Clinical and morphological features of chronic salpingoophoritis with different variants of the course in women of reproductive age

Authors

  • L. V. Kaluginа SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanovа of the NAMS of Ukraine», Kyiv, Ukraine
  • T. D. Zadorozhnа SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanovа of the NAMS of Ukraine», Kyiv, Ukraine https://orcid.org/0000-0003-2787-603X
  • T. I. Yusko SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanovа of the NAMS of Ukraine», Kyiv, Ukraine

DOI:

https://doi.org/10.15574/PP.2019.80.16

Keywords:

chronic salpingoophoritis, hydrosalpinx, endometrium, polyps, vaginal and endometrial microbiome, chronic endometritis

Abstract

Purpose — to investigate the structure of the vaginal microbiome and the endometrium in comparison with the features of the morphofunctional state and immunohistochemical characteristics of endometrium in women with chronic salpingoophoritis (CHF) with different variants of the course.
Patients and methods. 141 women with CHF were examined, the average age was 28±5.9 years, group I included 69 patients with CHF, group II formed 72 patients with CHF, which became more difficult to develop of similar age.
Results. Analysis of the clinical picture and features of the course of CHF and CHF in combination with hydrosalpinx showed that such patients suffer primarily from pain (78.3% and 95.8%), dysmenorrhea (26.1% and 43.1%), dyspareunia (28.9% and 47.2%), leading to infertility (from 24.6% to 61.1%) of patients with CHF, depending on the type of course, with primary infertility predominating, accounting for 21.7% and correspondingly 44.4%. Changes in vaginal microbiocenosis in women with CHF in combination with hydrosalpinx compared with CHF group indices were found to have an increase in colonization of conditionally pathogenic and pathogenic microflora due to reduced concentrations of lactobacilli and bacterium cultures, including sexually transmitted infections (Chlamydia trachomatis — 21.3% and 4.0%, respectively, Ureaplasma urealiticum/parvum (48.9% and 26.5%), Gardnerella vaginalis (68.1% and 44,9% respectively) and endometrial microbiome of these patients showed infection with opportunistic and pathogenic flora in 65.31% of patients with CHF and 83% of women with CHF combined with hydrosalpinx and colonization of Mycoplasma hominis at 14.3% and 12.8%, respectively, Ureaplasma urealiticum/parvum at 14.9% and 8.1% cases, respectively; from endometrial biopsy of healthy women revealed infections were sown in 6.6% and 3.3%, respectively. Analysis of the structure of the morphofunctional state and immunohistochemical characteristics of the endometrium revealed that women with hydrosalpinx were dominated by endometrial polyps (31.91% and 12.5% respectively for group I), chronic endometritis (25.53% and 38.78%), and micropolypses along with endometrial hyperplasia without atypia (12.77% and 10.2%, respectively).
Conclusions. Thus, the most clinically significant symptoms of CHF complicated by hydrosalpinx are pain, dysmenorrhea, dyspareunia. The vaginal microbiota of women with CHF with gyrosalpinx is characterized by an increase in colonization by opportunistic and pathogenic microflora against the background of reduced concentrations of lactobacilli; significantly higher association rates of 3 or more bacterial cultures, the greater pronounced nature of endometrial myrobomy in these women is likely to be associated with periodic drainage of the hydrosalpinx into the uterine cavity. The subfertility and infertility of women with hydrosalpinx may be associated not only with the tubal factor but, above all, with the high incidence of hyperproliferative endometrial pathology and chronic endometritis due to chronic infection.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanovа of the NAMS of Ukraine». The informed consent of the patient was obtained for conducting the studies.
No conflict of interest were declared by the authors.

References

Bessmertnaya VS, Samoilov MV, Serebrennikova KG, Babichenko II (2008). Morphological and immunohistochemical features of endometrium in women with primary and secondary infertility. Pathology Archive. 4: 31–4.

Dubchak AYe, Zadarazhna TD, Milevsky OV, Dovgan OI. (2015). Morphological and immunohistochemical features of the endometrium during the «implant window» in women with infertility on the background of chronic inflammatory diseases of the internal genital organs. Woman's health. 6: 178–181.

Kogan EA, Demura TA, Seidova AA. (2015). Expression of ezrin in women's endometrium with tubal-peritoneal factor infertility and repeated failures of the IVF program. Obstetrics and Gynecology. 10: 68–72.

Kornatska AG, Vovk IB, Chubey GV. (2012). Pelvic inflammatory disease caused by sexually transmitted infections. Gynecology. Review. Thematic number: 38–39.

Lyashenko IS. (2017). Tubal-perineal infertility is the most common cause of women's sterility. Young scientist. 14.2: 31–33.

Prilepskaya EA, Zaitsev AV, Tupikina NV. (2015). The role of an interdisciplinary approach in the treatment of infections of the lower urinary tract. Medical aspects of woman's health. 1(87): 26–33.

Prokopets VI, Strizhak DA, Petrov YuA. (2017) .The inflammatory processes of the genitals as a cause of women's sterility. International Journal of Applied and Fundamental Research. 1–2: 254–257.

Serdyukov SV. (2014) Endometrium: from nuclear receptors to the test model of new drugs. Molecular medicine. 5: 15–8.

Yuzko AM. (2017). Female infertility of tubal origin: (literature review). Woman's health. 2: 126–131.

Akopians AL, Pisarska MD, Wang ET. (2015). The Role of Inflammatory Pathways in Implantation Failure: Chronic Endometritis and Hydrosalpinges. Semin Reprod Med. 33 (4): 298–304. https://doi.org/10.1055/s-0035-1554916; PMid:26132934

Atalabi OM, Osinaike BB. (2014). Do abnormal findings on hystero-salphingographic examination correlate with intensity of procedure associated pain? Afr. J. Reproductive Hlth. 18 (2): 147–151.

Babu G, Singaravelu BG, Srikumar R, Reddy SV, Kokan A. (2017). Comparative Study on the Vaginal Flora and Incidence of Asymptomatic Vaginosis among Healthy Women and in Women with Infertility Problems of Reproductive Age. 11 (8): DC18-DC22. https://doi.org/10.7860/JCDR/2017/28296.10417; PMid:28969122 PMCid:PMC5620762

Brunham RC, Gottlieb SL, Paavonen J. (2015). Pelvic Inflammatory Disease. N Engl J Med. 372 (21): 2039–2048. https://doi.org/10.1056/NEJMra1411426; PMid:25992748

Gonzalez J, Rios Castillo JE, Pomares Toro E, Romero Nieto MI, Castelo-Branco C, Arjona Berral JE. (2016). Essure a novel option for the treatment of hydrosalpinx: a case series and literature review. Gynecol Endocrinol. 32 (2):166–170. https://doi.org/10.3109/09513590.2015.1103221; PMid:26513546

Haggerty CL et al. (2016). Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect. 92 (6): 441–446. https://doi.org/10.1136/sextrans-2015-052285; PMid:26825087 PMCid:PMC5013099

Kaspersen KA et al. (2015). Obesity and Risk of Infection. Epidemiology. 26 (4): 580–589. https://doi.org/10.1097/EDE.0000000000000301; PMid:25978794

Khan KN et al. (2018). Bacterial contamination hypothesis: a new concept in endometriosis. Reprod Med Biol. 17 (2): 125–133. https://doi.org/10.1002/rmb2.12083; PMid:29692669 PMCid:PMC5902457

Kroon SJ, Ravel J, Huston WM. (2018). Cervicovaginal microbiota, women's health, and reproductive outcomes. Fertil Steril. 110 (3): 327–336. https://doi.org/10.1016/j.fertnstert.2018.06.036; PMid:30098679

Miller JM et al. (2018). A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: Update by the Infectious Diseases Society of America and the American Society for Microbiologya. Clin. Infect. Dis. 67 (6): 813–816. https://doi.org/10.1093/cid/ciy584; PMid:30169655

Moreno I, Franasiak JM. (2017). Endometrial microbiota — new player in town. Fertil. Steril. 108 (1): 32–39. https://doi.org/10.1016/j.fertnstert.2017.05.034; PMid:28602480

Soper DE, Brockwell NJ, Dalton HP, Johnson D. (2016). Observations concerning the microbial etiology of acute salpingitis. Am J Obstet Gynecol. 170 (4): 1008–1017. https://doi.org/10.1016/S0002-9378(94)70094-X

Sun Y, Zhang J, Bai W. (2019). Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study. J Minim Invasive Gynecol. 26 (5): 935–940. https://doi.org/10.1016/j.jmig.2018.07.024; PMid:30273685

Tai F-W et al. (2018). Association of Pelvic Inflammatory Disease with Risk of Endometriosis: A Nationwide Cohort Study Involving 141,460 Individuals. J Clin Med. 7 (11): 379. https://doi.org/10.3390/jcm7110379; PMid:30352985 PMCid:PMC6262473

Workowski KA, Bolan GA; Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, MMWR. Recomm. reports Morb. Mortal. Wkly. report. Recomm. Reports. 64 (R-03): 1–137.