Endometriosis and STIs
Endometriosis affects around 176 million women worldwide and occurs in nearly 1 in 10 women of reproductive age. Despite being so common, many myths and stigmas about the disease continue to persist. Historically doctors often misdiagnosed endometriosis as pelvic inflammatory disease (PID). Researchers still do not know the exact cause of endometriosis. However, they now know that endometriosis is not the result of sexually transmitted infections (STIs) or a sexually transmitted disease (STD).
STIs can present endometriosis-like symptoms
There are certain STIs that present endometriosis-like symptoms and can even lead to infertility. For instance, pelvic inflammatory disease, which sexually transmitted bacteria such as chlamydia and gonorrhea can cause, presents with symptoms such as pelvic pain, pain with intercourse (dyspareunia), abdominal tenderness, inflammation, and painful urination. All of these are also overlapping symptoms of endometriosis.
However, STIs can also present other symptoms such as lumps, rashes, blisters, and warts around the vagina as well as itchiness. These symptoms are not present in endometriosis.
The definitive way to confirm endometriosis is via laparoscopic deep excision surgery.
STIs may increase the risk of endometriosis
Although endometriosis and STIs are not related, STIs can increase the risk of symptomatic endometriosis. Inflammation is one of the main factors that can add to the pathogenesis of endometriosis. Endometriosis lesions themselves can promote an inflammatory response. Furthermore, endotoxins secreted by bacteria transmitted during STIs can also trigger the production of inflammatory molecules.
Higher numbers of bacteria such as Escherichia coli occur in the menstrual blood of endometriosis patients. There are also higher levels of endotoxin. Microfloral imbalance in the lower genital tract can cause infections that can migrate to the upper genital tract. Indeed, most of the time, pelvic inflammatory disease is the result of the migrating gastrointestinal flora and not Chlamydia and Gonorrhea.
A Taiwanese study of almost 80,000 patients with inflammatory diseases of the cervix, vagina, and vulva found that they were at a higher risk of endometriosis than healthy controls. Lower genital tract infections presented an increased risk for endometriosis irrespective of other conditions such as infertility, fibroids, cancer, autoimmune diseases, and allergic diseases.
A similar study of more than 140,000 Taiwanese patients also showed that women with PID were at a higher risk of endometriosis than those without.
Endometriosis is not the same as endometritis
Endometritis is the irritation, chronic infection, or inflammation of the endometrial lining of the uterus. It is not the same as endometriosis, which is the growth of endometrial-like tissue outside the uterus. Endometritis is sometimes the result of STIs but can be due to the presence of other bacteria as well. It is also common after a miscarriage, childbirth, or after procedures such as dilation and curettage (D&C) or C-sections.
Symptoms of endometritis include abnormal vaginal bleeding or discharge, lower abdominal pain, and fever.
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