Background PID is diagnosed clinically when women have cervical motion, uterine and/or adnexal tenderness, but many women meeting these clinical criteria have no histological evidence of endometritis on endometrial biopsy. The objective of this study was to evaluate vaginal microbiological predictors of acute endometritis among women with signs and symptoms of PID.
Methods The Anaerobes and Clearance of Endometritis (ACE) study enrolled women with symptomatic PID in a clinical trial (NCT01160640) comparing treatment regimens with or without metronidazole. This analysis included 169 women who had evaluable endometrial biopsies; acute endometritis was defined as ≥1 plasma cell per 120X field in the stroma plus ≥5 neutrophils per 400X field in the epithelium. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) were detected by Aptima Combo 2 and vaginal swabs were evaluated by quantitative PCR for five species of Lactobacillus (crispatus, vaginalis, jensenii, gasseri, iners), three species of Prevotella (bivia, timonensis, amnii), Atopobium vaginae, Gardnerella vaginalis and Megasphaera phylotype I.
Results Only 31(18%) of 169 women with diagnosed PID had endometrial histology consistent with acute endometritis. By univariate analysis, lower genital tract CT, GC and BV-associated bacteria were each associated with increased endometritis, while L. crispatus, L, jensenii and L, vaginalis were negatively associated (P <0.05 for each). Based on the results of multivariable regression and factor analyses, a risk score for acute endometritis was developed combining CT (3 points), G. vaginalis, A. vaginae and P. amnii (1 point each if <106, 2 points each if >106) and L. crispatus (-2 points if <106 and -4 points if >106). A score of 5 or more detected 27 (87%) of 31 cases of endometritis and had a negative predictive value of 96%.
Conclusion Among women with symptomatic PID, a simple lower genital tract risk score including CT plus 4 vaginal bacteria was a predictor of acute endometritis.
Disclosure No significant relationships.
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