Chronic non-puerperal endometritis

Specialty: Gynecology and breast.

• Persistent endometrial infection
• chronic inflammation of the uterine cavity
• subclinical endometritis

Why it occurs

• Persistent low-grade bacterial infection due to common germs (Escherichia coli, Streptococcus spp., Enterococcus faecalis) or intracellular pathogens (Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum)
• Presence of an intrauterine device (IUD) retained or expired for many years
• Sequela of curettage procedures or previous uterine instrumentation

Initial workup

Diagnostic hysteroscopy (characteristic signs are evident: endometrial micropolyps of <1 mm, stromal edema, diffuse hyperemia in patches or "red dots"). Endometrium biopsy preferably performed in the late follicular phase for histopathological study with specific immunohistochemistry for CD138 (marker of stromal plasma cells, definitive diagnosis of chronic endometritis). Microbiological culture of the endometrial aspirate.

Standard management

• Doxycycline 100 mg orally every 12 hours for 14 days — most effective first-line empirical treatment
• Metronidazole 500 mg orally every 12 hours for 14 days associated with Ciprofloxacin 500 mg every 12 hours if the first cycle fails or gram-negative/anaerobic germs are suspected
• Josamycin 500 mg every 8 hours or Azithromycin 500 mg/day for 3 days as an alternative for Mycoplasma/Ureaplasma (note: a control hysteroscopy or new post-treatment CD138 biopsy should be performed in sterile patients before performing a new embryo transfer).