The ‘Silent STI’ Need Not Leave Infertility in its Wake

Sexually transmitted infections (STIs) have a major impact on the heath of people every day — from diseases like AIDS and syphilis to drug-resistant gonorrhea and herpes. But few know that chlamydia, one of the most common STIs, is a major cause of infertility when left untreated. Too many people are unaware of the long-term complications of chlamydia and how a simple test and cheap treatment can save fertility.

Few schools provide in-depth education about STIs. These infections remain highly stigmatized in most communities and are rarely talked about — even by healthcare professionals. Aside from ob/gyns and other sexual health experts, there is a serious lack of knowledge in this area. The ongoing silence and lack of awareness pose barriers to testing and treatment.

We urgently need new federal and state efforts to reduce stigma and provide STI testing and treatment to prevent infertility. Infertility prevention can improve the health of all women and families.

The Impact of Undetected and Untreated Chlamydia

In 2023 there were 1.6 million reported cases of chlamydia in the U.S., and likely twice that many went undetected and unreported. One in 10 women with chlamydia will develop long-term infection of the reproductive organs (pelvic inflammatory disease), often without any symptoms. Over time, chronic infection will rob women of their fertility. It is estimated that for every 150 untreated chlamydial infections in the U.S., there will be at least one case of permanent sterility.

Infertility can be a very difficult issue for people who want to have children. Infertility is a common cause of anxiety and depression, and can also contribute to relationship stress and divorce. Infertility is also very difficult and expensive to treat. The costs of infertility treatment are borne by everyone — families, employers, and taxpayers. Cases of infertility caused by chlamydia cost about $135 million in medical expenses every year.

Testing and Treating Chlamydia

Chlamydia, however, is easily detectable through testing and can be treated with a single course of antibiotics. What makes treatment challenging is that most women with chlamydia do not know they have it. In 70-75% of cases, the infection in women has no symptoms, which is why it’s known as the “silent STI.” The only way to know if you or your patient has chlamydia is through testing. The CDC recommends that all sexually active women get tested every year until the age of 25. Women 25 and older should get tested if they have new sex partners or a partner with an STI. Even with those recommendations, however, only about half of women who should get tested, get tested regularly.

We need a unified program to increase awareness about chlamydia and infertility among policy makers, medical providers, and young women. While insurance companies generally reimburse for STI testing, we need to make testing and treatment easier for women to access.

Newer FDA-approved tests allow women to collect swabs for testing in their own home and mail the swabs to nearby testing laboratories. Meanwhile, the CDC is working on a cheap, 15-minute test that people could buy in a store, or doctors could use in their office, without the need to involve a testing lab. Very accurate, more expensive, 30-minute chlamydia tests do exist, but many doctors don’t use these tests because most insurers don’t reimburse enough to cover the cost of testing; instead doctor’s offices use standard testing, which can take 1-to-2 days or more for results.

For 20 years, from 1993 to 2013, Congress supported the National Infertility Prevention Project. That program paid states and organizations to test for and treat chlamydia as well as other STIs, specifically in women. A similar program today could help millions of American women and restore the health and fertility of our nation.

Research shows that public funding for STI prevention works. For every 1% increase in federal funding for prevention, rates of chlamydia decrease by 0.17%. In 2023, the CDC received only about $110 million for STI prevention, or approximately 35 cents per U.S. resident. Doubling current federal funding might prevent over 2,200 cases of infertility caused by chlamydia in a single year, and only use a very small amount of the overall federal budget. That means hundreds or thousands more women would be able to have children, and more families would avoid the challenges and stigma of infertility.

Given the importance that we all place on healthy pregnancies and families, addressing preventable infertility must become a well-funded national priority.

Lao-Tzu Allan-Blitz, MD, MPH, is a pediatrician and adult medicine specialist at Brigham and Women’s Hospital and Harvard Medical School in Boston. Jeffrey D. Klausner, MD, MPH, is a professor of population and public health sciences at the University of Southern California Keck School of Medicine in Los Angeles, and a former CDC medical officer.

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