Sound­ing alarm on ‘si­lent dis­ease’

The Washington Times Weekly - - Culture, Etc. -

Not long ago, I heard about a lovely young woman who had got­ten some sad news. When she was in high school, she met a boy. She thought she was in love. He thought they should have sex, so they did.

She moved away and a few years passed. When her ab­domen wouldn’t stop feel­ing weird, she went to a doc­tor. Tests were run, and she’s infertile. She’s 19. I don’t know her di­ag­no­sis, of course, but it’s very likely that pelvic in­flam­ma­tory dis­ease (PID) has changed her life.

I called Dr. Jen­nifer Shu­ford, di­rec­tor of ap­plied sci­ence at the Med­i­cal In­sti­tute for Sex­ual Health in Texas, for an ex­pla­na­tion.

The two ma­jor causes of PID are chlamy­dia and gon­or­rhea, she said. Gon­or­rhea is some­what rare; there are about 360,000 cases a year re­ported in the United States, ac­cord­ing to the lat­est fed­eral re­port. But chlamy­dia — also known as the “si­lent dis­ease” — is spread­ing through the na­tion, with a record 1.1 mil­lion cases re­ported in the last fed­eral preva­lence re­port.

“Chlamy­dia is the No. 1 re­ported bac­te­rial sex­u­ally trans­mit­ted in­fec­tion,” Dr. Shu­ford said.

It’s “very preva­lent” in Amer­ica, es­pe­cially among youth un­der age 25.

Chlamy­dia is wor­ri­some be­cause it usu­ally is un­de­tectable, she said. Up to 90 per­cent of women don’t know they have it, so they don’t seek med­i­cal treat­ment.

The in­fec­tion moves quickly. It takes only a week for the bac­te­rial in­fec­tion “to rise all the way up through the fe­male re­pro­duc­tive tract,” in­flam­ing the cervix, uterus and Fal­lop­ian tubes, said Dr. Shu­ford, whose spe­cialty is in­fec­tious dis­ease. “It can even go out­side of that, on to the ovaries, or into the ab­dom­i­nal cav­ity,” she said.

As the in­fec­tion rises through the fe­male re­pro­duc­tive tract, it can cause PID.

PID moves slower — scar­ring oc­curs over weeks to months — but it can be dev­as­tat­ing. The Fal­lop­ian tubes, for in­stance, can be so dam­aged that eggs can’t make it from the ovary to the uterus. Some­times that means in­fer­til-


ity; some­times it means danger­ous ec­topic preg­nan­cies.

Chlamy­dia and PID are both hard to no­tice, she added. “When they’ve done stud­ies and asked women for symp­toms — and that’s in­clud­ing any sort of un­usual feel­ing in their pelvis — dif­fer­ent stud­ies say dif­fer­ent things, but up to 80 to 90 per­cent of women [with PID] said they don’t re­mem­ber feel­ing any­thing.”

Sadly, even if a woman feels “some­thing’s wrong,” there are plenty of other rea­sons to ex­plain it, such as men­strual pain or indi- ges­tion, she said.

Dr. Shu­ford’s as­sess­ment is this:

Al­though 1.1 mil­lion new chlamy­dia in­fec­tions are re­ported, as many as 2 mil­lion more cases are un­re­ported. Thus, count­less men and women go un­treated — and qui­etly trans­mit the in­fec­tion. (Most men don’t have symp­toms, ei­ther.)

Of un­treated chlamy­dia in­fec­tions in women, from 10 per­cent to 40 per­cent will end in PID.

Roughly 1 mil­lion women a year are treated for PID (from chlamy­dia and other sources), and more than 100,000 of th­ese women will end up infertile.

On the bright side, “chlamy­dia is eas­ily cur­able with stan­dard treat­ment,” Dr. Shu­ford said.

But out­side of ab­sti­nence or sex with only a monog­a­mous, in­fec­tion-free part­ner, it will be hard to avoid. Con­doms are about 50 per­cent pro­tec­tive, ac­cord­ing to the sparse re­search, she said.

Thus, the sad story I heard is just one of many, many out there. Count­less young peo­ple won’t even dis­cover their dam­aged re­pro­duc­tive sys­tems un­til they are try­ing to con­ceive and it doesn’t hap­pen. Un­treated chlamy­dia ster­il­izes men, too.

Ch­eryl Wetzstein can be reached at cwet­zstein@wash­ing­ton­

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