How condomless sex is causing infertility and STIs in young adults

Nancy*, 38, from Gilgil in Nakuru County, longs to have a baby. Despite having a 17-year-old daughter, her attempts to conceive for the past 10 years have been unsuccessful due to blocked fallopian tubes, a condition she only discovered after numerous medical consultations.

"I smile on the outside, but deep inside, I am hurting badly because I am not able to conceive," Nancy tells The Nairobian. "I have tried both herbal and conventional medicine to unblock my fallopian tubes, but nothing has worked. Each day, I go to bed praying for a baby. I trust that someday God will answer my prayer."

Nancy’s condition presented no symptoms, but after years of trying to conceive, she finally sought medical help. Doctors informed her that the blockage in her fallopian tubes was irreversible and suggested In Vitro Fertilization (IVF), a procedure costing Sh400,000, which she could not afford.

Although the exact cause of Nancy’s blocked tubes remains unknown, experts suspect chlamydia, a sexually transmitted infection (STI) commonly caused by unprotected sex.

Nancy's struggle mirrors the experiences of many young adults across Kenya facing infertility. The Ministry of Health has raised concerns over the increasing number of infertility cases attributed to chlamydia.

Data from the National Syndemic Disease Control Council (NSDCC) shows that in 2023 alone, at least 309,419 STI cases were treated in healthcare centres across the country. These include infections such as Human Papillomavirus (HPV), gonorrhoea, and chlamydia, all of which can have long-term effects if left untreated.

NSDCC Chief Executive Dr. Ruth Laibon-Masha has expressed concern over the rising infertility rates, especially among university students and young women of reproductive age. She explains that chlamydia is a silent threat, often leading to infertility when left untreated.

“If you visit infertility clinics today, you’ll find many young women with chlamydia. This is a concerning trend because it suggests a future increase in infertility cases,” says Dr Masha.

In addition to HIV prevention, the country faces a growing challenge of STI transmission, particularly chlamydia. Although Kenya has made significant progress in reducing HIV/AIDS transmission, other STIs are on the rise. According to Dr. Masha, untreated STIs can lead to infertility and other health complications.

World Bank data reveals that Kenya's fertility rate has declined over the years, dropping from 7.3 children per woman in 1960 to 3.3 in 2020. The current fertility rate stands at 3.311 births per woman, a 1.55 per cent decline from 2021.

Prof. Koigi Kamau, an expert from the University of Nairobi’s Department of Obstetrics and Gynecology, explains that chlamydia, caused by Chlamydia trachomatis, can severely damage the fallopian tubes, leading to infertility. The infection narrows the tubes, blocking the transport of eggs necessary for fertilization.

Prof. Kamau notes that the bacteria’s slow, insidious growth makes chlamydia particularly dangerous, as it often goes unnoticed until it causes severe damage. He warns that the same issue arises with gonorrhoea, which also damages the fallopian tubes.

According to Nairobi-based gynaecologist Dr Fredrick Kareithia, tubal blockage is a leading cause of infertility, with chlamydia contributing significantly. He notes that about 40% of infertility cases are attributed to males, another 40% to females, and the remaining 20% are of unknown causes.

Dr Kareithia emphasizes that early diagnosis and treatment of chlamydia can prevent complications, but many patients delay seeking help because the infection often presents few or no symptoms.

Dr. Masha stresses the importance of re-educating young people, particularly college students, about the dangers of unprotected sex. She advocates for the use of condoms and encourages individuals to enrol in medical insurance to cover regular check-ups and treatments.

“We are educating people that unprotected sex not only risks pregnancy or HIV but also other diseases, including STIs like chlamydia,” says Dr. Masha.

Prof. Kamau calls for the incorporation of sex education into school curricula to raise awareness about the consequences of reckless sexual behaviour. He notes that many individuals, especially those who recently completed university, face irreversible infertility due to untreated infections.

A recent study by the Kenya Medical Research Institute (KEMRI) revealed a high prevalence of curable STIs, with chlamydia being the most common. The study found that one in five women of reproductive age has chlamydia.

Clinical research scientist Dr. Felix Mogaka from KEMRI-RCTP in Kisumu notes that unprotected sex is the leading contributor to chlamydia, which, if untreated, can cause infertility. He also highlighted that STIs like chlamydia are prevalent among individuals on HIV Pre-exposure Prophylaxis (PrEP), an anti-retroviral medication used to reduce the risk of contracting HIV.

Worryingly, up to 70% of women with chlamydia and gonorrhoea show no symptoms, making them unlikely to seek timely treatment.