Pyometra in Humans: Causes, Symptoms and Treatment

Pyometra in humans is a rare medical pathology among the general population. It usually affects older women. Pyometra is the collection of pus originating from the uterine cavity. It happens due to the impaired drainage system of the cervix due to different other pathologies or malignancies. In addition, there may be stenosed cervical nodes to obstruct the drainage system.

Pyometra in humans is of grave concern due to the increased potential of cervical malignancies. It is common practice for the veterinary community due to increased incidence in dogs and cattle. However, it is quite a rare disease to be found in humans. We will also see the most common cause of pyometra in humans in this article. This article explains the primary etiology and treatment plan regarding pyometra in humans. Let us dig into the details to explore the significant aspects related to pyometra. 

What are the common causes of pyometra in humans?

Pyometra, a collection of pus, indicates a source of infection somewhere in the cervix or uterine cavity. This infectious state may occur due to several underlying hidden problems. There are multiple causes that lead to pyometra in humans. Some of the most common cause of pyometra in humans are as follows:

• Fibroid degeneration
• Endometrial polyp or carcinoma
• Cervical occlusion due to any surgical treatment (endometrial ablation or prolapse surgery)
• Senile cervicitis
• Senile endometritis
• Cervical stenosis
• Postoperative infection
• Puerperal infection
• Uterine compression sutures to avoid postpartum hemorrhage to prevent hysterectomy (B-lynch suture)
• Congenital anomalies of the cervical region
• Genital tuberculosis
• Following egg retrieval in IVF procedure
• Forgotten intrauterine device
• Radiotherapy

These are the most common causes of pyometra in humans. The main event is the blockage of the drainage system. Blockage of the drainage system leads to cervical infection, producing pus, as well as draining outside the uterine cavity. 

Symptoms of pyometra in humans:

Pyometra may exist even without symptoms and is found as an incidental finding on postmortem or imaging scans. In contrast, there are some specific symptoms related to pyometra that help to find the leading pathology. Let’s see the signs and symptoms of pyometra in humans.

• Symmetrical uterine enlargement
• Acute lower abdominal pain
• Blood-stained, purulent vaginal discharge
• Pyrexia due to infectious cause (rare finding)

Pyometra in humans may perforate the epithelial lining and present with acute abdominal pain. However, it is an infrequent phenomenon. Examination features might be indistinguishable from other diseases related to peritonitis. 

Is pyometra a common pathology in daily practice?

Pyometra is an extremely rare disease in humans. However, it is quite common practice in the veterinary community due to greater incidence in dogs and cattle. 

• Pyometra in humans is rare with an incidence of about 0.01 to 0.5% among all the gynecological patients.
• It is more common among postmenopausal as well as elderly women, who have any existing medical problems. 
• Pyometra in children is rare but may occur. 

Differential diagnosis

Pyometra in humans has a similar presentation to fibroids, malignancies, and congenital anomalies. It is critical to exclude all those pathologies for an accurate diagnosis and management plan. Differentiate it from the other common causes of uterine enlargement and blood-stained vaginal discharge-related pathologies. You should also know what Dysfunctional uterine bleeding means.

• Exclude the other causes of uterine like fibroids and adenomyosis
• Exclude endometrial causes like polyps, hematometra, endometrial malignancy, and gestational trophoblastic neoplasia.
• Exclude the congenital abnormalities that can cause uterine symmetrical growth
• Exclude blood-stained vaginal discharge causes like vulvar vestibulitis, vaginosis, genital infections, and any other related malignancies.
• Exclude other causes of acute abdominal pain in case of perforated pyometra.

Being a rare entity, it is important to exclude all the other main pathologies for the precise diagnosis. Perforated pyometra is considered a differential diagnosis in women with pneumoperitoneum with fever. 

What are the typical investigations to confirm the differential diagnosis?

Hypothetical diagnosis needs to be confirmed prior to the management plan. There are two prominent investigations that help to provide an accurate diagnosis.

Histopathology:

Histopathological examination reveals the microbiology of any infectious agents. Vaginal swabs are usually 50% negative in the case of pyometra. So, the principal microbes are anaerobes and are difficult to culture. If you suspect tuberculosis, there are specific tests to confirm the diagnosis. Tuberculin testing, culture histology, PCR, as well as hysterosalpingogram are vital tests to confirm tuberculosis.

Imaging methods:

Ultrasound is the initial imaging scan to diagnose the pyometra. CT scan or MRI is used to diagnose and assess perforated pyometra.

Moreover, Doppler scanning can help to visualize any blood flow changes to differentiate pyometra from endometrial carcinoma. Whereas pneumoperitoneum on X-ray or CT denotes spontaneous perforation. 

What is the possible treatment plan for pyometra?

Let’s now look into the treatment of pyometra in humans. Hysterectomy is usually advised for the patients. However, many women show better prognosis with cervical dilation and proper drainage of the pus. Regular checking as well as assessment help to detect any recurrence or persistence of the disease. Nowadays, interventional radiotherapy offers a promising alternative to the surgical treatment.

Antibiotics are only indicated when there is evidence of invasive infection. The infectious state exhibits generalized malaise, pyrexia, or abnormal laboratory findings. If there is a need for antibiotics, also consult appropriately with a microbiologist for accurate preparation to deal with aerobic and anaerobic bacteria. For tubercular pyometra, anti-tuberculosis therapy is sufficient to deal with the infection. This concludes the most important topic of this article, that is treatment of pyometra in humans.

Is there any complication related to pyometra in humans?

There are no such chief complications related to pyometra in humans. Some minor complications include:

• Hypoalbuminemia, which is also a risk factor for pyometra perforation.
• Spontaneous perforation occurs more likely if there is a delay in the treatment.

How better is the prognosis?

The prognosis for pyometra depends on the underlying etiology causing the disease. Any malignancy like endometrial carcinoma will lead to a questionable prognosis. Moreover, spontaneous perforation also worsens the prognosis. Early diagnosis and proper management surely help to improve the prognosis and better outcomes. 

A word of precaution:

Pyometra is an intrauterine rare infection with a collection of pus draining from the cervix. The most common cause is the blockage of the drainage system making the uterine contents difficult to drain. Moreover, pyometra also has an underlying malignant etiology. The classical symptoms include acute lower stomach pain, purulent vaginal discharge, as well as postmenopausal hemorrhage per vaginum. There are multiple hidden causes leading to this disease. The earlier it is diagnosed, the better the prognosis. 

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