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Analysis of chronic endometritis for Chlamydia trachomatis by polymerase chain reaction
R A Stern1, S M Svoboda-Newman, T S Frank
1Department of Pathology, University of Michigan Medical Center, Ann Arbor, USA.
Abstract:
Chronic endometritis is characterized histologically by plasma cells infiltrating endometrial stroma. Although it has been speculated that many instances of chronic endometritis are infectious, the origin of most cases is not apparent by routine histopathologic evaluation. Chlamydia trachomatis, an obligate intracellular bacterium, is known to cause chronic endometritis in the setting of pelvic inflammatory disease. The authors analyzed 43 specimens of histopathologically diagnosed chronic endometritis from 38 patients for C trachomatis by PCR using primers for the single-copy major outer membrane protein (MOMP) gene. C trachomatis was detected in only one such case in which dense plasma cell infiltrates were present and concurrent C trachomatis infection of the cervix was documented. Using serially diluted DNA from formalin-fixed, paraffin-embedded McCoy cells, the sensitivity of this method was shown to be equivalent to a single infected cell in a paraffin section. In conjunction with the results of other studies, these data indicate a limited role, if any, of C trachomatis in the origin of mild or moderate chronic endometritis.
Insights
Chlamydia trachomatis rarely causes chronic endometritis. PCR testing of endometrial tissue found this bacterium in only one case, suggesting it plays a limited role in this condition.
Area of Science:
- Reproductive Medicine
- Infectious Diseases
- Pathology
Background:
- Chronic endometritis is defined by plasma cell infiltration of the endometrial stroma.
- The infectious origin of most chronic endometritis cases remains unclear.
- Chlamydia trachomatis is a known cause of endometritis, particularly with pelvic inflammatory disease.
Purpose of the Study:
- To investigate the prevalence and role of Chlamydia trachomatis in histopathologically diagnosed chronic endometritis.
- To determine if C. trachomatis is a significant causative agent in mild to moderate chronic endometritis.
Main Methods:
- Polymerase chain reaction (PCR) was used to detect C. trachomatis.
- Primers targeted the major outer membrane protein (MOMP) gene of C. trachomatis.
- 43 endometrial specimens from 38 patients with chronic endometritis were analyzed.
Main Results:
- C. trachomatis was detected in only one of the 43 specimens.
- This positive case involved dense plasma cell infiltrates and documented concurrent cervical C. trachomatis infection.
- The PCR method demonstrated high sensitivity, capable of detecting a single infected cell in tissue sections.
Conclusions:
- Chlamydia trachomatis appears to play a limited role in the etiology of mild to moderate chronic endometritis.
- Routine histopathology may not identify the cause of most chronic endometritis cases.
- Further research is needed to elucidate the origins of the majority of chronic endometritis diagnoses.