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Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial
Ettore Cicinelli1, Dominique De Ziegler, Roberto Nicoletti
1Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, Bari, Italy. cicinelli@gynecology1.uniba.it
Objective:
To evaluate the type and etiopathogenic role of infectious agents detected in endometrial cultures obtained from women with chronic endometritis (CE).
Design:
Prospective controlled study.
Setting:
University hospital.
Patient(S):
2190 women undergoing hysteroscopy for different indications.
Intervention(S):
Vaginal and endometrial samples were collected from 438 women with a CE diagnosis at hysteroscopy and 100 women with no signs of CE (controls).
Main Outcome Measure(S):
Histology and cultures for common bacteria, Neisseria gonorrhoeae and Mycoplasma, and molecular biology testing for Chlamydia were performed.
Result(S):
We compared results of vaginal and intrauterine cultures obtained from women with and without CE. Histologic results were positive in 388 of these cases (88.6%), and at least one microorganism was found in 320 endometrial samples (73.1%). In the control group, histologic results and endometrial culture were positive in only 6% and 5% of cases, respectively. The most frequent infectious agents detected at the endometrial level were common bacteria (58% of cases). Ureaplasma urealyticum was detected in 10% and Chlamydia in only 2.7% of positive endometrial cultures. In only 143 (32.6%) cases were the same infectious agent isolated in endometrial and vaginal cultures.
Conclusion(S):
More than 70% of CE cases resulted from nongonococcal, nonchlamydial infections. Common bacteria and Mycoplasma were the most frequent etiologic agents. Vaginal cultures have low concordance with endometrial cultures.
