Definition
Metritis is a general inflammation of the uterus that normally occurs within the first 7-14 days after delivery. The term "metritis" is now obsolete, as it is too general and approximate. To date, to indicate an infectious-inflammatory process of the uterus in women, we prefer to speak of "pelvic inflammatory disease", while "metritis" is more commonly used in the veterinary field.
Classification of metrites
Based on the precise location of the pathology, several variants of metritis can be distinguished:
- Endometritis : inflammatory process of the endometrium, the mucosa that internally covers the uterine cavity
- Myometritis : inflammation of the myometrium, the muscular layer between endometrium and perimeter
- Perimetrite : phlogosis of the perimeter, the serous tunic that covers the uterus externally only in the body and in the bottom
- Cervicitis : inflammatory process involving the uterine cervix (cervix)
- Ovaritis : inflammation of the ovaries
Metritis recognizes an almost exclusively infectious origin. In most cases, uterine inflammation is linked to bacterial insults, sustained by sexually transmitted infectious agents.
The most involved pathogens are:
- Escherichia coli
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Mycoplasma hominis
More often, metritis is a consequence of a polymicrobial infection, which means it involves more bacteria.
Only rarely, metritis is an expression of extragenital infections, such as appendicitis or tuberculosis.
Curiosity
Although the contraceptive pill in no way limits the chances of contracting venereal diseases, its regular use can minimize the risk of metritis. In fact, the estroprogestinica pill increases the viscosity of the cervical mucus, thus hindering the ascent of the bacteria along the upper genital tract. Otherwise, the birth or the voluntary interruption of the pregnancy favor the penetration of the bacteria in the uterus, increasing the possibilities of metritis.
The risk of contracting metritis increases after childbirth or a voluntary abortion. The retention of abortive or placental residues inside the uterus is also a possible risk factor for metritis.
Similarly, the use of implantable contraceptive methods such as the spiral (IUD) can promote bacterial infections, since the bacteria tend to nest here.
Other possible predisposing factors for metritis are:
- Early sexual activity (biological defenses not yet fully formed)
- Paid relationships and prostitution
- Poor or excessive personal hygiene
- Past history of venereal diseases
- Malriuscite diagnostic / operative procedures (eg. Hysteroscopy, hysterosalpingography)
- Drug addiction
Symptoms
Clinically, metritis manifests itself with pain in the lower abdomen and pelvis, associated with malodorous and purulent vaginal discharge (leucoxantorrhea). In addition to the symptoms described above, the clinical picture of metritis is completed by: weakness, pain during intercourse (dyspareunia), low-grade fever / high fever, poor appetite, hypermenorrhea, low back pain, spotting and vomiting.
Metritis requires rapid medical intervention. When neglected or not treated, uterine inflammation can trigger a series of catastrophic consequences, such as ectopic pregnancies, acute pelvic pain and abscesses in the fallopian tubes. All the complications described above can lead to infertility.
Although it is quite rare, it is possible that metritis will run asymptomatically. This is the case of uterine infections sustained by Chlamydia trachomatis . In such circumstances, the woman, not realizing the infection in progress, faces serious complications.
Diagnosis and therapy
To minimize the risk of irreparable consequences, any suspicion of metritis requires a diagnostic assessment. Lower abdominal pain and smelly vaginal discharge are two very recurrent symptoms in the vast majority of female genital infections; therefore, to go back to the triggering cause, a gynecological examination is required.
The most accredited diagnostic tests to confirm or deny a presumed metritis are:
- Culture examination of the cervico-vaginal secretion (vaginal swab with antibiogram)
- Endometrial biopsy
- Scratching
- Pelvic ultrasound
- VES and PCR
- Partner urethral swab (if necessary)
After verifying the metritis, one proceeds with the therapy, exclusively antibiotic.
Metritis is fairly easy to treat, as long as the therapy is started from the earliest symptoms, when the infection is still in its early stages. The antibiotics used in the treatment of metritis - macrolides, tetracyclines, quinolones, lincosamides and penicillins - are normally given intravenously. The duration of therapy varies, normally, from one to two weeks.
Total abstention from sexual intercourse is recommended during the entire duration of antibiotic therapy
Next to the antibacterial treatment, the patient suffering from metritis can take pain-relieving drugs to mask pain and probiotics, to strengthen the immune defenses altered by the disease.
