Study of urogenital tract and gut microbiota in women with stage III and IV ovarian endometriosis

Aim. To confirm that dysbiosis of the urinary tract or gut may be associated with endometriosis course.

Materials and methods. We analyzed the samples of vaginal, cervical and intestinal epithelial cell scrapes in 32 patients with a confirmed intraoperative diagnosis of stage III and IV endometriosis and 25 healthy patients as a control group. A wide range of pathogenic and opportunistic microorganisms was evaluated using polymerase-chain reaction (PCR) method to determine real-time results. We found fundamental differences between the samples of microflora in the investigated group and the control group. The lack of opportunistic gram-positive Atopobium vaginae in the vaginal and cervical secretions of women with stage III–IV endometriosis was statistically significant (p < 0.05). In the samples of cervical canal of epithelial scrapes of patients with stage III–IV endometriosis, there were detected clinically significant amounts (more than 10⁴ million copies of DNA/ml) of opportunistic and pathogenic microorganisms Gardnerella vaginalis, Porphimonas spp. Opportunistic strains Gardnerella vaginalis, Prevotella bivia, Escherichia colli, Streptococcus spp. dominated in the rectal scrapes of the patients of the investigated group. On the basis of the obtained data of microbiota studying, individual correction of the detected dysbiosis was carried out.

Results. The obtained data demonstrated an altered microflora of the urogenital tract and gut in patients with stage III and IV endometriosis. After therapy, the groups ceased to differ in the frequency of detection of normocenosis, moderate dysbiosis and severe dysbiosis that testifies to the normalization of urogenital tract and intestinal microflora in patients with moderate and severe courses of ovarian endometriosis. Further research is needed to examine whether dysbiosis is a consequence of the development of moderate and severe endometriosis or dysbiosis is a concomitant background pathology that contributes to the formation of endometriosis of this degree of severity.