Plasma cell endometritis in women with symptomatic bacterial vaginosis

doi:10.1016/0029-7844(94)00400-8

Obstetrics & Gynecology

Volume 85, Issue 3, March 1995, Pages 387-390

https://doi.org/10.1016/0029-7844(94)00400-8 Get rights and content

Objective:

To evaluate the endometrial microbiology and histopathology in women with symptomatic bacterial vaginosis but no signs or symptoms of upper genital tract disease or other vaginal or cervical infections.

Methods:

Endometrial biopsies were performed on 41 women complaining of vaginal discharge or pelvic pain at a sexually transmitted disease clinic. These women had neither culture nor serologic evidence of Neisseria gonorrhoeae or Chlamydia trachomatis infection. Twenty-two women with bacterial vaginosis diagnosed by Gram stain examination of vaginal fluid, but with neither signs nor symptoms of upper genital tract infection, were compared with 19 women who had no evidence of bacterial vaginosis on vaginal fluid Gram stain. Endometrial biopsies were evaluated for histopathologic evidence of plasma cell endometritis and were cultured for N gonorrhoeae, C trachomatis, aerobic and anaerobic bacteria, Mycoplasma species, and Ureaplasma urealyticum.

Results:

Ten of 22 women with bacterial vaginosis had plasma cell endometritis, compared with one of 19 controls (odds ratio [OR] 15, 95% confidence interval [CI] 2–686; P < .01). Bacterial vaginosis-associated organisms were cultured from the endometria of nine of 11 women with and eight of 30 women without plasma cell endometritis (OR 12.4, 95% CI 2–132; P = .002).

Conclusion:

Plasma cell endometritis was frequently present in women with bacterial vaginosis and without other vaginal or cervical infections. This suggests the possibility of an association between bacterial vaginosis and nonchlamydial, nongonococcal, upper genital tract infection.

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Bacterial vaginosis (BV) is a common polymicrobial infection affecting women in the reproductive age and is associated with adverse obstetric and gynaecological outcomes. Gardnerella vaginalis is the most virulent anaerobic bacterial species predominantly associated with BV. However, a clear understanding of the mechanisms by which it contributes to the pathogenesis and persistence of BV is lacking. In this report, we demonstrate for the first time, the isolation of membrane vesicles (MVs) from G. vaginalis ATCC 14019. These MVs are approximately 120–260 nm in diameter. Proteomic characterization of the MVs by LC-MS/MS led to the identification of 417 proteins, including proteins involved in cellular metabolism as well as molecular chaperones and certain virulence factors. Immunoblot analysis of the MVs confirmed the presence of vaginolysin, the most well-characterized virulence factor of G. vaginalis. The exposure of the vaginal epithelial cells, VK2/E6E7 to the G. vaginalis MVs resulted in the internalization of the MVs. The MVs induced cytotoxicity and an increase in the levels of the pro-inflammatory cytokine, IL-8 in VK2 cells as well lysis of erythrocytes. The results of the study indicate that G. vaginalis MVs may be involved in the delivery of cytotoxic proteins and other virulence factors to the host cells and could thereby contribute towards enhancing the cellular damage associated with pathogenesis of BV.
Evaluation of peripheral and uterine immune status of chronic endometritis in patients with recurrent reproductive failure
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To investigate whether chronic endometritis (CE) affects the immune status of peripheral blood and endometrium in patients with recurrent reproductive failure (RRF).
Retrospective study.
Private fertility center.
A total of 524 RRF patients, including 324 women with recurrent miscarriage (RM) and 200 women with recurrent implantation failure (RIF).
Peripheral blood and endometrium samples were collected in the midluteal phase before in vitro fertilization treatment or pregnancy. The number of peripheral T, natural killer (NK), and B cells, as well as cytotoxicity of NK cells and expression of T_H1 cytokines were analyzed with the use of flow cytometry, and uterine immune cells were subjected to immunohistochemistry.
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The proportion and function of the analyzed immune cell subsets in peripheral blood as well as the percentages of CD56⁺ NK cells, CD163⁺ M2 macrophages, and CD1a⁺ immature dendritic cells in the endometrium were not significantly altered between non-CE and CE patients, whereas the proportions of uterine CD68⁺ macrophages, CD83⁺ mature dendritic cells, CD8⁺ T cells, and Foxp3⁺ regulatory T cells were significantly elevated in CE patients. After antibiotic treatment, the percentage of CD68⁺ macrophages, CD83⁺ mature dendritic cells, CD8⁺ T cells, and Foxp3⁺ regulatory T cells in endometrium were significantly reduced in patients with cured CE.
CE contributes to elevated endometrial infiltration levels of immune cells. The excessive presence of endometrial immune cells in CE patients may be involved in reduced endometrial receptivity and recurrent pregnancy failures.
Evaluación de las células inmunes uterinas y en sangre periférica en pacientes con endometritis crónica y fallo reproductivo recurrente
investigar si la endometritis crónica (EC) afecta el estado de las células inmunes presentes en la sangre periférica y el endometrio en pacientes con fracaso reproductiva recurrente (FRR).
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Un total de 524 pacientes con FRR, incluyendo 324 mujeres con aborto involuntario recurrente (AR) y 200 mujeres con fallo de implantación recurrente (FIR). Intervención (es): Se recogieron muestras de sangre periférica y endometrio en la fase lútea media antes del tratamiento de fertilización in vitro o embarazo El número de células T periféricas, células natural killer, (NK) y B, así como la citotoxicidad de las células NK y la expresión de las citocinas Th1 se analizaron utilizando citometría de flujo y las células inmunes uterinas se analizaron utilizando la técnica de inmunohistoquímica.
células inmunes periféricas, citocinas, citotoxicidad NK y células inmunes endometriales se compararon en pacientes con FRR y presencia de EC versus negativos para EC.
la proporción (%) y función de los subgrupos de células inmunes analizados en sangre periférica, así como los porcentajes de la células CD56+ NK, los macrófagos CD163+ M2 y las células dendríticas inmaduras CD1a+ en el endometrio no mostraron diferencias significativas entre las pacientes no EC y pacientes con EC, mientras que las proporciones de macrófagos uterinos CD68+, células dendríticas maduras CD83+, células T CD8+ y Foxp3+ las células T reguladoras estaban significativamente elevadas en pacientes con EC. Después del tratamiento antibiótico, el porcentaje de macrófagos CD68+, las células dendríticas maduras CD83+, las células T CD8+ y las células T reguladoras Foxp3+ en el endometrio se redujeron significativamente en pacientes con EC tratada.
La EC contribuye a incrementar la infiltración endometrial de células inmunes. La presencia excesiva de células inmunes endometriales en pacientes con EC pueden estar relacionada con una receptividad endometrial reducida y el fallo reproductivo recurrente.
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Citation Excerpt :
It is characterized by the inflammation of the endometrium [4]. In many cases, the inflammation of the endometrium of were caused by bacteria [5]. Once stimulation by bacteria, a lot of neutrophils were infiltrated into the uterus and released a large body of inflammatory mediators [6].
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No. 211-Screening and Management of Bacterial Vaginosis in Pregnancy
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To review the evidence and provide recommendations on screening for and management of bacterial vaginosis in pregnancy.
The clinical practice options considered in formulating the guideline.
Outcomes evaluated include antibiotic treatment efficacy and cure rates, and the influence of the treatment of bacterial vaginosis on the rates of adverse pregnancy outcomes such as preterm labour and delivery and preterm premature rupture of membranes.
Medline, EMBASE, CINAHL, and Cochrane databases were searched for articles, published in English before the end of June 2007 on the topic of bacterial vaginosis in pregnancy.
The evidence obtained was rated using the criteria developed by the Canadian Task Force on Preventive Health Care.
Guideline implementation will assist the practitioner in developing an approach to the diagnosis and treatment of bacterial vaginosis in pregnant women. Patients will benefit from appropriate management of this condition.
These guidelines have been prepared by the Infectious Diseases Committee of the SOGC, and approved by the Executive and Council of the SOGC.
The Society of Obstetricians and Gynaecologists of Canada.
There is currently no consensus as to whether to screen for or treat bacterial vaginosis in the general pregnant population in order to prevent adverse outcomes, such as preterm birth.
- 1.
  In symptomatic pregnant women, testing for and treatment of bacterial vaginosis is recommended for symptom resolution. Diagnostic criteria are the same for pregnant and non-pregnant women (I-A).
- 2.
  Treatment with either oral or vaginal antibiotics is acceptable for achieving a cure in pregnant women with symptomatic bacterial vaginosis who are at low risk of adverse obstetric outcomes (I-A).
- 3.
  Asymptomatic women and women without identified risk factors for preterm birth should not undergo routine screening for or treatment of bacterial vaginosis (I-B).
- 4.
  Women at increased risk for preterm birth may benefit from routine screening for and treatment of bacterial vaginosis (I-B).
- 5.
  If treatment for the prevention of adverse pregnancy outcomes is undertaken, it should be with metronidazole 500 mg orally twice daily for seven days or clindamycin 300 mg orally twice daily for seven days. Topical (vaginal) therapy is not recommended for this indication (I-B).
- 6.
  Testing should be repeated one month after treatment to ensure that cure was achieved (III-L).

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: Supported by National Institutes of Health, National Institutes of Allergy and Infectious Diseases grant no. 5-UO1-AI31499-03.

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Plasma cell endometritis in women with symptomatic bacterial vaginosis

Objective:

Methods:

Results:

Conclusion:

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