**6. Treatment**

these findings allows the hysteroscopist to rule out, with reasonable certainty, the presence of

**Figure 3.** Detail of micropolyps under hysteroscopic examination using a liquid distension medium: the micropolyps, which appear with a varied morphology, are scattered over the uterine wall and may often be encountered with pol‐

Conversely, if micropolyps are found, which is almost always associated with hyperemia or stromal edema, this should be interpreted a reliable sign of inflammation, as corroborated by

The presence of focal hyperemia with isolated micropolyps is associated, histologically, with a mild type of endometrial inflammation; conversely, the findings of generalized hyperemia, diffused micropolyps, or a thickened endometrium with polypoid diffusion are all associated

In summary, the presence of hyperemia, edema, and stromal micropolyps has a demonstrated

The potential development of endometritis, if left untreated, leads to the formation of intrau‐

Regarding tuberculous endometritis, certain hysteroscopic signs suggestive of disease have been described, such as the presence of a thin, uneven, and pale endometrium with irregular

It is not uncommon to observe intrauterine adhesions, while a much rarer finding is the presence of classic tubercles in the endometrial mucosa. Differential diagnosis should be established against the presence of granulomatous endometritis (sarcoidosis) and that of the fungal form [30]. Even CMV-related endometritis can manifest itself in the granulomatous

Finally, there is a rare form of endometritis that may mimic, at macroscopic level, an endo‐ metrial carcinoma [31]. This is xanthogranulomatous endometritis, whose etiology is still

the high positive predictive value attributed to this finding (98.4%).

with moderate-to-severe endometrial inflammation [27, 28].

whitish spots scattered over the uterine walls [29].

endometrial inflammation.

yps (A) and/or pseudopolyps.

40 Genital Infections and Infertility

diagnostic accuracy of 93.4%.

terine synechiae.

form.

The therapy for chronic endometritis is pharmacological and is based on the administration of broad-spectrum antibiotics [34, 35].

Generally, the drug of choice is doxycycline, administered in doses of 100 mg every 12 hours for 14 days, or alternatively, the administration of cephalosporins, macrolides, or quinolones is possible. It is preferable for the partner to also undergo the same antibiotic treatment.

Where antibiotic therapy fails and/or where the presence of endometritis persists, an endo‐ metrial culture with a relative antibiogram should be considered and an appropriate antibiotic treatment must be prescribed.

In particular, according to the Centers for Disease Control guidelines, the therapies recom‐ mended are in case of [12]:


**•** negative cultures: Ceftriaxone 250 mg IM in a single dose plus doxycycline 100 mg orally twice a day for 14 days with metronidazole 500 mg orally twice a day for 14 days.

In case of persistence of signs of chronic endometritis at subsequent hysteroscopy, the protocol can be repeated up to three times.

In the presence of confirmed tuberculous endometritis, the patient should be given a specific antibiotic therapy for tuberculosis (isoniazid, ethambutol, rifampicin, and pyrazinamide for 2 months, followed by isoniazid and rifampicin for another 4 months).
