Résumé
Introduction: The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understand the aetiology of these diseases. In addition, microorganisms possibly those associated with bacterial vaginosis may inhabit the uterine cavity [bacteria endometrialis] where they are responsible for some common gynecological and obstetric enigmas. The aim of the present work was to study vaginal and uterine ecosystem in some gynecologic disorders aiming at reconsidering the place of appropriate antibiotic regimens
Subjects and Methods: The present study was conducted on 100 patients admitted to Obstetrics and Gynecology Department, Ain Shams University Hospital. Their ages ranged from 36-60 years and they were all indicated for hysterectomy. Informed consent was obtained from each patient. They were subjected to history taking, general and local examinations and vaginal PH measurement before taking the specimens. The specimens included three swabs taken from cervical os and the posterior fornix of vagina immediately before the operation and three endometrial swabs taken immediately after hysterectomy and incising the uterine wall using full aseptic technique. Swabs were used for preparation of direct Gram stained smear, Isolation of aerobic and anaerobic bacteria. Results in the present study showed that metrorrhgia and uterine fibromyomas were the most common indications for hysterectomy and Lactobacilli were the most commonly isolated organism, followed by coagulase negative Staph, Diphtheroids, Peptococci, anaerobic Gram -ve bacilli and Gardnerella vaginalis [G Vaginalis]. However, there was no statistically significant association between any of the isolated organisms and the indications for hysterectomy. In premenopausal patients, Lactobacilli were the most commonly isolated organism while coagulase negative Staph was the most commonly isolated organism from postmenopausal patients. With exception of Lactobacilli, the difference between premenopausal and postmenopausal women regarding isolated organisms was statistically none significant. Organisms were isolated from the uterine cavity in 11 patients and the most commonly isolated organisms were G vaginalis and Staph aureus. Each organism was isolated from four cases, anaerobic Gram -ve bacilli was isolated from two cases and Peptococci was isolated only in one case. It could be concluded that presence of bacteria in the endometrial cavity could be implicated as a significant previously unrecognized; cause of obstetrics and gynecologic diseases, as in recent years, an unexpected infectious aetiology has been found for a variety of clinical conditions. Thus, the place of appropriate antibiotic regimens would need careful consideration. However, further studies are needed to confirm these results