Medically reviewed by Dr Danae Maragouthakis
If any of these questions have ever crossed your mind, you’re not alone! There’s a lot of misinformation out there about STIs, compounded by the unjustified stigma and shame that still surrounds the subject. For all of these reasons (and many more), STIs can feel awkward to talk about, be it with your closest friend or a medical professional.
But this has to change — particularly in places like the UK, where someone is diagnosed with an STI every 70 seconds! STIs are increasingly common and nothing to be ashamed of. If the last year has shown us anything, it’s that infections happen…and luckily, we have ways to treat them.
Often people may not realize that they have an STI because many infections can have mild symptoms or no symptoms at all. Without symptoms, they don’t seek treatment. Without treatment, they continue to unknowingly infect others. And the longer they go without treatment, the greater their risk of developing chronic health complications from an ongoing STI.
Sexual health is an important part of your overall health, which can significantly affect your fertility. So whether you’re pregnant, trying to become pregnant, or thinking about becoming pregnant at some point in the future, here are some important points when it comes to STIs and fertility.
Can you become pregnant if you have/had an STI?
Can you become pregnant if you have an STI? In short, the answer is yes. Pregnant people can contract and transmit all of the same STIs as people who are not pregnant. However STIs in pregnancy have the potential to be passed from mother to child, resulting in serious health problems for the baby and adverse outcomes. This is why people who are pregnant or trying to conceive are screened (and treated) for STIs as part of routine medical care.
Can you become pregnant if you had an STI? Generally speaking, the answer is yes. But the biggest determinants of this are which STIs you’ve had, and how quickly and effectively the infections were treated.
How do STIs affect fertility?
First, let’s talk about how exactly STIs can affect fertility. Even if an STI isn’t causing any symptoms, it’s still causing inflammation in the genital tract. Inflammation (especially if recurrent or ongoing) leads to scarring, which can impair fertility for:
- People with a penis and testicles: either by damaging the testicular tubes through which sperm travel (i.e. inhibiting sperm transport) or impairing the production of sperm in the testes (i.e. spermatogenesis).
- People with a vagina, uterus, and ovaries: by damaging the fallopian tubes, uterus, and/or surrounding tissues, thus preventing an egg from successfully implanting in the womb (i.e. pelvic inflammatory disease, or PID).
PID is one of the leading causes of infertility in women, with as many as 1 in 10 becoming infertile as a result. The good news? PID can be cured with antibiotics. The not so good news? Antibiotic treatment does not reverse scarring to the reproductive organs that has already been caused by infection. In an effort to avoid scarring, it is imperative that individuals with PID symptoms receive immediate treatment. According to the Centers for Disease Control and Prevention, up to half of PID cases are caused by chlamydia or gonorrhea infection.
Can you get pregnant with chlamydia or gonorrhoea?
Chlamydia and gonorrhoea are two of the most common bacterial STIs in the world, with 161,172 and 57,084 new diagnoses (respectively) in the UK last year. If left untreated, approximately 10–15% of chlamydia cases and 10–20% of gonorrhoea cases will go on to develop PID.
Fortunately, both chlamydia and gonorrhoea are curable with a course of antibiotics, making them the leading preventable causes of infertility. If treated early, most people who contract chlamydia or gonorrhoea won’t develop PID and won’t experience difficulties conceiving that are related to the infection.
Can you get pregnant with herpes?
Genital herpes is a common STI caused by either strain of the herpes simplex virus (HSV1 or HSV-2), which affects the skin around the mouth or genitals. In the UK, it is estimated that 70% of the population has HSV-1 and up to 20% has HSV-2. There is no cure for HSV, so after infection the virus will stay in your body. However HSV remains dormant most of the time, unless it is reactivated, causing an outbreak. Even during outbreaks, the symptoms of HSV can be effectively managed with medications. While intimate contact should be avoided during an outbreak to prevent transmission, herpes is not thought to cause infertility.
Can you get pregnant with HPV?
Human papillomavirus (HPV) is a collection of over 100 common viruses, many of which affect skin surrounding the mouth, throat, and anogenital areas. These viruses don’t cause problems in most people and the infection usually clears up on its own (without treatment), once the body develops its own immunity. However, as specific strains of HPV are known to cause anogenital warts, while others cause certain cancers, the different types of HPV are further classified as “low-risk” or “high-risk.”
Infection with most low-risk HPV strains will not cause symptoms. These viruses have no association with cancer, but they can cause warts around the genitals, mouth, or anus. Two of these HPV strains (types 6 and 11) cause more than 90% of such warts. However these low-risk HPV infections will not affect your fertility.
There are at least 12 high-risk HPV strains associated with cancer, of which two (types 16 and 18) cause the majority of HPV-related cancers, including cancer of the cervix, anus, penis, and throat. These high-risk HPV strains can cause “precancerous” changes in the cells that line the cervix (otherwise known as CIN — cervical intraepithelial neoplasia), which may lead to fertility issues.
This is because the procedures used to treat CIN (i.e. cryotherapy, loop electrosurgical excision procedure [LEEP], and cone biopsy) can narrow the cervix and change the consistency of your cervical mucus, both of which make it harder for sperm to reach and fertilize the egg. But according to Dr Bradley J Monk, MD and associate professor in the division of gynecologic oncology at the University of California Irvine School of Medicine, your overall risk of infertility is very low, as he estimates that these procedures might impact your ability to get pregnant by less than 5%.
How can you protect yourself?
To help optimize your fertility, preventing STIs and the complications of STIs is key!
- Have open and honest discussions with your partner(s) about their sexual health history. It is generally recommended that sexually active adults (and their partners) have a routine STI screen at least once per year.
- Use barrier methods (i.e. condoms, dental dams) consistently and correctly. It’s important to remember that barrier methods aren’t 100% effective and that they don’t cover all of the skin around your genitals — meaning that you can still contract/transmit herpes and HPV.
- Listen to your body, regularly inspect your genitals, and quickly seek medical attention if you notice an unusual symptom or lesion.
- Participate in the cervical national screening program, and if you’re eligible, the national HPV immunization program (check out the NHS eligibility requirements here).The HPV vaccine doesn’t protect against all types of HPV, but it does protect against the types that cause genital warts and cervical cancer.
- And finally, undergoing regular STI testing (for both you and your partner/s) allows for the prompt diagnosis and treatment of infection, which in turn helps minimize the risk of developing chronic health complications, including PID and infertility.