Infertility prevention through screening for sexually transmitted diseases

Sexually transmitted diseases (STDs) are preventable causes of tubal factor infertility (TFI) and ectopic pregnancy (EP). Pelvic inflammatory disease (PID) is a polymicrobial infection resulting from vaginal microorganisms ascending to the fallopian tubes. Chlamydia and gonorrhea have been identified in the etiology of PID, and other sexually transmitted and endogenous vaginal microorganisms have been implicated. PID can damage the fallopian tubes, causing scarring and partial or total blockage, and subsequent TFI and EP. A cohort study found that TFI and EP were more likely in women with laparoscopically confirmed PID. Since this study, the prevalence of gonorrhea has substantially decreased and remained low, but the prevalence of chlamydial infection has been increasing. Chlamydia screening of all asymptomatic sexually active young women is recommended. Chlamydia screening has been found to decrease the incidence of PID in two trials. Screening coverage has been found to be low in the United States, with screening at a small proportion of visits to a physician for Pap testing. Screening rates have been increasing in the United States, as estimated using HEDIS measures. PID has been found to be decreasing, although it is a problematic outcome because of its low specificity. Long term outcomes have not been found to be decreasing, with the incidence of TFI and EP remaining stable over the past several years. Current low chlamydia screening coverage is probably insufficient to impact the incidence of the long term outcomes of TFI and EP. Interventions are needed to increase chlamydia screening in at-risk populations.