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

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.