Original Paper Veterinarni Medicina, 55, 2010 (10): 504–511

Bacterial contamination of the uterus in cows

with various clinical types of metritis and endometritis
and use of hydrogen peroxide for intrauterine treatment
R. Dolezel, T. Palenik, S. Cech, L. Kohoutova, M. Vyskocil

University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic

ABSTRACT: The relationship of various clinical forms of uterine inflammation to bacterial contamination and
the applicability of hydrogen peroxide for intrauterine treatment of clinical endometritis was the subject of this
trial. Uterine contamination was compared among groups of cows according to clinical findings on days 10 ± 3
(mild or severe puerperal metritis and controls without symptoms of the disease: MM, n = 16 or SM, n = 8 and
CM, n = 13) and 25 ± 3 (mild or severe clinical endometritis and controls without symptoms of the disease: ME,
n = 28 or SE, n = 40 and CE, n = 10). The applicability of 3% hydrogen peroxide was evaluated on the basis of
macroscopic examination of intact and closed uteri from slaughtered cows after infusion of 50, 80, and 100 ml of
the solution, clinical as well as bacteriological examination of uteri in cows suffering from clinical endometritis
(Group E1 – treatment for the first time, n = 18 and Group E2 – previous treatment for retained placenta or puer-
peral metritis, n = 12) before and seven days after intrauterine administration of 80 ml of the solution as well as
subsequent reproductive performance of treated cows in comparison with untreated controls without symptoms
of the disease (Group C, n = 20). A wider bacterial spectrum was found in the cows on day 10 ± 3 compared to
day 25 ± 3. Arcanobacterium pyogenes was the main uterine contaminant in cows suffering from all clinical types
of uterine inflammation while this bacterium was not shown to be present in any of the control cows (MM 7/16
and SM 6/8 vs. CM 0/13, P < 0.05 and P < 0.01; ME 14/28 and SE 18/40 vs. CE 0/10, P < 0.05). No macroscopic
changes in uteri were found after infusion of various volumes of 3% hydrogen peroxide, only gas infiltration to the
surrounding tissue occurred in completely closed uteri after deposition of 100 ml of the solution. Clinical symptoms
of endometritis disappeared in 83% (E1) and 67% (E2) of affected cows and bacterial contamination decreased
markedly (but not significantly) in both groups up to day 7 after intrauterine treatment. Reproductive parameters
in treated cows compared to controls were not different. The results show an important role of A. pyogenes in
the etiopathogenesis of all clinical forms of uterine inflammations in postpartum cows and support the use of 3%
hydrogen peroxide for intrauterine treatment of clinical endometritis even though sufficient antibacterial effects
of the treatment are still to be confirmed.

Keywords: postpartum cows; puerperal metritis; clinical endometritis; bacterial contamination; 3% hydrogen
peroxide

Inflammations of the uterus in cows, recently clas- et al., 2006) because the occurrence of various
sified as puerperal metritis, clinical endometritis, types of intrauterine puerperal metritis and clini-
subclinical endometritis, and pyometra represents cal endometritis in herds usually reaches 20–40%
one of the most important causes of (sub)infertility and the occurrence of subclinical endometritis is
in dairy herds (Nakao et al., 1992; Huszenicza et al., probably even higher (Sagartz and Hardenbrook,
1999; LeBlanc et al., 2002a; Kim and Kang, 2003; 1971; Markusfeld, 1987; Stevenson and Call, 1988;
Maizon et al., 2004; Gilbert et al., 2005; Sheldon Peeler et al., 1994; Gilbert et al., 2005; Foldi et al.,

Supported by the Ministry of Education, Youth and Sports of the Czech Republic (Grant No. MSM 6215712403).

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Veterinarni Medicina, 55, 2010 (10): 504–511 Original Paper

2006; Sheldon et al., 2006). Therefore intrauterine involution of uterus, n = 28), and SE (cows with
antimicrobial treatment represents a common and severe clinical endometritis – purulent secretion,
frequent procedure in dairy farms even though the incomplete involution of uterus, n = 40).
results of the treatment are variable (Gilbert, 1992; Uterine swabs for bacteriological examination
Whitacre, 1992; Montes and Pugh, 1993; Smith et (Uterine Culture Swab, EQUI-VET) were asepti-
al., 1998; Olson, 1996; Drillich et al., 2005; Dolezel cally collected from each cow, the samples were im-
et al., 2008). Nevertheless, bacterial contamination mediately inserted into the transport media Amies
of the uterus in early postpartum cows is common (CM425; Oxoid, Basingstoke, UK) and were trans-
(Huszenicza et al., 1999) and the development of ported to the university laboratory within 3 h after
uterine inflammation depends on local immunity collection, where they underwent bacteriological
and on the intensity of contamination and the spec- examination. Individual swabs were cultured on
trum of contaminants (Foldi et al., 2006; Sheldon Columbia agar (CM331; Oxoid, Basingstoke, UK)
et al., 2009a,b). Thus an effective control of post- containing 5% citrated sheep blood and MacConkey
partum contamination of the uterus provides the agar (CM115; Oxoid, Basingstoke, UK). After in-
chance to improve both fertility and general health oculation the plates were incubated aerobically
condition of dairy herds. The purpose of this study and anaerobically for 18 to 24 h at 37 °C and for
was to compare uterine contamination in cows suf- a further 24 h if bacterial growth had not ensued.
fering from various clinical types of uterine inflam- Bacteriological routine diagnostic procedures in-
mation with cows without any clinical symptoms of cluding Gram-staining, catalase-testing and bio-
the disease (Experiment I) and evaluation of the ap- chemical confirmation by diagnostic kits (Micro-La
plicability of 3% hydrogen peroxide as a new agent Test, Pliva-Lachema Diagnostika, Brno, Czech
for intrauterine treatment of clinical endometritis Republic) were used for culture identification.
(Experiment II). Differences in bacterial contamination among the
groups were evaluated using the Chi-square test.

MATERIAL AND METHODS

Experiment II
Experiment I
Part 1 – Estimation of an adequate dose of 3%
One hundred and fifteen postpartum cows hydrogen peroxide for in vitro conditions. Twelve
(Holstein) from two commercial dairy farms with involuted uteri from slaughtered dairy cows were
500 and 800 housed cows were used in the ex- used in the test. Uterotubal junctions were ligated
periment. Clinical examination was performed on in six uteri. Fifty, 80 and 100 ml of 3% hydrogen
37 cows on day 10 ± 3 with the aim of diagnosing peroxide were infused into the uteri transcervically
puerperal metritis and in 78 cows on day 25 ± 3 using a catheter (each volume was infused into two
post partum with the aim of diagnosing clinical intact and into two ligated uteri). Internal uterine
endometritis mostly during July and August. The orifices were closed by forceps immediately after
examination included manual vaginal examination the infusion in six ligated uteri. Macroscopic ex-
with withdrawal and evaluation of secretion from amination of uteri was performed 0, 15, 30, 60 and
the vagina and transrectal palpation of the uterus. 180 min after infusion of the solution. The uteri
All examined cows were divided into six experi- were opened and the endometrium was macroscop-
mental groups on the basis of postpartum period ically examined at the end of observation. Eighty
and clinical findings. The groups were established milliliters were determined to be an adequate vol-
as follows: CM (control cows without clinical symp- ume of the solution for intrauterine administration
toms of puerperal metritis – normal lochia, n = 13), (see Results).
MM (cows with mild puerperal metritis – marked Part 2 – Evaluation of the therapeutic effect of 3%
purulent lochia, n = 16), SM (cows with severe pu- hydrogen peroxide under in vivo conditions. Thirty
erperal metritis – putrid lochia, n = 8), CE (control dairy cows (Holstein) 22–28 days post partum
cows without symptoms of clinical endometritis – suffering from clinical endometritis diagnosed by
clean mucus, complete involution of uterus, n = 10), rectal and vaginal examination (see Experiment I)
ME (cows with mild clinical endometritis – muco- were used in the trial. Involution of the uterus and
purulent secretion, complete or almost complete quality of the secretion manually withdrawn from

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Original Paper Veterinarni Medicina, 55, 2010 (10): 504–511

the vagina were evaluated and a marked content mation on day 10 ± 3 as well as 25 ± 3. In contrast,
of pus in the secretion was considered to be the A. pyogenes was the most frequent contaminant of
main marker of endometritis. The levels of clini- uteri in cows suffering from puerperal metritis as
cal endometritis were not assessed. Intrauterine well as clinical endometritis; thus, the occurrence
administration of 80 ml of 3% hydrogen peroxide of this bacteria was significantly higher in Groups
was performed in these cows immediately after MM and SM compared to Group CM (7/16 and
clinical examination. The cows were either treated 6/8 vs. 0/13) and similarly in Groups ME and SE
for the first time (Group E1, n = 18) or had been compared to Group CE (14/28 and 18/40 vs. 0/10)
treated previously for retained placenta or puer- (Tables 1 and 2).
peral metritis (Group E2, n = 12). A control group
(C, n = 20) consisted of non-treated cows without
symptoms of the disease in the same postpartum Experiment II
period. Bacteriological (eight cows in groups E1
and E2 and four cows in group C) examination of Part 1. Greater distension was found in closed
uteri (see Experiment I) were performed before uteri compared to intact uteri after deposition
treatment and seven days later after the 2nd clini- of 50, 80, and 100 ml of 3% hydrogen peroxide.
cal examination. In addition, calving to first serv- Plentiful outlet of the solution with gas from the
ice interval, first service pregnancy rate, calving to cervix of intact (open) uteri occurred after intrau-
conception interval, services per conception, and terine deposition (Figure 1). Nevertheless, no mac-
pregnancy by day 100 and 150 post partum were roscopic injuries were found in any examined uteri
compared among the groups. but symptoms of gas infiltration to the surrounding
Statistical evaluation of the differences in clinical tissue were observed in closed (ligated) uteri after
and bacteriological findings was performed using deposition of 100 ml of the 3% hydrogen peroxide
Fisher’s exact test, and reproductive parameters (Figure 2). On the basis of these results 80 ml of the
were compared using the Cruscal-Wallis test. solution was determined as the maximum volume
applicable for intrauterine treatment in cows.

RESULTS

Experiment I

A wider bacterial spectrum and higher occur-

rence of Escherichia coli was found in the cows on
day 10 ± 3 compared to day 25 ± 3. Namely, the
occurrence of E. coli was higher at the earlier post-
partum term, and the difference between groups
SM and SE was significant (2/8 vs. 0/40, P < 0.05).
The presence of A. pyogenes was not shown in any Figure 1. Discharge after intrauterine deposition of
cow without clinical symptoms of uterine inflam- 100 ml of 3% hydrogen peroxide

Table 1. Occurrence of uterine bacteria in the CM (cows without symptoms of puerperal metritis), MM (cows with
mild puerperal metritis) and SM (cows with severe puerperal metritis) groups on day 10 ± 3 post partum

CM (n = 13) MM (n = 16) SM (n = 8)
ab a
A. pyogenes (%) 0 44 75b
Bacillus spp. (%) 46 13 25
E. coli (%) 23 0 25
P. mirabilis (%) 15 6 13
Staphyloccocus CN (%) 0 13 13
a
P < 0.05; bP < 0.01

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Veterinarni Medicina, 55, 2010 (10): 504–511 Original Paper

Table 2. Occurrence of uterine bacteria in the CE (cows without symptoms of clinical endometritis), ME (cows with
mild clinical endometritis) and SE (cows with severe clinical endometritis) groups on Day 25 ± 3 post partum

CE (n = 10) ME (n = 28) SE (n = 40)

A. pyogenes (%) 0ab 50a 45b
Bacillus spp. (%) 20 7 8
E. coli (%) 0 0 0
P. mirabillis (%) 0 0 0
Staphyloccocus CN (%) 10 7 5
a
P < 0.05; bP < 0.05

120 Before administration

(%)
After administration
100

80

60

40

20

0
E1 (n = 18) E2 (n = 12) C (n = 20)

Figure 2. Infiltration of gas to the surrounding tissue Figure 3. Occurrence (%) of clinical symptoms in pre-
after intrauterine deposition of 100 ml of 3% hydrogen viously non-treated (E1) or treated (E2) cows suffering
peroxide from clinical endometritis on day 7 after i.u. administra-
tion of 3% hydrogen peroxide and in controls (C)

Part 2. Clinical symptoms of endometritis disap- Similarly, total infection (Figure 4) and infection
peared in 15 out of 18 (83%, P < 0.05) and eight out with A. pyogenes (Figure 5) in treated cows decreased
of 12 (67%, P < 0.05) of the cows in Groups E1 and approximately by about 50% but differences were
E2, respectively, on day 7 after treatment (Figure 3). not significant. Surprisingly, negative bacteriologi-
These symptoms also occurred in 1 untreated con- cal findings were found in all cows without clinical
trol cow from control Group C. symptoms of endometritis at both examinations.

Table 3. Reproductive parameters in previously non-treated (E1) or treated (E2) cows suffering from clinical
endometritis after i.u. administration of 3% hydrogen peroxide and in controls (C)

E1 (n = 18) E2 (n = 12) C (n = 20)

Calving to first service interval (days) 83 ± 25.4 92 ± 25.3 73 ± 14.0
First service pregnancy rate (%) 39 25 50
Calving to conception interval (days) 103 ± 32.6 125 ± 38.5 106 ± 48.2
Services per conception (days) 1.6 ± 0.50 2.2 ± 1.11 2.0 ± 1.41
Pregnancy until day 100 (%) 50 25 55
Pregnancy until day 150 (%) 94 83 85

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70 Before administration 60 Before administration

(%) (%)
60 After administration 50 After administration
50
40
40
30
30
20
20
10 10
0 0
E1 (n = 8) E2 (n = 8) C (n = 4) E1 (n = 8) E2 (n = 8) C (n = 4)

Figure 4. Occurrence (%) of uterine contamination in Figure 5. Occurrence (%) of A. pyogenes in the uteri of
previously non-treated (E1) or treated (E2) cows suffer- previously non-treated (E1) or treated (E2) cows suffer-
ing from clinical endometritis before and on day 7 after ing from clinical endometritis before and on day 7 after
i.u. administration of 3% hydrogen peroxide and in con- i.u. administration of 3% hydrogen peroxide and in con-
trols (C) trols (C)

Even though all reproductive parameters were becomes contamination-free usually from day 40,
generally worse in Group E2 in comparison with even though in some cows without symptoms of
Groups E1 and C, the differences were not signifi- uterine inflammation, bacterial contamination of
cant (Table 3). the uterus can be observed until day 60 post par-
tum (Kudlac and Vlcek, 1970; Studer and Morrow,
1981; Schirar and Martinet, 1982; Lofstedt, 1984;
DISCUSSION Hussain et al., 1990; Zerbe et al., 1996). Although
a similar course of uterine infection is described
Purulent or fetid secretions manually obtained during physiological as well as pathological post
from the vagina are usually considered to be the partum involution, some differences were found in
most important symptoms of postpartum uterine the quantity and spectrum of contaminants. (Endo)
inflammation (Drillich et al., 2002; Zilaitis et al., metritis in cows is usually associated with contami-
2004; Drillich, 2006). Accordingly, these symp- nants such as E. coli, A. pyogenes, Fusobacterium
toms were considered as key in the diagnosis of necrophorum, Bacteroides melaninogenicus, which
the uterine condition in our trial. We evaluated show varied interactions (Foldi et al., 2006; Yavari
the fetid character of secretions as a more serious et al., 2007; Azawi et al., 2008; Wang Jun et al., 2008;
stage of inflammation compared to the purulent Petit et al., 2009). E. coli usually asserts itself at the
character on day 10 ± 3 post partum, and the pu- beginning of inflammation and together with en-
rulent character of the secretion as a more serious dotoxins (lipopolysaccharide) facilitates a subse-
stage compared to muco-purulent character on day quent infection with A. pyogenes (Dohmen et al.,
25 ± 3 post partum, because the content of pus 2000; Zilaitis et al., 2004) and in addition inhibits
in secretion reaching up to 50% and its gradual follicular growth as well as the secretion of oestra-
reduction in the course of the early post partum diol (Williams et al., 2008a,b; Sheldon et al., 2009a).
period is described as physiological (Dohmen et al., PMN phagocytosis has been shown to be inhibited
1995; LeBlanc et al., 2002b; Williams et al., 2005). in the presence of E. coli (Watson, 1989; Zerbe et al.,
Thus, the diagnosis of a pathological condition of 2001). In addition, a positive correlation between the
the uterus on the basis of the content of pus in a occurrence of A. pyogenes and Bacteroides spp. or
secretion obtained from the vagina before day 25 F. necrophorum has been described (Bekana et al.,
post partum is questionable. For this reason only 1994; Dohmen et al., 1995; Huszenicza et al., 1999).
abundant content (> 50%) of pus was considered to Occasionally, streptococci, staphylococci, Proteus
be a symptom of mild puerperal metritis in the early or Clostridium spp. are also associated with (endo)
postpartum period, and muco-purulent secretion metritis (Dohmen et al., 1995; Mateus et al., 2002).
(content of pus < 50%) a symptom of mild clinical Accordingly, with these data we observed E. coli only
endometritis in a later period. on day 10 ± 3 but did not find it in any cow on day
Bacterial contamination of the postpartum uterus 25 ± 3 post partum while Bacillus spp. were found
is common and decreases during puerperium and in all experimental groups regardless of the term

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Veterinarni Medicina, 55, 2010 (10): 504–511 Original Paper

post partum. Convincing findings supporting the pose in our trial. The effect of the treatment under
results of the above mentioned reports were made in vivo conditions was confirmed successively by
for A. pyogenes. We isolated this bacterium only in the disappearance of clinical symptoms of uterine
cows suffering from (endo)metritis. The occurrence disorders in most treated cows, decrease of bacte-
of A. pyogenes ranged from 44 to 75% in the individ- rial contamination and comparable reproductive
ual groups of affected cows. Thus, we unambiguously parameters with controls.
show A. pyogenes to be the main uterine contami- In conclusion our results show a wider spec-
nant in cows suffering from (endo)metritis. Thus, the trum of uterine bacteria in cows on day 10 ± 3
presence of this bacterium can be considered as an compared to day 25 ± 3 post partum, the domina-
indicator of a pathological condition in the bovine tion of A. pyogenes in the uterus of cows suffering
uterus. Therefore, in our trial, a high occurrence of from mild as well as severe puerperal metritis or
this bacterium was associated with inflammation clinical endometritis and the applicability of 3%
also in cows with purulent secretion on day 10 ± 3 as hydrogen peroxide for intrauterine treatment of
well as in cows with mucopurulent secretion on day clinical endometritis in cows even though a suffi-
25 ± 3 post partum. Associations of fetid secretion cient antibacterial effect of the treatment remains
with A. pyogenes, E. coli, non-hemolytic streptococci to be confirmed.
and Mannheimia haemolytica and mucopurulent
or purulent secretion with A. pyogenes, Proteus and
F. necrophorum have been described previously Acknowledgements
(Williams et al., 2005).
Hydrogen peroxide represents a water soluble and The authors thank the farmers (Agro-cooperation
mildly acidic fluid with strong oxidative proper- Blizkovice and Bonagro Blazovice) who allowed the
ties and with the ability to inhibit many enzymatic trial to be performed on their farms.
processes (Musil, 1990). Above all it is used for
disinfection and suppression of weak haemorrhage
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Accepted after corrections: 2010–10–02

Corresponding Author:
Radovan Dolezel, Prof. Ass. D.V.M., PhD., Ruminant Clinic, Faculty of Veterinary Medicine, University of Veterinary
and Pharmaceutical Sciences Brno, Palackeho 1-3, 612 42, Brno, Czech Republic
Tel. +420 541 562 316, Fax +420 541 562 332, E-mail: dolezelr@vfu.cz

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