Condomless sex causing infertility and STIs in young adults

The 38-year-old woman from Gilgil in Nakuru county has been trying to conceive unsuccessfully for the past 10 years.

Despite having a 17 year-old-daughter, she tells The Nairobian that her longing to have another child remains unmet due to blocked fallopian tubes, a condition she learned about only after years of unsuccessful attempts to have a child and numerous medical consultations.

“I smile on the outside, but deep inside, I am hurting badly because I am not able to conceive. I have tried both herbal and conventional medicine to unblock my fallopian tubes but none has worked,” narrates Nancy.

She adds, “Each day, I go to bed praying for a baby. I trust that someday, God shall answer my prayer. I long for the day I will cuddle my bundle of joy”.

The blocked fallopian tubes did not however, present with any symptoms. The struggle started when Nancy, after many years of trying to get pregnant, finally sought medical help.

“I visited a gynaecologist after many years of trying to conceive despite being intimate with my husband. I thought it was his problem, but numerous tests revealed I had blocked fallopian tubes,” says Nancy.

Doctors who examined her informed her that the condition was irreversible, and that she could opt for In Vitro Fertilisation (IVF). However, the junior government employee cannot raise the Sh400,000 required for the procedure.

Although her medical records do not specify the cause of the blockage, experts observe cause of blocked fallopian tubes might be due to chlamydia.

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Nancy’s encounter mirrors struggle facing hundreds of young adults across the country faced with infertility, as experts and Ministry of Health raises concern over increased cases of infertility attributed to chlamydia, a disease caused by engaging in unprotected sex.

Data by the National Syndemic Disease Control Council (NSDCC), shows that in 2023 alone, at least 309,419 cases of STIs were attended to in healthcare centres across the country.

A number of cases were also undiagnosed and untreated. Among the sexually transmitted infections reported include Human Papilloma Virus (HPV), gonorrhoea and chlamydia, which have long-term effects if untreated.

The experts note that infertility is highly observed among university students and young women of reproductive age.

NSDCC chief executive Dr Ruth Laibon-Masha, says that chlamydia is a major concern as it causes infertility.

She regrets that the country is recording more cases of infertility due to chlamydia, as partners engage in unsafe sex.

“If you to go to infertility clinics today, and look at the queues, most of the girls have clamydia. This is a concerning trend because it suggests a future increase in infertility cases,” says Dr Masha.

The rising cases of infertility in young adults are reported at a time the country is racing against new HIV infections in adolescents and young adults, with targets of eliminating infections by 2030.

“Apart from HIV transmission, the other challenge we are facing as a ministry is the number of young people getting STIs, in particular chlamydia, which is a silent pandemic,” cites the NSDCC boss.

Although Kenya has made significant gains in reducing HIV/Aids transmission and deaths, the official said, there is a trend of increased STIs.

She adds, “As HIV is reducing, sexually transmitted diseases are going to increase, when people get wounds in their private parts, they increase their chances of contracting HIV.”

Word Bank data shows that Kenya’s fertility rates have declined in the recent past, from 7.3 children per woman in 1960 to 5.1 in 2000. In 2020, it waned to 3.3 children per woman.

The current fertility rate stands at 3.311 births per woman, a 1.55 percent decline from 2021.

Prof Koigi Kamau, from the University of Nairobi, Department of Obstetrics and Gynaecology, explains that that chlamydia is a sexually transmitted infection caused by a specific strain of bacteria known as Chlamydia trachomatis.

He explains that clamydia can severely damage the fallopian tubes, leading to infertility by blocking trasport of eggs from necessary for fertilisation.

Damage to the lining of the fallopian tubes (endosalplnx), makes it impossible to have the transportation of eggs for fertilization process.

Blocked tubes can also damage the fimbria, which helps in taking up the egg because fertilization occurs in the fallopian tubes.

“The bacteria can cause the tubes to narrow, it destroys the inner lining of the fallopian tube, which is what transports both the sperms and egg or ovum in order to facilitate the fertilization process. If anything blocks the process, then it will cause infertility,” says Prof Kamau.

He noted that the narrowing of fallopian tubes due to chlamydia because of inflammation and attachment (fimbria phymosis), is also the same with gonococcus (bacteria that causes gonorrhoea).

According to the fertility expert, infertility due to tubal damage is the most common, with nearly 80 percent, chlamydia being the leading cause, of gonorrhoea, and infections as a result of unsafe abortions, endometriosis, and adenomyosis.

Dr Fredrick Kareithia, a gynaecologist based in Nairobi confirms an increase in infertility cases among the population, with 40 percent of patients seen recording tubal blockage, though not exclusively from clamydia.

Kareithia notes that at least 40 percent of infertility cases are attributed to males, 40 per cent to females, whereas 20 per cent of infertility cases remain unknown.

“A bigger number of patients treated with infertility have blocked tubes, some of them attributed to chlamydia,” says the gynaecologist.

A number of patients with chlamydia reviewed by the specialist have damaged and blocked fallopian tubes.

The specialist adds that majority of patients are mostly from low social economic status areas, where people cannot afford to buy medicine.

“I have treated infections, among them, those caused by chlamydia, but there is no credible data,” adds Kareithia.

Prof Kamau adds that chlamydia is dangerous because its growth is insidious (slow) and not easily (imperceptible) detected. Most patients are diagnosed at an adverse stage.

“Growth and damage of chlamydia is insidious, and not easily noticed, and the little pain it causes tends to be ignored, unlike gonorrhoea when the pain comes, it is severe and therefore easy to seek medical attention,” says the expert.

Immunological tests can detect the antigens (components of chlamydia), but they do not necessarily detect active disease.

“Chlamydia has been marked by mystery, yet it is extremely common, but it is married by the fact that its effects are insidious until tissues get attached together. It blows in the society without announcing its presence.”

According to Kareithia, the best way of preventing chlamydia is to have a monogamous relationship.

“If you have multiple partners, you risk contracting the disease. We advise if anyone experiences pain or abnormal discharge after engaging in sex , to go for check-up and treatment because chlamydia can be treated easily, but if someone does not get treatment on time, it becomes complicated,” advises the gynaecologist.

Dr Masha emphasises on the need to re-educate the population, more so college students, on dangers of engaging in unprotected sex.

The population, she says there is need to adopt alternatives that guarantee their safety, like buying condoms and enrolling to a medical insurance.“We are educating them that it is not only pregnancy, or HIV that come with unprotected sex but other diseases too,” observes the NSDCC boss.

Prof Kamau observes the need to have public education, and incorporating sex education in the curriculum. “People should be told in black and white, more so young generation that sexual recklessness causes infertility.

We are seeing more cases of infections in individuals who have just completed university, and are looking for babies and when you look at their history, you realize they had reckless sexual behavior, but eventually, in most cases the process is irreversible,” observes the specialist.

A recent study by Kenya Medical Research Institute (Kemri) revealed a high burden of curable sexually transmitted infections.

According to the study, chlamydia is the leading sexually transmitted disease currently observed in the population.

Upto one in every five women of reproductive age have the sexually transmitted disease.

In an in-depth past interview with The Nairobian, Felix Mogaka, a clinical research scientist at KEMRI- Research Care and Training Programme (KEMRI-RCTP) in Kisumu said the frequency of chlamydia surpasses that of syphilis and gonorrhoea, a trend that is worrying.

“Unprotected sex contributes to chlamydia, an infection that may end up making our population face serious consequences, including infertility,” said Dr Mogaka.

In a study conducted in Kisumu, it was revealed that curable sexually transmitted infections are common among individuals who are on HIV Pre-exposure Prophylaxis (PrEP).

HIV PrEP is an anti-retroviral medication used by HIV-negative people at substantial risk of HIV, which reduces the risk of contracting HIV.

“People use Prep to prevent HIV, but unfortunately, it does not prevent against other STIs such as chlamydia. It can cause complications such as pelvic inflammatory disease, chronic abdominal pain, pregnancy complications and infertility,” Dr Mogaka explains.

Worryingly, a large percentage of women who have chlamydia and gonorrhoea, representing up to 70 per cent, do not have any symptoms and are therefore, unlikely to seek treatment.