Aim: To evaluate whether diagnostic hysteroscopy may cause pelvic inflammatory disease; to evaluate whether there is a group of patients with a high risk of developing pelvic inflammatory disease.
Experimental design: A prospective study of 300 non-consecutive hysteroscopies with a follow-up 20 days after the test.
Setting: The study was performed at Sanremo Hospital (Regione Liguria, USL 1 Imperiese, Sanremo Hospital Board) through the Hysteroscopy Clinic of the Gynecology Division (Head: Dott. G. Armentano) and Microbiology Service of the Test Laboratory.
Patients: A total of 300 non-consecutive patients undergoing hysteroscopy for any indication were enrolled during 1992 of whom 253 completed the study. The main criteria used for selection were the possibility of performing an atraumatic hysteroscopy and immediately prior to this a cervical smear for the direct and/or cultured assay of aerobic and anaerobic bacteria, fungi, microplasms, Chlamydia, protozoa.
Method: Hysteroscopy was performed in all cases without cervical dilatation, following the disinfection of the cervix using povidone-iodine 10%, using a hysteroscope with a diameter of 5 mm (Microhysteroscope Hamou I-Storz); CO2 was used as the means of distending the uterine cavity and was supplied by an electronically controlled insufflator (Hysteroinsufflator acc. Hamou-Storz).
Results: Germs were identified in the cervical canal in 35 out of 253 women an the incidence of positivity decreased with age. A positive correlation was also found with the type of indication for hysteroscopy. Pelvic inflammatory disease developed in 2 cases out of 253 (0.79%) and both cases belonged to the group with germs in the cervical canal; in both cases the etiological agent was Chlamydia trachomatis. No case of pelvic inflammatory disease was observed in the group of patients without germs in the cervical canal.
Conclusions: Patients under the age of 35, with hysteroscopic indications relating to sterility and painful pelvic syndrome, must be regarded as being at higher risk of developing posthysteriscopic pelvic inflammatory disease.