Microbiological Study of Vaginal Microbiota and Endometrium in Women with Chronic Endometritis

Natalia M. Voropaeva, Lyudmila M. Lazareva, Irina N. Danusevich, Natalia L. Belkova, Uliana M. Nemchenko, Ekaterina V. Grigorova

International Journal of Biomedicine. 2021;11(4):511-514.
DOI: 10.21103/Article11(4)_OA17
Originally published December 10, 2021


The research objective was to study the spectrum of the vagina and endometrium microorganisms in women with chronic endometritis (CE) in order to take adequate therapeutic measures.
Methods and Results: We did a cross-sectional study in 47 women (average age of 35.38±5.19 years) with histologically confirmed CE.  The vaginal microbiota and endometrial biopsies were assessed using microbiological research methods in accordance with the medical technology "Integral assessment of the state of the vaginal microbiota." To identify the share of different types of microorganisms in the structure of the biocenosis, the coefficient of constancy of the species (C) was used. Only 19% of patients had a titer of Lactobacillus spp. within the age norm, while the deficit was observed in 80% of women. Among the representatives of Enterobacteriaecae, Escherichia coli and Klebsiella aerogenes were sown, which are considered to be random species (C=11% and C=2.1%, respectively). The average titer for E. coli was 3.6±1.3 lg CFU/swab and for K. aerogenes - 2.14 lg CFU/swab. An atypical variant of E. coli with hemolytic properties was found in only one sample. All isolates of the genus Staphylococcus were also random species (C did not exceed 25%). Coagulase-negative staphylococci (CoNS) were detected in 7 patients (C=15%), while the average titer was 2.1±0.4 lg CFU/swab. S. aureus was isolated from only one patient at a titer of 5 lg CFU/swab. Corynebacterium spp. were isolated in 11% of cases (C = 11% - random species), in a titer of 3.2±0.8 lg CFU/swab. Enterococcus spp. also belonged to random species (C=23.4%). At the same time, E. faecalis was inoculated in 19% of cases and E. faecium was sown in 4.3%, the average titer of which was 3.1±0.9 and 5 lg CFU/swab. Streptococcus spp. were recorded in only one case at a concentration of 5 lg CFU/swab. Fungi of the Candida were isolated as a random species in 8.5% of cases. The growth of microorganisms in endometrial samples was obtained only in 3 examined women with CE (6.4% of cases). The endometrial microbiota were represented only by random species, for which the C index ranged from 2.1% to 4.3%.
Conclusion: The microbiological study of the microbiota of vaginal discharge showed the presence of dysbiotic disorders with a significant deficiency of lactobacilli (80%) without the dominance of representatives of the Lactobacillus spp. In the structure of opportunistic microflora, Escherichia coli, coagulase-negative staphylococcus, Enterococcus spp., and E. faecalis prevailed as random species. Representatives of the microbiota in endometrial biopsies were identified only in 6.4% of cases, and are represented by random species.

chronic endometritis • microbiota • vagina • endometrium
  1. Shurshalina AV. [Chronic endometritis: modern views on the problem]. Consilium Medicum. 2011;13(6)36–39. [Article in Russian].
  2. Ailamazyan EK, Kulakova VI, Radzinsky VE, Savelyeva GM. Obstetrics: national guidance: M, GEOTAR-Media; 2007. [In Russian]
  3.  Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, De Ziegler D, Resta L. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014 May;21(5):640-7. doi: 10.1177/1933719113508817. 
  4. Cicinelli E, Resta L, Nicoletti R, Tartagni M, Marinaccio M, Bulletti C, Colafiglio G. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol. 2005 Nov-Dec;12(6):514-8. doi: 10.1016/j.jmig.2005.07.394.
  5. Kushnir VA, Solouki S, Sarig-Meth T, Vega MG, Albertini DF, Darmon SK, Deligdisch L, Barad DH, Gleicher N. Systemic Inflammation and Autoimmunity in Women with Chronic Endometritis. Am J Reprod Immunol. 2016 Jun;75(6):672-7. doi: 10.1111/aji.12508. 
  6. Yang R, Du X, Wang Y, Song X, Yang Y, Qiao J. The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch Gynecol Obstet. 2014 Jun;289(6):1363-9. doi: 10.1007/s00404-013-3131-2. 
  7. Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U, Marrocchella S, Greco P, Resta L. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015 Feb;30(2):323-30. doi: 10.1093/humrep/deu292. 
  8. Johnston-MacAnanny EB, Hartnett J, Engmann LL, Nulsen JC, Sanders MM, Benadiva CA. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril. 2010 Feb;93(2):437-41. doi: 10.1016/j.fertnstert.2008.12.131. 
  9. Baeva AV, Leshchenko YaA, Kuleshova MV, Leshchenko OYa, Cherkashin AK. Family and demographic processes in the Irkutsk region. Irkutsk, 2017: 212. [In Russian]
  10. Leshchenko OYa, Genich EV. [Reproductive disorders and their pathogenetic mechanisms in HIV-infected women]. HIV Infection and Immunosuppression. 2019;11(4):20-29. doi: 10.22328/2077-9828-2019-11-4-20-29. [Article in Russian].
  11. Moreno I, Codoñer FM, Vilella F, Valbuena D, Martinez-Blanch JF, Jimenez-Almazán J, Alonso R, Alamá P, Remohí J, Pellicer A, Ramon D, Simon C. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016 Dec;215(6):684-703. doi: 10.1016/j.ajog.2016.09.075. 
  12. Moreno I, Franasiak JM. Endometrial microbiota-new player in town. Fertil Steril. 2017 Jul;108(1):32-39. doi: 10.1016/j.fertnstert.2017.05.034.
  13. Baker JM, Chase DM, Herbst-Kralovetz MM. Uterine Microbiota: Residents, Tourists, or Invaders? Front Immunol. 2018 Mar 2;9:208. doi: 10.3389/fimmu.2018.00208. 
  14. Peric A, Weiss J, Vulliemoz N, Baud D, Stojanov M. Bacterial Colonization of the Female Upper Genital Tract. Int J Mol Sci. 2019 Jul 11;20(14):3405. doi: 10.3390/ijms20143405.
  15. Tsypurdeeva ND, Shipitsyna EV, Savicheva AM, Gzgzyan AM, Kogan IYu. [The composition of the endometrial microbiota and the severity of chronic endometritis in patients with ineffective in vitro fertilization protocols. Is there a connection?] Journal of Obstetrics and Women's Diseases. 2018;67(2):5–15. doi: 10.17816/JOWD6725-15. [Article in Russian].
  16. Espinoza J, Erez O, Romero R. Preconceptional antibiotic treatment to prevent preterm birth in women with a previous preterm delivery. Am J Obstet Gynecol. 2006 Mar;194(3):630-7. doi: 10.1016/j.ajog.2005.11.050. 
  17. Danusevich IN, Ivanova EI, Mikhalevich IM. [Characteristics of the microbiocenosis of the vaginal tract and its role in initiating inflammatory process in endometrium in women with reproductive disorders]. Acta Biomedica Scientifica. 2017;2(5(2)):15-20. doi: 10.12737/article_5a3a0d6243ea24.16475434. [Article in Russian].
  18. Leshchenko OYa. [Chronic endometritis and reproductive disorders: version and con traversion]. Bulletin of Siberian Medicine. 2020;19(3):166-176. https://doi.org: 10.20538 / 1682-0363-2020-3-166-176. [Article in Russian].
  19. Danusevich IN, Sharifulin EM, Nemchenko UM, Lyubov I. Kolesnikova LI. Features of the Immune System Functioning with Persistence of Infectious Agents in Women with Chronic Endometrial Inflammation and Reproductive Disorders. International Journal of Biomedicine. 2020;10(4):362-368. doi: 10.21103/Article10(4)_OA6
  20. Godovalov AP, Gushchin MO, Karpunina TI. [Features of intermicrobial relations in the vaginal microbiota of infertile women]. Medical Bulletin of the North Caucasus. 2019;14(1.1):40-44. doi: 10.14300/mnnc.2019.14045 [Article in Russian].
  21. Ankirskaya AS, Muravyova VV.[ Integral assessment of the conditione of the vaginal microbiota. Diagnosis of opportunistic vaginitis]. Akusherstvo i Ginekologiya: Novosti, Mneniya, Obuchenie. 2020;8(1);69-76. doi: 10.24411/ 2303-9698-2020-11009. [Article in Russian].
  22. Zakharova EA, Azizov IS. [Microecological characteristics of the intestinal microbiocenosis of frequently ill children].  Microbiol Journal. 2012;2:63–68. [Article in Russian].
  23. Tamrakar R, Yamada T, Furuta I, Cho K, Morikawa M, Yamada H, Sakuragi N, Minakami H. Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women. BMC Infect Dis. 2007 Nov 7;7:128. doi: 10.1186/1471-2334-7-128. 
  24. Smith SB, Ravel J. The vaginal microbiota, host defence and reproductive physiology. J Physiol. 2017 Jan 15;595(2):451-463. doi: 10.1113/JP271694. 
  25. Budilovskaya OV. [Modern ideas about the vagina lactobacilli in women of reproductive age]. Journal of Obstetrics and Women's Diseases. 2016;LXV(4):34–43.doi: 10.17816/JOWD6534-43. [Article in Russian].
  26. Dicke GB. Bacterial vaginosis: new aspects of etiopathogenesis and choice of therapeutic strategies. RZhM. Mother and Child. 2019;2(4):307-313. doi: 10.32364/2618-8430-2019-2-4-307-313
  27. Kungurtseva EA, Belkova NL, Prefix AA, Ivanova EI, Darenskaya MA, Serdyuk LV, Leshchenko OYa. [The structure of the opportunistic microbiota of the nasopharynx and vaginal tract in women with reproductive disorders and chronic endometritis]. Klinicheskaya Laboratornaya Diagnostika. 2017;62(4):252-256. doi: 10.18821/0869-2084-2017-62-4-252-256  [Article in Russian].
  28. Babu G, Singaravelu BG, Srikumar R, Reddy SV, Kokan A. Comparative Study on the Vaginal Flora and Incidence of Asymptomatic Vaginosis among Healthy Women and in Women with Infertility Problems of Reproductive Age. J Clin Diagn Res. 2017 Aug;11(8):DC18-DC22. doi: 10.7860/JCDR/2017/28296.10417. 

Download Article
Received September 30, 2021.
Accepted October 14, 2021.
©2021 International Medical Research and Development Corporation.