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  • Title: [Sexually transmissible diseases and female sterility].
    Author: Aubriot FX, Dubuisson JB, Henrion R.
    Journal: Rev Fr Gynecol Obstet; 1988 Apr; 83(4):257-8, 261-3. PubMed ID: 3393797.
    Abstract:
    Regarding personal studies and a review of the literature, the authors are discussing the consequences of STD on fertility. Thus, through salpingitis, STD represent the main cause of tubal sterility, distal and proximal, and ectopic pregnancies. It seems desirable to look for them in the latter and treat them with a suitable antibiotherapy. The chlamydia serology seems a good screening examination. The best prevention of STD will certainly permit to decrease the frequency of tubal sterility and ectopic pregnancies, in the years to come, limiting therefore the major public health expenses they involve. 30-50% of cases of female sterility are due to tubal factors, of which infection is the most important. 60-80% of cases of salpingitis are believed to result from sexual transmission. The microbes usually ascend from the cervical mucus to the endometrium and the tubes. Most often, the infections are polymicrobial and combine sexually transmitted exogenous agents with endogenous gonorrhea, responsible for 44-65% of cases of salpingitis in the US and 5-32% in Europe. But Chlamydia trachomatis is now accounting for 25-65% of cases. The danger of Chlamydia results from the difficulty of diagnosis if it is not specifically sought as well as from its resistance to the drugs usually prescribed for salpingitis. The possible role of mycoplasmas in tubal sterility is more difficult to define, although they can infect the cervical mucus to impede sperm migration or proliferate in the endometrium, possibly causing sterility or spontaneous abortion. THe fertility risk to women posed by salpingitis is increased by previous episodes of salpingitis, by use of the IUD, and by nulliparity. Oral contraceptives provide relative protection, particularly against very serious tubal infections. Ectopic pregnancy is the other major consequence of salpingitis besides tubal sterility. A previous study by the author comparing the medical histories of 588 women undergoing tubal microsurgery, 69 undergoing in vitro fertilization due to definitive tubal sterility, 50 sterile women with apparently health y tubes, and 8356 who gave birth showed that acute salpingitis and Chlamydia seropositivity were much more common in the 1st 2 groups. Moreover, the frequency of Chlamydia seropositivity increased with the severity of tubal damage as attested by the type of surgical repair. Histologic and laboratory evidence from the author's own studies and a review of the literature support the argument that tubal infection is the principal cause of ectopic pregnancy. It is probable that salpingitis modifies not only tubal anatomy but tubal physiology and in particular ovum transport. Screening for infection and especially Chlamydia and appropriate treatment are advisable in case of ectopic pregnancy. Prevention or timely diagnosis and treatment of sexually transmitted diseases, increased use of oral contraceptives by women at risk, and greater efforts at informing women of the risks of sexually transmitted diseases may lead to a declining incidence of tubal infertility.
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