Evaluation of chlorhexidine hydrochloride treatment on endometrial health of normal mares

Chlorhexidine gluconate solution is a potent antimicrobial and therefore could be used effectively for treatment of endometritis, but historically this substance has been implicated as irritating to mucous membranes, including the endometrium of the mare. The use of chlorhexidine hydrochloride suspension (Nolvasan Suspension, Zoetis, Florham Park, NJ, USA) was evaluated in the uterus of normal mares to determine if adverse effects on endometrial health were noted. Twelve healthy, adult light breed mares were included in this study. Procedures were approved by the Auburn University Institutional Animal Care and Use Committee. All mares were determined to be reproductively normal by evaluation of endometrial histopathology, cytology, and bacterial culture. Mares were randomly assigned to treatment or control groups (n = 6 per group). Each mare was treated during estrus with an intrauterine infusion of 1 g (28 mLs per tube; 35.7 mg/mL) of chlorhexidine hydrochloride suspension (treatment group) or an equal volume of lactated ringer's solution (control group) once daily for 3 consecutive days. Biopsy and cytology samples were taken 3, 7, and 14 days after completion of treatment. Cytology and biopsy samples were read by a board-certified pathologist (L.N.) blinded to treatments, and biopsy samples were graded using a standardized Kenney-Doig score. There was no difference with respect to biopsy grade, degree of endometrial fibrosis, or presence of cytologic inflammation comparing control and treatment groups (P = 0.55, 0.7, and 0.06, respectively), neither when accounting for sampling day. The suspension was visible within the uterine lumen when mares were examined with transrectal ultrasonography for up to 4 days after treatment. Treatment with chlorhexidine hydrochloride in this formulation and at this concentration does not appear to have a deleterious effect on short term endometrial health in mares.