How Gonorrhea Affects Female Fertility
In women, untreated gonorrhea can ascend from the cervix to the upper reproductive tract, leading to pelvic inflammatory disease (PID). PID is a major cause of infertility, as it can result in scarring and blockage of the fallopian tubes, preventing sperm from meeting the egg.
According to the Centers for Disease Control and Prevention (CDC), up to 10-20% of women with untreated gonorrhea will develop PID. Among those, approximately 1 in 5 will experience infertility.
Gonorrhea is also linked to:
- Ectopic pregnancy, a life-threatening condition where a fertilized egg implants outside the uterus.
- Chronic pelvic pain, which can persist even after the infection is treated
- Increased susceptibility to other STIs, including HIV
Early detection and treatment of gonorrhea is critical to preserving fertility and preventing long-term reproductive harm.
How Gonorrhea Affects Male Fertility
In men, gonorrhea often presents with symptoms like urethral discharge or pain during urination—but it can also be asymptomatic. Left untreated, it can cause epididymitis, an infection of the epididymis that stores and carries sperm. Epididimitis can lead to:
- Scarring of the reproductive tract
- Obstruction of sperm flow
- Pain and swelling
- Potential infertility in severe and untreated cases
Although it’s rare, if gonorrhea is left untreated, it can cause the testicles to shrink and harm the cells that produce sperm. This can lead to lower sperm production and potentially affect fertility. Studies suggest that gonorrhea may also negatively affect sperm motility and function due to inflammatory responses.
Diagnosis and Treatment
The CDC recommends annual screening for sexually active women under 25 and older women at increased risk. For men, screening is advised for those in high-risk groups, including men who have sex with men.
The preferred diagnostic test is NAAT (nucleic acid amplification testing), which is both highly sensitive and specific. It can be performed using urine samples or genital swabs.
The CDC currently recommends the following treatment:
- Ceftriaxone: a 500 mg intramuscular dose for individuals under 150 kg
- Ceftriaxone: a 1 g intramuscular dose for individuals over 150 kg
- Doxycycline: 100 mg twice daily for 7 days may be added if chlamydia co-infection is suspected.
Partners should be treated simultaneously to prevent reinfection.
Impact on Pregnancy and Future Fertility
Gonorrhea during pregnancy can lead to:
- Pregnancy loss
- Preterm labor
- Neonatal complications, especially ophthalmia neonatorum, which can cause blindness if untreated.
Pregnant individuals should be screened early and treated promptly to reduce these risks.
Fertility Preservation Considerations
For individuals at risk of infertility due to STIs like gonorrhea, early testing and treatment are essential—but in some cases, fertility preservation may also be worth considering. This can include:
- Egg freezing or embryo freezing for women at risk of tubal damage
- Sperm analysis and freezing for men with known infections or reproductive concerns
If infertility is suspected, further evaluation (e.g., hysterosalpingography for women or semen analysis for men) may be recommended after treatment.
Prevention Strategies
Gonorrhea is preventable. Key prevention measures include:
- Consistent condom use during vaginal, anal, or oral sex
- Routine STI screening, particularly for women under 25 and individuals with new or multiple partners prompt treatment of STIs for both partners
- Regular testing during fertility treatment or preconception planning
Unfortunately, there is currently no vaccine available.
Conclusion
Gonorrhea is a preventable but serious threat to fertility in both men and women. Timely diagnosis and treatment are key to protecting reproductive health. If you’re trying to conceive or considering fertility treatment, make sure STI screening is part of your care plan.
