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for testing males. The treatment is most commonly metronidazole (Flagyl). There is no agreement about the influence of Trich on fertility for males, but it may contribute to male factor infertility. There is, however, some evidence that Trich can affect a pregnancy causing low birth weight, premature rupture of membranes, or prematurity. Some studies have found an association between Trich and infertility, but overall, there is no strong evidence that Trich causes infertility.

      Ureaplasma and mycoplasma

      Ureaplasma and mycoplasma are microorganisms that can affect different parts of the body, depending on the strain. The genital tracts of both sexes can carry mycoplasma or ureaplasma. The following list gives some other information about the diseases:

       As many as 40 percent of women and men are carriers of bacteria called ureaplasma or mycoplasma.

       Some controversy exists about whether certain strains of ureaplasma and mycoplasma cause problems in getting pregnant; some studies show that they increase the incidence of miscarriage and/or problems with the embryo implanting in the uterus. This seems to be related to either partner having the infection, which is easily passed between partners.

       Scientific studies have failed to demonstrate statistically that either ureaplasma or mycoplasma reduces fertility.

      

As with other STDs, both partners are easily treated with a 14-day course of an antibiotic, such as doxycycline. Both partners must take the drug, or they’ll probably continue to reinfect each other.

      A new kid on the block: Zika

      Zika is a virus which can cause severe problems for infants if their mother becomes infected while pregnant.

      The American College of Obstetricians and Gynecology (ACOG) issued a committee opinion in April of 2019 recommending that healthcare providers continue to caution patients about potential exposure to Zika even though the rate of infection seems to be decreasing.

      Infectious agents come in basically four flavors: bacteria, yeast, parasites, and virus. The first three organisms all stay outside of the cell, but the virus enters the cell and hijacks the cell’s genetic machinery to turn out more virus — nice Trojan horse! Zika is spread to humans by mosquitos (Aedes species). Transmission of the virus has been reported to occur through sexual contact, blood transfusion, and to a fetus.

      Since the virus is spread by mosquitos, which have defined habitats, areas where the mosquitoes reside are consider areas for possible exposure. The virus can also be contracted by having sex with an infected partner without the use of a condom. The signs of being infected include fever, rash, muscle aches, and inflammation of the eye. Symptoms usually occur within the first 3–14 days after exposure.

      Zika has been classified as a fetal teratogen (something which causes a malformation of a fetus). If a fetus becomes infected, the fetus may develop a distinct pattern of birth defects which affect the nervous system, the brain, and the skull. Other problems have been reported as a result of a Zika infection such as heart abnormalities, miscarriage, preterm birth, and stillbirth. Women can transmit the virus to a fetus throughout a pregnancy, and the risk of a congenital birth syndrome is 5–10 percent.

As of 2019, there was no vaccine for Zika. Because the infection is from a virus, antibiotics do not work and there is no cure for the infection. That means that the only way to limit the risk of being infected is to avoid those areas where Zika lives. Thus, ACOG has made recommendations that include avoiding travel to areas where Zika outbreaks occur. Make sure to check before planning your next trip, even in you are in the preconception phase. Sorry, folks! Many of these Zika hot spots are in tropical oases (think Hawaii, the Caribbean, and so on). Keep in mind that skipping this babymoon may be the best gift you give to your future family.

      Also, if a woman has been subject to the risk of Zika and is considering conceiving, she should wait at least eight weeks either from having Zika-like symptoms or exposure to try to conceive. If a male partner is at risk either from exposure or symptoms, then the couple should wait at least three months before trying to conceive. ACOG recommends that people with possible exposure or people who are considering traveling to Zika risk areas should consult their obstetrician for advice. The Zika recommendations will change as new information occurs and as possible vaccines are commercially available, so consultation with an OB should provide the latest methods for managing Zika.

STIs May Cause PID: More Than Just a “Pain in the Derriere”

      Even though many of the infections discussed earlier in this chapter can be taken care of with appropriate antibiotic treatment, in some cases, there may be lingering effects.

      

Severe abdominal pain with a fever should be immediately evaluated.

      Pelvic inflammatory disease (PID) is an infection of the upper female reproductive system, which includes the uterus, tubes, and ovaries. PID is most commonly associated with sexually transmitted diseases and as such, starts in the vagina and moves up into the upper reproductive organs. PID classically shows itself as severe pain in the entire lower abdomen and can include a fever (a body temperature of ≥101 degrees Fahrenheit taken twice, six hours apart), a general feeling of being sick, and nausea. PID is most commonly caused by gonorrhoeae or Chlamydia trachomatis.

It has been estimated that about 10 percent of women with these infections develop PID, and PID from gonorrhoeae seems to be more severe. Frequently, other bacteria contribute to the infection. The CDC reports that the rate of PID has been decreasing. In 2006, about 0.8 percent of women between the ages of 15 and 29 contracted PID, but by 2013, this was down to about 0.6 percent, which is a 25 percent decrease. PID can cause damage to the fallopian tubes in the form of scarring or damage to the transport function of the tubes. PID can also cause general pelvic scarring and chronic pain. Estimates have reported that for young women with PID, about 20 percent develop chronic pain, 8 percent have an ectopic pregnancy, and about 15 percent have infertility. PID is treated with antibiotics, and early diagnosis and treatment decrease the long-term complications.

Exploring Specific Lifestyle Choices and Busting Some Common Myths

      Most everyone knows about drinking, smoking, and drugs being bad for you when you’re trying to get pregnant. In this section, we talk about a few things that affect getting pregnant of which you may not be aware.

      Gauging the truth about hot tubs — and other “short” stories

      

Anything that raises the temperature of a man’s testicles can decrease sperm production and motility. Hot tubs, saunas, steam rooms, and tight underwear are out for men! Well … maybe not out altogether.

      It seems that the evidence for this belief is derived from a study published in 2007. Searching for other studies failed to identify any. Even the study authors cautioned that their study was a pilot study and suggested further research, but none was ever reported in searchable databases. The study looked at 11 males, asked them to stop using the hot tub, and found that 5 out of the 6 who did stop had an improvement in the motility of the semen analysis. The study did not attempt to determine whether this change increased the chance for conception. Based upon this extraordinarily weak evidence, it is hard to make a recommendation about hot tubs and fertility. A 1996 study looked at using a scrotal cooling device and infertility. The study had 25 subjects, and 16 of the 25 men had an improvement in the semen while 6 achieved a pregnancy. So admittedly, constantly heating the testicles is probably not a good idea, but there is very little evidence that heat exposure affects male fertility. Finally, a 1998 study looked at the influence of boxer shorts on male fertility and guess what? No effect! So, boxers or briefs or commando are okay.

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