Metritis

Definition

Metritis is a generic inflammation of the uterus which normally occurs within the first 7-14 days after birth. The term "metritis" is now obsolete, as it is too general and approximate. To date, to indicate an infectious process- inflammation 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 are distinguished:

• Endometritis: inflammatory process affecting the endometrium, the mucous membrane that lines the uterine cavity internally
• Myometritis: inflammation of the myometrium, the muscular layer between the endometrium and the perimetry
• Perimetritis: inflammation of the perimeter, the serous tunic that covers the uterus externally only in the body and in the bottom
• Cervicitis: inflammatory process involving the cervix (neck of the uterus)
• Ovaritis: inflammation of the ovaries

Causes

Metritis recognizes an "almost exclusively infectious origin. In most cases, the" inflammation of the uterus 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 than not, metritis is the result of a "polymicrobial infection, involving multiple bacteria.
Only rarely, metritis is an expression of extragenital infections, such as appendicitis or tuberculosis.

Curiosity

Although the contraceptive pill does not in any way limit the chances of contracting STDs, its regular use can minimize the risk of metritis. In fact, the estrogen-progestogen pill increases the viscosity of the cervical mucus, thus hindering the ascent of bacteria along the upper genital tract. Otherwise, childbirth or voluntary termination of pregnancy favor the penetration of bacteria into the uterus, increasing the chances 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 IUD can promote bacterial infections, since bacteria tend to lurk here.
Other possible predisposing factors for metritis are:

• Early onset of sexual activity (biological defenses not yet fully formed)
• Paid relationships and prostitution
• Poor or excessive personal hygiene
• Previous history of venereal diseases
• Failed diagnostic / operative procedures (eg hysteroscopy, hysterosalpingography)
• Drug addiction

Symptoms

Clinically, metritis is manifested by pain in the lower abdomen and pelvis, associated with foul-smelling and purulent vaginal discharge (leucoxanthorrhea). 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, loss of appetite, hypermenorrhea, low back pain, spotting and vomiting.
Metritis requires prompt medical intervention. When neglected or untreated, uterine inflammation can trigger a range of catastrophic consequences, such as ectopic pregnancy, acute pelvic pain and abscesses in the fallopian tubes. All the complications described above can lead to infertility.
Although quite rare, it is possible for metritis to develop asymptomatically. This is the case of uterine infections caused by Chlamydia trachomatis. In such circumstances, the woman, not realizing the infection in progress, undergoes even serious complications.

Diagnosis and therapy

To minimize the risk of irreparable consequences, any suspicion of metritis requires a diagnostic investigation. Pain in the lower abdomen and foul-smelling vaginal discharge are two very recurrent symptoms in the vast majority of infections of the female genital tract; therefore, to trace 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
• Curettage
• Pelvic ultrasound
• ESR and PCR
• Partner's urethral swab (if needed)

After having ascertained the metritis, we proceed with the therapy, exclusively antibiotic.
Metritis is quite simple to cure, as long as therapy is started from the very first symptoms, when the infection is still in its infancy. The antibiotics used in the treatment of metritis - macrolides, tetracyclines, quinolones, lincosamides and penicillins - are usually given. intravenously The duration of therapy usually varies from one to two weeks.

Total abstention from sexual intercourse is recommended during the entire duration of antibiotic therapy

Alongside the antibacterial treatment, the patient suffering from metritis can take painkilling drugs to mask the pain and probiotics, to strengthen the immune defenses altered by the disease.