A 10-year prospective study of women with a history of recurrent fetal losses fails to identify Listeria monocytogenes in the genital tract.

An attempt was made to isolate L. monocytogenes from the cervix and endometrium of patients who presented to the Dartmouth-Hitchcock Medical Center's Reproductive Counseling Unit with a history of two or more fetal losses. Endometrial tissue and endocervical swabs were cultured in a prospective fashion for the presence of L. monocytogenes. During the 10-year study period, none of the patients with recurrent fetal losses were found to harbor the organism in their genital tract. It would appear that L. monocytogenes contributes to fetal loss, but probably not on a recurrent basis. Routine culturing for L. monocytogenes in the asymptomatic patient in a clinical setting is not cost-effective and is therefore unwarranted. The portal of entry is possibly the GI tract, with bacteremia and transplacental spread to the fetus. Ascending infection through the introduction of L. monocytogenes into the vagina and cervix may occur. Because of the difficulty in identifying L. monocytogenes in the feces, as well as the self-limiting nature of listeriosis, it would appear unwarranted to give routine administration of antibiotics in patients who have had a history of a fetal loss because of L. monocytogenes.