ANNAPOLIS, MD. (FRONTLINE MEDICAL NEWS) – The microbial profile of women with endometritis was found to be similar to women who were asymptomatic of pelvic inflammatory disease, a study has shown.

The results suggest that symptoms of pelvic inflammatory disease (PID) are not indicative of all upper genital tract infections, Leslie Meyn, PhD , a researcher at the Magee Women’s Research Institute at the University of Pittsburgh, said at the annual scientific meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

The cohort study indicated that 40% of women biopsied for endometritis had the disease, despite having no symptoms. Further, a third of women who were symptomatic of PID had negative biopsy results.

“The results are important because there is so much asymptomatic PID, we need to come up with better ways to detect it and aggressive ways to treat it if we’re going to prevent some of the downstream morbidities,” R. Phillips Heine, MD , IDSOG program chair and division chief of maternal fetal medicine at Duke University, Durham, N.C., said in an interview.

In the cohort study, 208 women who presented to a single site with symptoms of PID consistent with the Centers for Disease Control and Prevention criteria were biopsied and evaluated for endometritis. During the same period, another 134 women who were asymptomatic for PID but who were considered at risk were also biopsied. Dr. Meyn and her colleagues found that of those 342 patients, regardless of symptoms, 116 had histologically confirmed endometritis, while 226 did not.

Of the 116 women with endometritis, 70 had symptoms, and were on average 2 years older than the 46 women without symptoms. The older women were also more likely to have a history of PID (P less than .001). About half of each cohort were black women in their mid-20s. Whites comprised about a quarter of each cohort. Just over half of each cohort were determined to have bacterial vaginosis.

Asymptomatic women were considered at risk if they had mucopurulent cervicitis, endocervical Chlamydia trachomatis, or a recent partner infected with gonorrhea, C. trachomatis, or nongonococcal urethritis.

The biopsies were also tested for a range of sexually transmitted diseases. “Among women with histologically confirmed endometritis, Neisseria gonorrhoeae was the only microorganism statistically significantly associated with symptoms of PID (P = 0.02). Haemaphilus influenzae was also only found in the endometrium of women with symptoms of PID, but this association did not reach statistical significance due to smaller numbers,” said Dr. Meyn in an interview.

Endometrial Mycoplasma genitalium and C. trachomatis were found in both cohorts, but only half of the women infected with these bacteria presented with symptoms. A quarter of women had no pathogens, regardless of symptoms. This might have been the result of “spontaneous resolution or undetected infectious agents, or some noninfectious etiology,” Dr. Meyn said. “The results could mean that the conventional definition of endometritis is not specific.”

The variety of endometrial microbial profiles could have been due in part to different points in the progression of PID, or differences in access in health care, according to Dr. Meyn. Regardless, “the data highlight the importance of continued screening for sexually transmitted disease pathogens in all women, regardless of symptoms,” Dr. Meyn said in an interview.

Dr. Meyn reported having no relevant financial disclosures. No disclosure information was available for Dr. Heine. This study was funded by the National Institute of Allergy and Infectious Diseases.

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