Role of bacterial vaginosis–associated microorganisms in endometritis,☆☆,,★★

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Abstract

OBJECTIVE: Our goal was to define the role of bacterial vaginosis and bacterial vaginosis–associated microorganisms in endometritis. STUDY DESIGN: Endometrial biopsies were obtained for histologic and microbiologic study from 178 consecutive women with suspected pelvic inflammatory disease, and 85 of them underwent laparoscopy to diagnose salpingitis. RESULTS: Histologic endometritis was confirmed in 117 (65%) of the women. Among women who underwent laparoscopy, salpingitis was present in 68% of those with and 23% of those without endometritis. Some but not all bacterial vaginosis–associated microorganisms were linked with endometritis. By logistic regression analysis, after adjustment for bacterial vaginosis and isolation of Neisseria gonorrhoeae and Chlamydia trachomatis, endometritis was associated with endometrial N. gonorrhoeae (odds ratio 5.7, 95% confidence interval 1.8 to 17.5), C. trachomatis (odds ratio 4.8, 95% confidence interval 1.3 to 18.2), anaerobic gram-negative rods (odds ratio 2.6, 95% confidence interval 1.1 to 5.7), and nonwhite race (odds ratio 2.3, 95% confidence interval 1.1 to 4.8). CONCLUSIONS: The association of anaerobic gram-negative rods with endometritis, after adjustment for bacterial vaginosis, N. gonorrhoeae, and C. trachomatis, supports the role of these microorganisms in the etiology of histologic endometritis among women with clinically suspected pelvic inflammatory disease. (Am J Obstet Gynecol 1996;175:435-41.)

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Study population

Women with clinically suspected pelvic inflammatory disease were enrolled into this study of the etiology, pathogenesis, and therapy of pelvic inflammatory disease at Harborview Medical Center from 1984 to 1988. All women had a history of lower abdominal pain and had tenderness on bimanual pelvic examination of the uterus and adnexa. Patients were excluded if they received more than a single dose of an antimicrobial agent in the 14 days before presentation, had pelvic or abdominal surgery in

RESULTS

Histologic endometritis was detected in 117 (65%) of the 178 women with suspected pelvic inflammatory disease. Characteristics of the women with or without histologic evidence of endometritis are summarized in Table I. Women with endometritis were more likely to be nonwhite, to have had a new sexual partner in the past month, and to perceive themselves as probably or definitely infertile. Women with endometritis were significantly more likely to be in the first half of the menstrual cycle than

COMMENT

In this study of 178 women with clinically suspected pelvic inflammatory disease, the recovery of anaerobic gram-negative rods from the endometrium was associated with histologic endometritis. However, the clinical entity of bacterial vaginosis was not independently associated with endometritis in the multivariate analysis, suggesting that invasion of the upper female genital tract by bacterial vaginosis - associated microorganisms is a greater risk for histologic endometritis than bacterial

Acknowledgements

We thank Cathy M. Critchlow, PhD, for biostatistical support.

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    Citation Excerpt :

    Greater than 85% of PID cases are caused by BV-related bacteria and/or STIs.4,14 Of those cases, fewer than half are caused by Neisseria gonorrhoeae or Chlamydia trachomatis, suggesting an important role for ascension of BV-associated anaerobic bacteria and other non-BV–related pathogens (eg, Mycoplasma genitalium) in endometritis and PID pathophysiology.15–17 PID and endometritis are associated with adverse health outcomes, such as chronic pain, ectopic pregnancy, tubo-ovarian abscess, and infertility.18,19

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From the Departments of Obstetrics and Gynecology,a Pathology,b and Medicinec and the Center for Acquired Immunodeficiency Syndrome and Sexually Transmitted Diseases,d University of Washington.

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Supported by National Institutes of Heath grant AI12192.

Reprint requests: Sharon L. Hillier, PhD, University of Pittsburgh/Magee-Womens Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, 300 Halket St., Pittsburgh, PA 15213-3180.

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