摘要：Background: The genetic-epigenetic theory postulates that endometriosis is triggered by a cumulative set of
genetic-epigenetic (GE) incidents. Pelvic and upper genital tract infection might induce GE incidents and thus
play a role in the pathogenesis of endometriosis. Thus, this article aims to review the association of endometriosis
with upper genital tract and pelvic infections.
Methods: Pubmed, Scopus and Google Scholar were searched for ‘endometriosis AND (infection OR PID OR
bacteria OR viruses OR microbiome OR microbiota)’, for ‘reproductive microbiome’ and for ‘reproductive
microbiome AND endometriosis’, respectively. All 384 articles, the first 120 ‘best match’ articles in PubMed
for ‘reproductive microbiome’ and the first 160 hits in Google Scholar for ‘reproductive microbiome AND
endomytriosis’ were hand searched for data describing an association between endometriosis and bacterial, viral
or other infections. All 31 articles found were included in this manuscript.
Results: Women with endometriosis have a significantly increased risk of lower genital tract infection, chronic
endometritis, severe PID and surgical site infections after hysterectomy. They have more colony forming units
of Gardnerella, Streptococcus, Enterococci and Escherichia coli in the endometrium. In the cervix Atopobium
is absent, but Gardnerella, Streptococcus, Escherichia, Shigella, and Ureoplasma are increased. They have
higher concentrations of Escherichia Coli and higher concentrations of bacterial endotoxins in menstrual
blood. A Shigella/Escherichia dominant stool microbiome is more frequent. The peritoneal fluid of women with
endometriosis contains higher concentrations of bacterial endotoxins and an increased incidence of mollicutes and
of HPV viruses. Endometriosis lesions have a specific bacterial colonisation with more frequently mollicutes (54%)
and both high and medium-risk HPV infections (11%). They contain DNA with 96% homology with Shigella.
In mice transplanted endometrium changes the gut microbiome while the gut microbiome influences the growth
of these endometriosis lesions.
Conclusions: Endometriosis is associated with more upper genital tract and peritoneal infections. These infections
might be co-factors causing GE incidents and influencing endometriosis growth.
关键词：Endometriosis; pathophysiology; infection; prevention of endometriosis; adolescent endometriosis;
