Levofloxacin or gonadotropin releasing hormone agonist treatment decreases intrauterine microbial colonization in human endometriosis

Khan KN, Fujishita A, Muto H, Masumoto H, Ogawa K, Koshiba A, Mori T, Itoh K, Teramukai S, Matsuda K, Nakashima M, Kitawaki J · European Journal of Obstetrics & Gynecology and Reproductive Biology · 2021 September

DOI 10.1016/j.ejogrb.2021.07.014

Objective

To investigate whether antibiotic treatment, with or without gonadotropin-releasing hormone agonist (GnRHa), decreases intrauterine infection, leading to reduced tissue inflammation, cell proliferation, and angiogenesis in human endometriosis.

Conclusions

Antibiotic treatment, either alone or in combination with GnRHa, was found to significantly decrease specific bacterial genera in women with endometriosis, leading to a decrease in chronic endometritis occurrence and improvements in macrophage infiltration, cell proliferation, and micro-vessel density, indicating a potential effectiveness in improving uterine infection and associated pathological changes in human endometriosis.

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Insights

Administering a broad-spectrum antibiotic with or without gonadotropin releasing hormone agonist reduced uterine infection and decreased tissue inflammation, cell proliferation, and angiogenesis in women with endometriosis.

This research was a prospective non-randomized observational study which collected endometrial samples during surgery from both a control group and a group of women suffering from endometriosis. These groups were treated with levofloxacin or a gonadotropin releasing hormone agonist before surgery. The samples were subjected to a polymerase chain reaction amplification of bacteria and followed by an immunohistochemical analysis using various antibodies associated with plasma cells, macrophages, cell proliferation, and vascular cells. Analyzing the metagenome assay of the 16S rDNA revealed that treatment with levofloxacin, or a combination of Gonadotropin releasing hormone and levofloxacin had effectively lessened several major bacterial genera compared with the untreated group. Particularly in women suffering from endometriosis, such treatment significantly reduced the presence of certain bacteria. A Cochran-Mantel-Haenszel test indicated that the occurrence rate of chronic endometritis decreased following treatment involving levofloxacin and the gonadotropin releasing hormone. The findings were consistent with considerable reduced infiltration of certain stained macrophages, cell proliferation and micro-vessel density in both endometria and endometriotic lesions. These improvements were visually confirmed with improvements in ovarian endometrioma morphology.