CURRENT CAPABILITIES OF THE ETIOLOGICAL DIAGNOSIS OF CHRONIC ENDOMETRITIS

Objective. To study the microflora of the genital tract in women with or without chronic endometritis (CE) to provide a pathogenetic rationale for the etiological role of a microbial factor in the genesis of CE. Subjects and methods. The study enrolled 42 reproductive-aged patients who were divided into 3 groups according to histological findings: 1) 20 patients with CE; 2) 8 with endometrial polyps; 3) 14 without endometrial abnormality (a control group). Hysteroscopy and diagnostic endometrectomy were performed in 27 patients; aspiration endometrial biopsy was carried out with a Pipelle de Cornie curette in 15. All the women underwent microflora examination in the reproductive tract (vagina, cervical canal, endometrium) by cultural studies; polymerase chain reaction was used to detect absolute pathogens (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium) and viruses (herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) and cytomegalovirus (CMV)). The Mann-Whitney test, χ 2 test, and Spearman’s correlation analysis were employed for statistical processing. The values of p<0.05 were considered statistically significant for all types of analysis. Results. Opportunistic microorganisms (OMs) were revealed in the endometrium of every two (55.0%) patients with CE. The endometrial homogenate most frequently showed the following OMs: Gardnerella vaginalis in 29.4% of cases, Enterococcus faecalis in 17.6%, and Escherichia œli in 11.8%. In the control group, there was no growth of OMs in the endometrial biopsy specimen. The etiological implication of absolute pathogens, genital Mycoplasma, HSV-1, and HSV-2 was not corroborated. CMV was found in 2.4% of cases. A strong direct relationship was established between the changes in the vaginal microflora and the detection of OMs in the endometrial biopsy specimen (r=0.76;p<0.05).

chronic endometritis, opportunistic microorganisms, endometrium