many chlamydia infections go untreated is that people don’t know they have symptoms. Chlamydia’s symptoms (if it causes any) are mild and frequently ignored until they become more serious. Most people infected with chlamydia don’t have any symptoms.[1] The most common signs of chlamydia infection are [4,5]:

If you suspect you have any of these symptoms or think you might have chlamydia, consider taking an at-home chlamydia test.

While untreated chlamydia causes problems for both sexes, people with vaginas tend to have more complications the longer the time until treatment.[4,5]

The increased risk of more severe infections and infertility in those people assigned female at birth (AFAB) is why the CDC recommends annual chlamydia and gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors. Such factors include having new or multiple sex partners or a sex partner who has a sexually transmitted infection.[1]

The Chlamydia, PID, and Female Infertility Connection

If they aren’t treated, about 1 in 10 women will develop a more severe infection of their reproductive system called pelvic inflammatory disease (PID).[1] PID happens when the bacteria and the infection they cause in your vagina or cervix spread up into your uterus, fallopian tubes, and ovaries.[6]

If not treated, PID can cause scar tissue and pockets of infected fluid called abscesses. Scar tissue, abscesses, and the inflammatory response to the infection can cause permanent damage, resulting in problems getting pregnant.[7-8]

Getting pregnant requires that your fallopian tubes are open, and microscopic propellers called cilia help the egg (both before and after fertilization) move safely down into your uterus for implantation.

Scarring, blocked tubes, and chronic inflammation of the fallopian tube increase people’s risk of having a pregnancy in the tubes, called an ectopic pregnancy. Ectopic pregnancies can be a life-threatening medical emergency, costing people their future fertility and even their lives if a fallopian tube ruptures.[9]

Studies estimate that approximately 20% (2 out of every 10 women) with chlamydial lower genital tract infection will develop PID.[7] About three out of every 100 women with chlamydia will develop infertility.[7]

Male Infertility and Chlamydia

Half of all infertility cases are male-related.[3] Chlamydia interferes with the normal functioning of the male reproductive system. It can spread beyond the entry point (the urethra in the penis) to cause inflammation and infection of male reproductive organs such as the testes, epididymis, and prostate. Infection and inflammation of the male reproductive tract can cause [3]:

  1. Changes in sperm motility
  2. Changes in semen concentration
  3. Changes in the shape and appearance of sperm

These STD-related changes may cause up to 15% of male infertility cases.[3] Because so many cases of chlamydia in men don’t have any symptoms, too many people put their fertility (and their partner’s fertility) at risk by not getting regularly tested for STDs like chlamydia.

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Other Potential Health Consequences of Untreated Chlamydia Infections

Infertility is not the only possible consequence of not treating your chlamydia infections. Other long-term effects of chlamydia can include:

  1. Epididmytitis (in those with testicles)
  2. Reactive arthritis

Beyond putting you at risk for infertility, epididymitis is painful, can cause a fever, and may require emergency treatment if you have acute pain or severe swelling of your scrotum. The epididymis is a small, coiled tube found at the back of the testicles responsible for storing and transporting sperm.[10]

Reactive arthritis is joint pain and swelling triggered by an infection in another part of the body, in this case, the genitals. This condition usually affects the knees, ankles, and feet. Your eyes, skin, and the tube that carries urine out of your body (urethra) may also become inflamed. Typically, symptoms of reactive arthritis resolve within one year but can come and go.[11]

Rapid Chlamydia Testing and Treatment Can Prevent Infertility

Infertility caused by a chlamydia infection is entirely preventable. There is a cure for chlamydia—antibiotics effectively kill the bacteria responsible for this common STD. Sometimes, they can be taken as a one-time single dose of an antibiotic called Azithromycin, depending on your allergy status.[12]

Unfortunately, it can seem like chlamydia can come back, even after treatment. Chlamydia may not be completely treated if you do not take your medication as prescribed by your healthcare provider or if your partner reinfects you. It is important to tell all sexual partners from the last three months that you have chlamydia and encourage them to get chlamydia testing. Doing so will help slow the spread of chlamydia and its related infertility woes later on.

To avoid infecting your sex partners, you should abstain from sexual intercourse for 7 days after you take your single-dose chlamydia therapy (Azithromycin) or until completion of a 7-day regimen (Doxycycline or Levofloxacin) and resolution of any symptoms, if you had them.[12] To avoid passing chlamydia back and forth, you should abstain from sexual intercourse until all of your sex partners have been treated (at least 7 days).

Early chlamydia treatment to prevent infertility requires regular screening, even if you don’t have any symptoms. For women, chlamydia can be diagnosed by vaginal or cervical swabs or from urine. For men, urethral chlamydial infection (in the penis) can be diagnosed by testing first-void urine or with a urethral swab. Optimal urogenital specimen types for chlamydia screening include first-catch urine (for men) and vaginal swabs (for women) [12]. At-home sample collection chlamydia testing is available over-the-counter through companies like Everlywell.

While it does not cause infertility, chlamydia can be spread through rectal and oral sex as well. The CDC recommends annual rectal screening for Chlamydia infection for men and women having anal intercourse after a shared clinical decision-making discussion between you and your healthcare provider. Oral chlamydia infections can be spread to genital areas, so they should be treated if tests show that you have a chlamydia infection of your mouth or throat. The CDC does not currently recommend routine screening of your mouth or throat for chlamydia.[12]

Fast and Discreet Chlamydia Testing and Treatment Is Just a Click Away With Everlywell

With the Everylwell online STD treatment telehealth option, you can access sexual health right at your fingertips. Specialized telehealth providers can speak with you within 2 hours, helping you determine your risk factors for STDs and which STD tests might be right for you, such as a chlamydia test.

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References

  1. STDs and infertility. CDC. https://www.cdc.gov/std/infertility/default.htm. Published April 1, 2023. Accessed November 15, 2023.
  2. Infertility. WHO. https://www.who.int/news-room/fact-sheets/detail/infertility. Published April 3, 2023. Accessed November 15, 2023.
  3. Goulart ACX, Farnezi HCM, França JPBM, Santos AD, Ramos MG, Penna MLF. HIV, HPV and Chlamydia trachomatis: impacts on male fertility. JBRA Assist Reprod. 2020;24(4):492-497. Published 2020 Oct 6. doi:10.5935/1518-0557.20200020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558888/.
  4. Chlamydia. Planned Parenthood. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/chlamydia. Accessed November 15, 2023.
  5. Chlamydia trachomatis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chlamydia/symptoms-causes/syc-20355349. Published April 14, 2023. Accessed November 15, 2023.
  6. Pelvic inflammatory disease (PID). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed January 21, 2021.
  7. Paavonen J, Eggert-Kruse W. Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update. 1999;5(5):433-447. doi:10.1093/humupd/5.5.433.
  8. Passos LG, Terraciano P, Wolf N, Oliveira FDS, Almeida I, Passos EP. The Correlation between Chlamydia Trachomatis and Female Infertility: A Systematic Review. A correlação entre clamídia trachomatis e infertilidade feminina: Uma revisão sistemática. Rev Bras Ginecol Obstet. 2022;44(6):614-620. doi:10.1055/s-0042-1748023.
  9. Mullany K, Minneci M, Monjazeb R, C. Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Women’s Health. 2023;19. doi:10.1177/17455057231160349.
  10. Epididymitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/epididymitis/symptoms-causes/syc-20363853. November 15, 2021.
  11. Reactive arthritis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838. Accessed November 15, 2023.
  12. Sexually transmitted infections treatment guidelines, 2021. CDC. Published July 22, 2021. Accessed November 15, 2023. https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm.
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