of males who are in the age range where the vaccine is recommended (ages 11–26) actually have been vaccinated. Optimally, the vaccines should be given to all males and females at age 11–12. There are three different vaccines as of this writing, and for the 9-valent vaccine, the upper age for immunization has been increased to 45 years old for both men and women. As of 2019, the CDC did not recommend vaccinating adults over age 45.
Chlamydia: The most reported STI
Chlamydia is the most reported sexually transmitted infection in the United States — meaning we more often test for it than the other infections. The bacterium Chlamydia trachomatis is responsible for the infection. Both men and women can be infected, and both male and female fertility can be damaged. Chlamydia is easily tested by swabbing the penis or vagina and sending the swab to a lab for testing. A new test using urine is also being developed. Chlamydia is easily treated with antibiotics.
Here are some facts about the disease:
About 2 million new cases of chlamydia are diagnosed every year.
Almost two-thirds of new chlamydia infections occur in 14- to 24-year-olds.
Of those women who develop pelvic inflammatory disease (PID), 30 percent will have chlamydia. Each occurrence of PID reduces the chance of achieving a pregnancy by 25 percent due to the damage the infection does to the fallopian tubes.
Women with PID are seven to ten times more likely to have an ectopic pregnancy, a pregnancy that grows outside the uterus, usually in the tubes. (For more about ectopic pregnancies, see Chapter 13.)
Most women (75 percent) have no symptoms of infection; symptoms include lower abdominal pain, burning with urination, and vaginal irritation.
Twenty-five percent of men have no symptoms from chlamydia; the rest may have a discharge from the urethra, or pain and burning on urination.
Men with untreated chlamydia can develop epididymitis, an infection in the testicles, where sperm are developed. This condition can lead to low sperm counts.
Each year, 100,000 women become infertile from chlamydia. With a first episode of PID from chlamydia, 12 percent of women become infertile; a second episode of PID increases infertility to 40 percent. Eighty percent of women who have had PID from chlamydia three or more times are infertile.
Chlamydia is largely a silent disease. Only about 10 percent of men become symptomatic, and anywhere from 5–30 percent of women become symptomatic.
It is important to know that symptoms of a chlamydia infection, if any, may not appear until weeks after the person becomes infected. Diagnosis is made using vaginal swabs (for a woman) and penile swabs (for a man).
Chlamydia is treated with oral antibiotics: either a single dose of azithromycin or a seven-day course of doxycycline.
Cytomegalovirus (CMV)
Cytomegalovirus (CMV) is caused by a virus — unlike chlamydia, which is caused by a bacterium. The difference is that bacteria do their damage outside of cells while viruses invade cells and do their damage by hijacking part of the DNA machinery. CMV is present in over half of the people by age 40 and one in three children are infected by age 5. Most people have no symptoms when they become infected, but CMV may cause mild symptoms of cough, fatigue, swollen glands, and sore throat. People infected with CMV are infected for life. CMV is spread through human fluids: direct contact through saliva or urine, sexual contact/semen, transplanted organs, blood transfusions, and breast milk (which, along with direct contact, is how many little ones contract the infection).
Most of the time, CMV is inactive (dormant), but it can activate at any time. When the infection activates, it can be spread to other people and babies. Healthy people rarely experience significant problems from CMV, although it can cause mononucleosis. Adults with a compromised immune system are more susceptible to infections that affect the eye, digestive system, and nervous system, and it can cause pneumonia. Infants can be born with congenital CMV, but this is more likely to happen if the mother contracts CMV for the first time when she is pregnant and not from reactivated CMV. Congenital CMV may cause the baby to have loss of vision, neurological problems, hearing loss, seizures, muscle problems and loss of coordination, and impaired intellect. The most common problem for infants with congenital CMV is hearing loss.
There is no cure for CMV, and healthy people generally do not need treatment. However, antiviral medications may be given to babies and people with weakened immune systems.
CMV does not appear to have an impact on fertility, but if it is an active infection, CMV can cause problems in a developing fetus leading to low birth weight, blindness, deafness, mental retardation, small head size, seizures, or damage to the liver or spleen. Testing “positive” for CMV means that you have been infected sometime in your lifetime, but there’s no way of knowing when. If your infection is not active, the risks in pregnancy are reduced.
Gonorrhea
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can infect the genital tract, mouth, or rectum. Infants can get the disease from an infected mother during childbirth. It can be carried by males and females and can be cured with antibiotics. Here are some other facts about gonorrhea:
Each year, 820,000 new cases of gonorrhea are diagnosed.
Gonorrhea is the second most reported STI.
Gonorrhea can lead to infertility. Like chlamydia, gonorrhea in women can cause PID, leading to tubal damage. Some doctors test for gonorrhea and chlamydia before doing common fertility tests such as a hysterosalpingogram (HSG), in which dye is injected into the uterus and fallopian tubes to see whether there are any irregularities. (We discuss HSGs in more detail in Chapter 11.) If you have gonorrhea or chlamydia and push dye into the tubes and uterus, you may push the infection up also and end up with more tube or uterine damage than you had to begin with.
Men with gonorrhea usually have a discharge from the penis and a burning sensation; women may have no symptoms or sometimes pain on urination or an increased vaginal discharge.
Gonorrhea is diagnosed by testing the urine or by taking swabs of the cervix, mouth, or anus. Treatment for uncomplicated gonorrhea involves intramuscular
