As part of the routine fertility evaluation we usually obtain cervical cultures including a test for mycoplasma and ureaplasma. These are bacteria that have essentially no symptoms but may decrease fertility and may also influence the chance of pregnancy loss and even preterm labor and delivery. However, the data is not particularly good and thus, many clinics do not routinely perform these cultures.
Years ago when I was in practice in Long Island I was doing an examination and sonogram on a new patient. I carefully explained each step and while doing the speculum exam I said that I was going to take some swabs of the cervix to check for infections that may be related to or cause infertility. She said fine and then after the exam left the office. An hour later she called irate. How dare I do such a test on her without her consent! She was going to report me to the Board of Medicine for being such a lousy doctor!
Needless to say I was completely unprepared for this assault. I reminded her that I had asked her permission to do the test…That doesn’t count, she said, because I had her in a compromised position and how could she say no? When I told her that I could just throw out the samples and not send them she was suddenly relieved and much happier.
I have always wondered exactly what set her off. Perhaps she had STD risk factors that she didn’t want to share with me?? Who knows. In any case, sometimes the simplest things can be blown up into major issues. I do not take any testing lightly, but seemed like a bit of an over-reaction.
So here is today’s Question of the Day from 100 Questions and Answers about Infertility.
13. What is ureaplasma, and how did I get it?
Most reproductive endocrinologists routinely obtain samples from the cervix (cervical cultures) to assess their patients for gonorrhea, chlamydia, ureaplasma, mycoplasma, and other bacteria. Gonorrhea and chlamydia are sexually transmitted diseases that can cause tubal damage and infertility when these infections are passed back and forth between sexually intimate partners. Patients with gonorrhea may have a yellowish discharge associated with pelvic pain and fever. Although chlamydia can be associated with these symptoms, chlamydial infections are often silent; despite their lack of symptoms, these infections may result in significant tubal scarring and damage.
Ureaplasma and mycoplasma are somewhat more problematic to label as reproductive tract pathogens, because they are often found in fertile, healthy couples in addition to those with infertility. These bacteria have been hypothesized to play a role in both infertility and miscarriage, but the specific mechanisms by which they alter fertility are unclear. Whether ureaplasma or mycoplasma can cause reproductive tract damage or whether their presence increases the rate of miscarriage is controversial. As a consequence, many clinics do not test for ureaplasma or mycoplasma routinely. If the cultures for ureaplasma and mycoplasma are positive, both the patient and her sexual partner are treated with antibiotics. As these bacteria are may be present for many years without causing any symptoms, the finding of ureaplasma and mycoplasma on cervical cultures does not in any way indicate infidelity or sexual misconduct.