Globally up to 8% of women may be infected with Chlamydia trachomatis (CT) in industrialised countries (higher rates in Africa) and as many as 3.5% have gonorrhoea (Gc).
Mass screening programmes are important in order to decrease the rates of CT and its complications. Such screening of large numbers in general practice in the UK showed that the process did not have a negative impact on psychological well being where the results of the test was negative; in fact they suggested that the process can lead to a general decrease in anxiety .Other research strongly suggests that CT positive patients are at increased risk of general anxiety, fear of infecting their partner and concern about infertility. In particular women tended to blame themselves for acquiring CT and feel stigmatised, whereas men are less concerned in general about CT, less willing to disclose to partners and tend to project the blame of acquisition onto others rather than themselves. As many as 10% of those who found out they are CT positive end their current relationship as a direct result of the infection. A history of past sexual abuse in patients with recurrent sexually transmitted infections (STIs) is associated with a higher degree of psychological distress compared to those who have not suffered sexual abuse in the past.
Consistent and correct condom usage has been shown to confer a significant degree of protection against CT and Gc. CT and Gc are the most likely organisms to cause acute pelvic inflammatory disease(PID). The usual symptoms of this are lower abdominal pain and deep pain on sexual intercourse. PID also causes infertility by blocking the Fallopian tubes. Gc PID is usually more severe in terms of pain but less likely than CT to cause infertility. The rate of PID in women who are CT infected ranges from 5% to 30%. Another important outcome of PID is ectopic pregnancy. Deep pain at sex may or may not be present with background pelvic pain- it is associated with anxiety, depression and a history of sexual abuse.
Young women may continue to have intercourse in spite of pain at sex because they feel sexual intercourse affirms them being a normal woman and to satisfy their partner’s sexual needs. Tubal infertility is an important cause of long term distress, anxiety, depression and relationship problems.