Dados do Trabalho

Title

Influence of sexually transmitted infections on female fertility

Objective

This study aims to assess the influence of late diagnosis and treatment of Sexually Transmitted Infections (STIs) on female fertility.

Methods

It is a bibliographic review of articles published in English and Portuguese within the last 5 years, using PubMed and SciELO databases. The search was conducted using the following keywords: "Sexually transmitted diseases (STD)," "sexually transmitted infections (STI)," "Pelvic Inflammatory Disease (PID)," and "female fertility," which resulted in 28 articles. The inclusion criteria were studies involving women aged 18 to 40, with infertility complaints due to a history of STIs, and a correlation between STIs and female infertility. After removing duplicates and reviewing titles and abstracts, 9 articles were utilized for this study.

Results

Different authors point out that STIs negatively impact around 30% of female fertility. For example, bacterial infections like Chlamydia (Chlamydia trachomatis) and Gonorrhea (Neisseria gonorrhoeae) have adverse effects on pregnancy, even when asymptomatic, and may lead to Pelvic Inflammatory Disease (PID) affecting structures such as the uterus, fallopian tubes, and ovaries. Infections in the upper genital tract cause inflammation that can result in adhesions and obstruction of the fallopian tubes, conditions associated with female infertility due to tubal factors and ectopic pregnancy, caused by impaired egg transport. Different studies show that tubal factors account for 25-35% of female infertility causes, and in women with recurrent PID (more than 3 episodes), over 50% may experience tubal dysfunction. Chlamydia infections have also been associated with chronic pelvic pain, spontaneous abortion, and other adverse pregnancy events. Systematic reviews indicate that Chlamydia infection is primarily linked to stillbirths (OR = 5.05) and spontaneous abortion (OR = 1.30), with approximately 76% of published studies supporting these associations. Furthermore, the research indicates that positive associations between STIs, spontaneous abortion, infertility, and ectopic pregnancy are more frequent in low-to-middle-income countries compared to high-income countries. The treatment for PID involves broad-spectrum antibiotic therapy, best initiated as early as possible, and including partner treatment to prevent reinfections. Despite a good response to treatment, recurrent infections increase the risk of developing tubal infertility, making the investigation of STI history crucial in the assessment of infertile couples. Treatments for tubal infertility resulting from PID, besides treating the infection, include laparoscopic or hysteroscopic removal of adhesions and in vitro fertilization.

Conclusion

Therefore, it is evident that STIs, particularly Chlamydia and Gonorrhea, significantly reduce female fertility. Healthcare professionals must conduct early diagnoses and provide appropriate treatments for pelvic inflammatory diseases to prevent severe consequences on reproductive health. Additionally, providing adequate medication for both the patient and their partner, with special attention to cases of reinfections, is essential. With these measures, the negative effects of STIs on female fertility can be mitigated, enhancing the reproductive health of women of reproductive age.

Keywords

Sexually transmitted diseases; sexually transmitted infections; Pelvic Inflammatory Disease; female fertility