2414 Endometriosis and the Prevalence of Infectious Agents within the Endometrium and Endo-Cervix

Abstract

Study Objective The presence of endometriosis has been shown to be strongly associated with chronic endometritis, and, furthermore, chronic endometritis has been associated with infectious agents in the endometrial cavity (73% in published data). We planned to evaluate the prevalence of infectious agents within in the endometrial cavity and endo-cervix when endometriosis is present. Design Retrospective review of all patients that underwent diagnostic laparoscopy, diagnostic hysteroscopy, and the collection of sterile endometrial/endo-cervical cultures during surgical evaluation for suspected endometriosis and chronic endometritis. Setting Referral center for reproductive medicine and surgery in an academic medical center. Patients or Participants All patients diagnosed with endometriosis at the time of laparoscopy who underwent collection of endometrial/endo-cervical cultures from 2016 – 2018 (N=97). Interventions N/A. Measurements and Main Results Sterile endometrial/endo-cervical cultures were collected, per standardized protocol, prior to preparation of the vagina. Aerobic/anaerobic cultures; PCR for mycoplasma/ureaplasma/gonorrhea/chlamydia; viral cultures; and yeast cultures were performed. In patients diagnosed with endometriosis at the time of laparoscopy, 70% tested positive for an infectious agent on endometrial/endo-cervical culture. Organisms were found in 65% of individuals diagnosed laparoscopically with mild endometriosis (American Society for Reproductive Medicine Revised Classification of Endometriosis “ASRM Classification” Stage 1-2), and 75% diagnosed with severe endometriosis (ASRM Classification Stage 3-4). Gram positive organisms were the most common infectious agent cultured at 72%, and were primarily E. Faecalis (31%), Lactobacillus (17%), and Group B Strep (15%). Gram negative organisms (18%) were primarily E. coli (10%). Less commonly, yeasts (13%), anaerobes (3%), and ureaplasma (1%) were found. No gonorrhea, chlamydia, mycoplasma, or viruses were detected. No significant correlation was found between severity of endometriosis and prevalence of any single organism. Conclusion For individuals with endometriosis, regardless of severity, the presence of infectious organisms in the endometrium and endo-cervix is similar to published data on chronic infectious endometritis.