Sexually Transmitted Infection Case Study

Sexually Transmitted Infection Case Study

Introduction

Infertility is the inability to conceive after 12 months or more of regular unprotected sexual intercourse. Infertility is a major public health concern worldwide. The burden of infertility is mostly carried by women. Female infertility may be due to a variety of reasons, and which may include endocrine factors, vaginal factors, cervical factors, uterine factors, tubal factors and pelvic-peritoneal factors (Tsevat et al., 2018). Tubal factor infertility is the most common cause of infertility.

Sexually Transmitted Infection Case Study

STDs and Infertility

Tubal factor infertility is mostly attributed to untreated infections of the female reproductive tract. Sexually transmitted infections can ascend along the reproductive tract and cause inflammation of the fallopian tubes as well as scarring and damage. Scarring of the fallopian tubes interferes with the motility of ova to the uterus. This also predisposes the woman to an ectopic pregnancy in the event that fertilization occurs. Pelvic-peritoneal adhesions may result from persistent infections. Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes of STIs associated with tubal factor infertility and pelvic inflammatory disease (Low & Broutet, 2017).

From the case study provided, it is highly likely that the woman has an STI that may have progressed to a PID. This is evidenced by the manifestation of symptoms. She has fever, nausea, vomiting, abdominal pain, and vaginal discharge. Her fertility can be affected because her STI has resulted in the development of PID. The signs of PID are adnexal tenderness, lower abdominal pain, fever, chills and the chandelier sign which is usually an indication of inflammation in the pelvis. Pelvic inflammation causes scarring and adhesions that contribute to tubal factor infertility. The scarring interferes with motility of both the sperms and ova.

Inflammatory Markers and STDs

An STD is an infection. An infection is an inflammatory process. Inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plasma viscosity (PV) are commonly used in primary care for diagnosis of inflammatory conditions such as infections. ESR is defined as the distance that erythrocytes settle in anticoagulated blood in one hour. CRP is usually better for checking infections (Watson et al., 2019). Other inflammatory markers such as white blood cells are also useful for checking for infections caused by bacteria. Therefore, WBC and CRP will rise in STD or PID. The lab results for this patient indicate a high CRP and WBC levels.

During an infection, pathogen-associated molecular patterns activate pattern recognition receptors of the innate immune system. Proinflammatory and anti-inflammatory mediators are produced as a result with the main aim being to contain the infection. Inflammation is critical in the resolution of infection. Neutrophils are mobilized to the site of infection to try and fight the infection. Neutrophils are the most common type of white blood cells and increase during bacterial infections (McCance & Huether, 2019). This increase in neutrophils can be elicited by lab testing which is seen as high WBCs. As in the case provided, the patient has both high WBCs and CRPs. The congregation of neutrophils to the site of infection leads to the secretion of inflammatory markers to recruits more defense cells against the infection. This explains the rise in WBCs and other inflammatory markers in STD/PID.

Conclusion

STIs such as chlamydia and gonorrhoea generally affect female fertility due the sequelae of such infections. One such sequelae of such infections is pelvic inflammatory disease which lead to scarring and adhesions in the fallopian tube. Also, STDs are infections that cause an inflammatory process that leads to a rise in inflammatory markers. White blood cells are also recruited to fight infections.

References for Sexually Transmitted Infection Case Study

  • Low, N., & Broutet, N. J. (2017). Sexually transmitted infections-Research priorities for new challenges. PLoS Medicine14(12), e1002481. https://doi.org/10.1371/journal.pmed.1002481
  • McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
  • Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal Of Obstetrics And Gynecology216(1), 1–9. https://doi.org/10.1016/j.ajog.2016.08.008
  • Watson, J., Jones, H. E., Banks, J., Whiting, P., Salisbury, C., & Hamilton, W. (2019). Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners69(684), e462–e469. https://doi.org/10.3399/bjgp19X704309