Chronic pelvic pain - caused by ureaplasma?

[twig39]

Since August 2007 I have been suffering bad pelvic pain - like period pains with a feeling of fullness in the pelvis and pain in the back passage and vagina, along with a heavy vaginal discharge (a mixture of white and clear), which at one time smelled highly of amonia.  I also suffered urinary frequency.

All swabs came back negative.  I then had a PCR assay done on my urine and this showed the presence of ureaplasma urealyticum.   I took four courses of azithromycin, of differing strengths and lengths, and my husband was also treated with a single 1g dose.

The next test I had done for ureaplasma showed it was no longer present.  However, symptoms remained, and while they are not so severe now, I still experience dull aches, and an internal exam is quite painful (as was my PAP test in December).  The discharge has changed to all white, but is still heavy - although this may be due to the fact that, having had breast cancer in August 2008, I am now on tamoxifen.

I have had all gynae tests (pelvic scan, hysteroscopy) which showed nothing untoward, and I also had a cystoscopy which showed that my bladder was healthy.

My questions, therefore, are:

1. - Could the ureaplasma have caused a pelvic infection/inflammation?
2. -Could the hysteroscopy actually have made things worse by introducing the ureaplama into the womb during the procedure?
3.  - Could the fact that I am still suffering some pain mean that while, the infection has gone, there is still some residual inflammation there and, if so, will it eventually ease?
4.  - Could the infection have caused permanent damage?

For your information, I am 56, have never had children, and was perimenopausal with irregular periods up until the time I started taking tamoxifen when my periods stopped altogether.

I look forward to your reply.

Thank you.

[Elaine Brown, MD]

HI!
Ureaplasma is a common colonizing organism of the genital tract and can be found in cultures obtained from up to 80% of women.  It CAN cause infection, and in someone with symptoms simlar to yours, I would treat.  In someone with no symptoms I would ignore it completely--its similar to finding staph on your skin, or e coli in your colon--everyone has it.
I would put my money on the tamoxifen as the cause of at least some of your symptoms.  It can cause atrophic vaginitis which makes intercourse and pelvic exams very difficult.  It can also cause a whitish discharge and itching/irritation.

The deep pelvic pain is a little more difficult. You didn't mention colonoscopy which is the next "oscopy" I would suggest.  Both because of symptoms and because you are over 50.  Tamoxifen tends to shrink and quiet down the reproductive organs (anti-estrogen), so I would take a good look at the colon!

Also, I don't even want to mention the possibility, but I am going to assume that you have been worked up for metatstatic disease ( spread of the cancer) It can spread to ovaries and/or bone--spine.  Maybe a PET scan would be a reasonable thought too.

Hope this is helpful!
Dr B

[twig39]

Thank you very much for this helpful reply.  I hope you don't mind, but there are one or two points I would like to follow up with you.

I understand what you say about tamoxifen being the cause of some of my symptoms.  However, I was not diagnosed with breast cancer and did not start taking tamoxifen until August 2008 - a year after I strated to experience the pelvic pains.  That is why I asked whether inflammation from ureaplasma urealyticum could remain after the infection has gone.  In fact the UU remained untreated for about 15 months, and I wonder therefore whether this could be why it took such a long time for pelvic pain to subside even after a test showed the UU not present.

As far as difficulties with pelvic exams, I don't think this is due to atrophic vaginitis.  The discomfort I experience with pelvic exams is not because of problems with the vagina, but because when my gynaecologist has given me a bi-manual exam (pressing against the cervix with one hand and against my pelvis with the other) I experience pelvic tenderness.  This again makes me concerned that there is still some inflammation there that is causing chronic pain.

I was very interested in what you said about spread of the cancer.  When I had surgery for mny breast cancer (wide excision to remove the lump and some surrounding tissue, leaving the rest of the breast intact) I also had axillary lymph node sampling carried out.  The biopsy on the lymph nodes came back "all clear", and I was told that therefore the disease hadn't spread.  However, I have also recently experienced pain radiating from a very tender spot on my lower spine, round my hips and into my groins and the tops of my legs.  Bearing in mind that the lymph node biopsy showed no sign of the cancer spreading, should I be concerned about these back/hip symptoms?

Thank you once again for your help, and I look forward to hearing from you.