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.
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 infertility; 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 indigestion, 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.
"Infertility will continue to rise as long as chlamydia continues to rise," Dr. Shuford said. "It's silent. It's happening to so many people. There's no need to feel stigmatized [by getting chlamydia]," she added. "You just need to go get treated."
• Cheryl Wetzstein can be reached at email@example.com.