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David A. Eschenbach - One of the best experts on this subject based on the ideXlab platform.
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The antimicrobial treatment of subacute Endometritis: a proof of concept study.
American journal of obstetrics and gynecology, 2004Co-Authors: Linda O. Eckert, Nancy B. Kiviat, Soe Soe Thwin, Sharon L. Hillier, David A. EschenbachAbstract:Abstract Objective Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for Endometritis. Study design A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute Endometritis and to determine the treatment effect on Endometritis resolution. Results After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic Endometritis (38% vs 4%), all P Chlamydia trachomatis or Neisseria gonorrhoeae . In women without prior PID, Endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae ( P =.002 for trend). Conclusions In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic Endometritis. Prior PID is additive with current cervical infection as a risk for Endometritis.
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Endometritis: The clinical-pathologic syndrome
American journal of obstetrics and gynecology, 2002Co-Authors: Linda O. Eckert, Stephen E. Hawes, Pål Wølner-hanssen, Nancy B. Kiviat, Judy N. Wasserheit, Jorma Paavonen, David A. Eschenbach, K. HolmesAbstract:OBJECTIVE: The purpose of this study was to evaluate histologically proved Endometritis as a clinical syndrome that is distinct from laparoscopically confirmed salpingitis. STUDY DESIGN: This was a cross-sectional study of 152 women in an urban hospital with a suspected pelvic inflammatory disease. All women provided a standardized medical history and underwent physical examination, endometrial biopsy, and laparoscopy. We defined Endometritis by the presence of plasma cells in endometrial stroma and neutrophils in the endometrial epithelium. RESULTS: Of 152 women who were enrolled, 43 women had neither Endometritis nor salpingitis; 26 women had Endometritis alone without salpingitis, and 83 women had salpingitis. Those women with Endometritis alone more often had couched recently, had a current intrauterine device, and were in menstrual cycle day 1 to 7, compared with women with no Endometritis or salpingitis (P = .007, .04, .005, respectively) or women with acute salpingitis (P = .03, .01, .02, respectively). Infection with Neisseria gonorrhoeae and/or Chlamydia trachomatis was found more frequently in women with Endometritis alone than in women with no Endometritis or salpingitis (P < .001) and less frequently than in women with salpingitis (P = .05). Lower quadrant, adnexal, cervical motion, rebound tenderness, peritonitis, tenderness score, fever, and laboratory abnormalities that indicated inflammation and detection of gonorrheal or chlamydial infection were significantly less common in women with Endometritis alone than in women with salpingitis but were somewhat more common in women with Endometritis alone than among women with no salpingitis or Endometritis. CONCLUSION: Among women with suspected pelvic inflammatory disease, the histopathologic manifestations of Endometritis were associated with clinical manifestations, infection, and specific risk factors that were intermediate in frequency between women with salpingitis and women with neither Endometritis nor salpingitis.
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role of bacterial vaginosis associated microorganisms in Endometritis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, King K HolmesAbstract: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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Role of bacterial vaginosis–associated microorganisms in Endometritis
American journal of obstetrics and gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, K. HolmesAbstract: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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bacterial vaginosis as a risk factor for post cesarean Endometritis
Obstetrics & Gynecology, 1990Co-Authors: D H Watts, Sharon L. Hillier, Marijane A Krohn, David A. EschenbachAbstract:Bacterial species associated with bacterial vaginosis have been isolated more frequently from endometrial cultures of patients with postpartum Endometritis than expected from the prevalence of bacterial vaginosis among pregnant women. To further assess the association between bacterial vaginosis and postpartum Endometritis, vaginal Gram smears were obtained from women admitted for delivery. Vaginal smears of women delivered by cesarean were scored as normal or as indicating bacterial vaginosis. Factors related independently to postpartum Endometritis by multiple logistic regression analysis included maternal age less than 25 years, any duration of membrane rupture, and bacterial vaginosis. The unadjusted odds ratio for the development of postpartum Endometritis associated with bacterial vaginosis (odds ratio = 6.1, 95% confidence interval 3.3-15.9) was not appreciably changed in the multivariable analysis (odds ratio = 5.8, 95% confidence interval 3.0-10.9) after adjusting for maternal age, duration of labor, and duration of membrane rupture. At the time of Endometritis, Bacteroides sp, Peptostreptococcus sp, and Gardnerella vaginalis were isolated more frequently from the endometrium using a triple lumen endometrial sampling method among patients with bacterial vaginosis than among those with a normal Gram stain. Bacterial vaginosis appears to be an important risk factor for postpartum Endometritis after cesarean delivery.
Sharon L. Hillier - One of the best experts on this subject based on the ideXlab platform.
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gene expression signatures can aid diagnosis of sexually transmitted infection induced Endometritis in women
Frontiers in Cellular and Infection Microbiology, 2018Co-Authors: Xiaojing Zheng, Sharon L. Hillier, Harold C. Wiesenfeld, Catherine M Oconnell, Wujuan Zhong, Taylor B Poston, Maria Trent, Charlotte A Gaydos, George C Tseng, Brandie D TaylorAbstract:Sexually transmitted infection (STI) of the upper reproductive tract can result in inflammation and infertility. A biomarker of STI-induced upper tract inflammation would be significant as many women are asymptomatic and delayed treatment increases risk of sequelae. Blood mRNA from 111 women from three cohorts was profiled using microarray. Unsupervised analysis revealed a transcriptional profile that distinguished 9 cases of STI-induced Endometritis from 18 with cervical STI or uninfected controls. Using a hybrid feature selection algorithm we identified 21 genes that yielded maximal classification accuracy within our training dataset. Predictive accuracy was evaluated using an independent testing dataset of 5 cases and 10 controls. Sensitivity was evaluated in a separate test set of 12 women with asymptomatic STI-induced Endometritis in whom cervical burden was determined by PCR; and specificity in an additional test set of 15 uninfected women with pelvic pain due to unknown cause. Disease module preservation was assessed in 42 women with a clinical diagnosis of pelvic inflammatory disease (PID). We also tested the ability of the biomarker to discriminate STI-induced Endometritis from other diseases. The biomarker was 86.7% (13/15) accurate in correctly distinguishing cases from controls in the testing dataset. Sensitivity was 83.3% (5/6) in women with high cervical Chlamydia trachomatis burden and asymptomatic Endometritis, but 0% (0/6) in women with low burden. Specificity in patients with non-STI-induced pelvic pain was 86.7% (13/15). Disease modules were preserved in all 8 biomarker predicted cases. The 21-gene biomarker was highly discriminatory for systemic infections, lupus, and appendicitis, but wrongly predicted tuberculosis as STI-induced Endometritis in 52.4%. A 21-gene biomarker can identify asymptomatic women with STI-induced Endometritis that places them at risk for chronic disease development and discriminate STI-induced Endometritis from non-STI pelvic pain and other diseases.
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The antimicrobial treatment of subacute Endometritis: a proof of concept study.
American journal of obstetrics and gynecology, 2004Co-Authors: Linda O. Eckert, Nancy B. Kiviat, Soe Soe Thwin, Sharon L. Hillier, David A. EschenbachAbstract:Abstract Objective Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for Endometritis. Study design A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute Endometritis and to determine the treatment effect on Endometritis resolution. Results After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic Endometritis (38% vs 4%), all P Chlamydia trachomatis or Neisseria gonorrhoeae . In women without prior PID, Endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae ( P =.002 for trend). Conclusions In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic Endometritis. Prior PID is additive with current cervical infection as a risk for Endometritis.
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Endometritis does not predict reproductive morbidity after pelvic inflammatory disease
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Catherine L Haggerty, Sharon L. Hillier, Roberta B. Ness, Antonio J. Amortegui, Jeffrey F. Peipert, Susan L Hendrix, Robert L Holley, Hugh Randall, Steven J Sondheimer, David E. SoperAbstract:Abstract Objective: We investigated the association between Endometritis and reproductive morbidity. Study Design: Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with Endometritis (≥5 neutrophils or ≥2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without Endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility. Results: Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without Endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates. Conclusion: Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, Endometritis/UGTI was not associated with reproductive morbidity. (Am J Obstet Gynecol 2003;188:141-8.)
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role of bacterial vaginosis associated microorganisms in Endometritis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, King K HolmesAbstract: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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Role of bacterial vaginosis–associated microorganisms in Endometritis
American journal of obstetrics and gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, K. HolmesAbstract: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.)
W H Johnson - One of the best experts on this subject based on the ideXlab platform.
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endometrial cytology and ultrasonography for the detection of subclinical Endometritis in postpartum dairy cows
Theriogenology, 2004Co-Authors: R Kasimanickam, J.s. Walton, Robert A. Foster, T F Duffield, K E Leslie, C J Gartley, W H JohnsonAbstract:Abstract The objectives of the study were to validate the use of endometrial cytology (EC) and ultrasonography (US) to diagnose subclinical Endometritis in clinically normal postpartum dairy cows, and to measure the impact of subclinical Endometritis on reproductive performance. Holstein cows from two dairy farms were examined at Visit 1 (V1) at 20–33 days in milk (DIM), and clinically normal cows ( n =228), based on the absence of abnormal discharge on external inspection and vaginoscopy, were selected. The reproductive tract of selected cows was evaluated by transrectal palpation, US and EC. All cows in the study were re-examined at Visit 2 (V2) at 34–47 DIM (2 weeks after V1) and were subsequently followed for a minimum of 8 months (until pregnant or culled). Survival analysis was used to derive a case definition of subclinical Endometritis, based on factors associated with decreased relative pregnancy rate. Positive EC at V1 (>18% polymorphonuclear leukocytes; PMN) or fluid in uterus at V1 (FIU1) were associated with a significant reduction in the relative pregnancy rate and identified cows with subclinical Endometritis. Similarly, a positive EC (>10% PMN) at V2 or fluid in the uterus at V2 (FIU2), identified cows with subclinical Endometritis. Cows with subclinical Endometritis at V1 and at V2 had a relative pregnancy rate of 41 and 51% (hazard ratio for pregnancy of 0.59 and 0.49), respectively, compared to cows without subclinical Endometritis. Given EC or US findings, no diagnostic criteria based on transrectal palpation of the uterus had predictive value for risk of pregnancy. In conclusion, subclinical Endometritis, diagnosed by EC or US, was associated with reduced relative pregnancy rate.
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defining and diagnosing postpartum clinical Endometritis and its impact on reproductive performance in dairy cows
Journal of Dairy Science, 2002Co-Authors: S J Leblanc, J.s. Walton, T F Duffield, K E Leslie, K G Bateman, Gregory P Keefe, W H JohnsonAbstract:The objectives of this study were to validate diagnostic criteria for clinical Endometritis in postpartum dairy cows and to measure the impact of Endometritis on reproductive performance. Data were collected from 1865 cows in 27 herds, including history of dystocia, twins, retained placenta, or metritis. All cows were examined once between 20 and 33 d in milk (DIM) including external inspection, vaginoscopy, and transrectal palpation of the cervix, uterus, and ovaries. All cows were followed for a minimum of 7 mo or until pregnancy or culling. Survival analysis was used to derive a case definition of Endometritis based on factors associated with increased time to pregnancy. The significance of clinical findings depended on the interval postpartum when examination took place. The presence of purulent uterine discharge or cervical diameter > 7.5 cm after 20 DIM, or mucopurulent discharge after 26 DIM identified cows with clinical Endometritis. Given vaginoscopy, no diagnostic criteria based on palpation of the uterus had predictive value for time to pregnancy. The prevalence of clinical Endometritis was 16.9%. Vaginoscopy was required to identify 44% of these cases. Accounting for parity, herd, and ovarian status, cows with clinical Endometritis between 20 and 33 DIM had a hazard ratio of 0.73 for pregnancy (took 27% longer to become pregnant), and were 1.7 times more likely to be culled for reproductive failure than cows without Endometritis.
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the effect of treatment of clinical Endometritis on reproductive performance in dairy cows
Journal of Dairy Science, 2002Co-Authors: S J Leblanc, J.s. Walton, T F Duffield, K E Leslie, K G Bateman, Gregory P Keefe, W H JohnsonAbstract:Abstract The objective of this field trial was to compare the effect of intrauterine (i.u.) antibiotic or intramuscular (i.m.) prostaglandin F 2α (PGF 2α ) on time to pregnancy in dairy cows diagnosed with clinical Endometritis between 20 and 33 days in milk (DIM). The case definition of Endometritis was the presence of purulent uterine discharge or cervical diameter >7.5cm, or the presence of muco-purulent discharge after 26 DIM. There were 316 cows with Endometritis from 27 farms assigned randomly within herd to receive 500mg of cephapirin benzathine intrauterine (i.u.), 500μg of cloprostenol i.m., or no treatment. The rate of resolution of clinical signs 14 d after treatment was 77% and was not affected by treatment. Reproductive performance was monitored for a minimum of 7 mo after treatment. Survival analysis (multivariable proportional hazards regression) was used to measure the effect of treatment on time to pregnancy. There was no benefit of treatment of Endometritis before 4 wk postpartum. Administration of PGF 2α between 20 and 26 DIM to cows with Endometritis that did not have a palpable corpus luteum was associated with a significant reduction in pregnancy rate. Between 27 and 33 DIM, cows with Endometritis treated with cephapirin i.u. had a significantly shorter time to pregnancy than untreated cows (hazard ratio=1.63). In this time period, there was no difference in pregnancy rate between PGF 2α and untreated cows, but the difference in pregnancy rate between cows treated with cephapirin i.u. and with PGF 2α was not statistically significant. Treatment of postpartum Endometritis should be reserved for cases diagnosed after 26 DIM, based on criteria that are associated with subsequent pregnancy rate.
Nancy B. Kiviat - One of the best experts on this subject based on the ideXlab platform.
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The antimicrobial treatment of subacute Endometritis: a proof of concept study.
American journal of obstetrics and gynecology, 2004Co-Authors: Linda O. Eckert, Nancy B. Kiviat, Soe Soe Thwin, Sharon L. Hillier, David A. EschenbachAbstract:Abstract Objective Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for Endometritis. Study design A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute Endometritis and to determine the treatment effect on Endometritis resolution. Results After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic Endometritis (38% vs 4%), all P Chlamydia trachomatis or Neisseria gonorrhoeae . In women without prior PID, Endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae ( P =.002 for trend). Conclusions In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic Endometritis. Prior PID is additive with current cervical infection as a risk for Endometritis.
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Endometritis: The clinical-pathologic syndrome
American journal of obstetrics and gynecology, 2002Co-Authors: Linda O. Eckert, Stephen E. Hawes, Pål Wølner-hanssen, Nancy B. Kiviat, Judy N. Wasserheit, Jorma Paavonen, David A. Eschenbach, K. HolmesAbstract:OBJECTIVE: The purpose of this study was to evaluate histologically proved Endometritis as a clinical syndrome that is distinct from laparoscopically confirmed salpingitis. STUDY DESIGN: This was a cross-sectional study of 152 women in an urban hospital with a suspected pelvic inflammatory disease. All women provided a standardized medical history and underwent physical examination, endometrial biopsy, and laparoscopy. We defined Endometritis by the presence of plasma cells in endometrial stroma and neutrophils in the endometrial epithelium. RESULTS: Of 152 women who were enrolled, 43 women had neither Endometritis nor salpingitis; 26 women had Endometritis alone without salpingitis, and 83 women had salpingitis. Those women with Endometritis alone more often had couched recently, had a current intrauterine device, and were in menstrual cycle day 1 to 7, compared with women with no Endometritis or salpingitis (P = .007, .04, .005, respectively) or women with acute salpingitis (P = .03, .01, .02, respectively). Infection with Neisseria gonorrhoeae and/or Chlamydia trachomatis was found more frequently in women with Endometritis alone than in women with no Endometritis or salpingitis (P < .001) and less frequently than in women with salpingitis (P = .05). Lower quadrant, adnexal, cervical motion, rebound tenderness, peritonitis, tenderness score, fever, and laboratory abnormalities that indicated inflammation and detection of gonorrheal or chlamydial infection were significantly less common in women with Endometritis alone than in women with salpingitis but were somewhat more common in women with Endometritis alone than among women with no salpingitis or Endometritis. CONCLUSION: Among women with suspected pelvic inflammatory disease, the histopathologic manifestations of Endometritis were associated with clinical manifestations, infection, and specific risk factors that were intermediate in frequency between women with salpingitis and women with neither Endometritis nor salpingitis.
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role of bacterial vaginosis associated microorganisms in Endometritis
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, King K HolmesAbstract: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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Role of bacterial vaginosis–associated microorganisms in Endometritis
American journal of obstetrics and gynecology, 1996Co-Authors: Sharon L. Hillier, Stephen E. Hawes, Nancy B. Kiviat, David A. Eschenbach, Mary Beth Hasselquist, Pål Wølner Hanssen, K. HolmesAbstract: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.)
L V Madoz - One of the best experts on this subject based on the ideXlab platform.
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application of a bacteriological on farm test to reduce antimicrobial usage in dairy cows with purulent vaginal discharge
Journal of Dairy Science, 2017Co-Authors: L V Madoz, R L De La Sota, I Prunner, Maria Jaureguiberry, C C Gelfert, Mauricio J Giuliodori, M DrillichAbstract:The objective of this study was to assess the effect of a selective antibiotic treatment strategy based on a quick bacteriological on-farm test (Petrifilm, 3M Corp., St. Paul, MN) compared with the conventional antibiotic treatment of all cows having clinical Endometritis (CE) defined by the presence of purulent vaginal discharge on both clinical cure rate and reproductive performance. The study was simultaneously conducted with dairy cows reared under a highly supplemented rotational grazing system in Argentina and in a freestall system in Slovakia. Cows having an abnormal vaginal discharge (VD, indicative of clinical Endometritis) on 21 to 35 d in milk (DIM) were randomly allocated to 1 of 2 study groups: selective treatment (ST) or conventional treatment (CT). All cows in the CT group (n = 174) received a single intrauterine administration of 500 mg of cephapirin. In the ST group (n = 178), treatment decision was made according to the results of the bacteriological on-farm test. For this test, we collected intrauterine samples with the cytobrush technique and stroke the brushes onto 2 different Petrifilm plates, one for aerobic count and another for Enterobacteriaceae count, incubated the plates, and counted the number of colonies after 24 h. Positive cows (≥5 colonies in one or both plates) received a single intrauterine treatment with 500 mg of cephapirin, whereas negative cows (<5 colonies) remained untreated. Clinical cure rate was assessed by direct vaginal inspection at 14 d after treatment (VD-0). The odds for conception at first artificial insemination, artificial insemination by 80 DIM, pregnancy by 100 DIM, and for nonpregnancy by 200 DIM were estimated with mixed logistic regression models. The hazard of conception was also assessed with proportional hazard regression model. The selective antibiotic treatment strategy based on the outcome of Petrifilm test reduced the number of required treatments (57%) and maintained similar efficacy in terms of clinical cure and reproductive performance as the conventional antibiotic treatment of all endometritic cows.
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a clinical approach to determine false positive findings of clinical Endometritis by vaginoscopy by the use of uterine bacteriology and cytology in dairy cows
Theriogenology, 2010Co-Authors: S Westermann, M Drillich, L V Madoz, T B Kaufmann, W HeuwieserAbstract:Abstract Clinical Endometritis in dairy cows is defined as mucopurulent or purulent vulvar discharge 21 days or more after parturition. The diagnosis of clinical Endometritis is commonly based on vaginal examination. Techniques to reduce the proportions of false negative findings have been described. This paper discusses a clinical approach to determine the proportion of false positive findings that might occur by vaginal inspection. The consequences of false positive findings in dairy practice are unnecessary or inadequate treatments. In research, incorrect diagnoses have an impact on the interpretation of studies on the diagnosis and treatment of clinical Endometritis. The objective of the present study was to compare intrauterine bacteriology and endometrial cytology in cows diagnosed with clinical Endometritis with findings obtained by vaginoscopy. Clinical Endometritis was defined as mucopurulent or purulent vulvar discharge. On two commercial dairy farms, cows were examined 21 to 28 d postpartum. Uterine samples (n = 230) were collected from cows with clinical Endometritis with the cytobrush technique to determine the proportion of polymorphonuclear neutrophils (PMN) and to culture smears for aerobic bacteria. Two threshold values for the proportion of PMN (5 and 18%) were chosen as possible indicators for an inflamed endometrium. Common uterine pathogens A. pyogenes and E. coli were found in 33.5 and 10.4% of the samples, respectively. With increasing vaginal discharge score, proportion of samples positive for A. pyogenes increased significantly. The proportion of cows exceeding the thresholds for PMN increased with vaginal discharge score and the presence of A. pyogenes . Considering only the presence of aerobic uterine pathogens and a proportion of PMN above the threshold values of 5 and 18% as indicative for Endometritis, a proportion of 17.3 and 28.5%, respectively, of diagnoses by vaginoscopy were false positive.
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subclinical Endometritis and its impact on reproductive performance in grazing dairy cattle in argentina
Animal Reproduction Science, 2010Co-Authors: J Plontzke, M Drillich, L V Madoz, R L De La Sota, W HeuwieserAbstract:Abstract Recently several studies have reported that subclinical Endometritis impairs reproductive performance in cattle. Most of the studies were conducted in western industrialized countries under intensive housing conditions. The objective of the present study was to determine the prevalence of subclinical Endometritis and its impact on reproductive performance outcomes in clinically healthy postpartum dairy cows in a pasture-based extensive dairy farming system in Argentina. Lactating Holstein cows ( n =201) at 18–38 days postpartum (dpp) from three commercial dairy farms in Buenos Aires Province, Argentina, were examined for signs of clinical Endometritis by external inspection and manual vaginal examination. Only cows without signs of clinical Endometritis i.e. no vaginal discharge were enrolled in this study and examined for subclinical Endometritis using the cytobrush technique. Cows with ≥5% polymorphonuclear cells (PMN) in the cytological sample were regarded as affected by subclinical Endometritis. All cows were reexamined 14 days later following the same examination protocol. Prevalence of subclinical Endometritis 18–38dpp was 38% and decreased to 19% at reexamination. The proportion of cows pregnant at first service was 29% and proportion of cows pregnant at 360pp was 73% and 75% in cows with subclinical Endometritis and those without, respectively. The probability of conception at first service, hazards of insemination and pregnancy, respectively, were not affected by subclinical Endometritis. Primiparous cows had a greater chance for insemination (HR=0.66; 95% CI=0.47–0.92) and pregnancy (HR=0.63; 95% CI=0.45–0.90) than multiparous cows. In conclusion subclinical Endometritis did not affect reproductive performance outcomes in a pasture-based, extensive dairy farming system in Argentina.