Unlike acute endometritis, however, Chlamydia and Neisseria infections are uncommon causes of chronic endometritis. In addition, genital tuberculosis can result in chronic granulomatous endometritis, a condition most often seen in developing countries. coli, Klebsiella, Staphylococcus, Mycoplasma, Ureaplasma, Gardnerella, Pseudomonas, and yeasts (including Candida and Saccharomyces). Causative organisms include Streptococcus, Enterococcus, E. Ĭhronic endometritis is also thought to be a polymicrobial infection. The risk of infection increases during uterine instrumentation, for example, during an endometrial biopsy or placement of an intrauterine device (IUD). Other potential causes include Mycoplasma genitalium, Streptococcus and Staphylococcus species, Haemophilus influenzae, Escherichia coli and anaerobes. In acute endometritis/PID, >85% of infections are caused by STIs (primarily Chlamydia trachomatis and to a slightly lesser extent Neisseria gonorrhoeae), and/or BV-causing organisms, such as Gardnerella vaginalis. Īcute and Chronic Endometritis Unassociated With PregnancyĮndometritis not associated with pregnancy is also due to altered endometrial microbiota. Although rare, serious infections with Streptococcus pyogenes, Staphylococcus aureus, Clostridium sordellii, or Clostridium perfringens are associated with increased morbidity and mortality. Ĭhlamydia is an uncommon cause of postpartum endometritis, though it is often associated with late-onset presentations. While symptoms are frequently mild and often go undetected by both patients and clinicians, the condition is associated with recurrent pregnancy loss and other fertility challenges. It is characterized by the presence of plasma cells in the endometrial stroma and other signs of chronic inflammation. Ĭhronic endometritis is a more subtle chronic inflammatory condition unrelated to pregnancy, lasting at least 30 days. Additionally, although acute salpingitis (which frequently accompanies acute endometritis in PID) is associated with tubal factor infertility due to scarring, acute endometritis alone does not appear to be associated with reduced fertility rates. Histologically, it is characterized by the formation of microabscesses and neutrophilic invasion. It is typically due to either a sexually transmitted infection (STI) or bacterial vaginosis (BV)-causing organisms. Īcute endometritis unrelated to pregnancy is typically classified as pelvic inflammatory disease (PID) and represents an endometrial infection present for less than 30 days. Endometritis is 5-20 times more common in patients that undergo cesarean delivery (compared to vaginal delivery). Most cases of postpartum endometritis are polymicrobial, involving both aerobic and anaerobic bacteria, and are due to the translocation of normal vaginal flora into the uterine cavity during the processes of labor and delivery. Postpartum endometritis is the most common postpartum infection. Endometritis can be either acute or chronic and may be either related or unrelated to pregnancy. When the inflammation extends into the muscular layer, the process is termed endomyometritis, and when it extends all the way through to the parametrium, it has been termed endoparametritis. Endometritis is an infectious inflammation of the endometrium, which is the innermost uterine layer.
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