Equine Endometritis, Venereal Disease, Retained Cups

Question 1

Endometritis involves only the _______

Answer 1

Endometrium

Question 2

Metritis involves ______

Answer 2

Deeper tissues, including the myometrium

- severe sequela include peritonitis and laminitis

Question 3

______ is the #1 cause of reduced fertility in mares

Answer 3

Endometritis

Question 4

Uterus is contaminated via

Answer 4

• parturition
• natural breeding
• repro exams
• AI
• poor conformation

Question 5

How do normal mares respond to uterine contamination?

Answer 5

Transient inflammatory response

• PMNs, phagocytosis, uterine contractions, PGs
• able to clear bacteria/infection and fluid

Question 6

Susceptible mares

Answer 6

Unable to clear the infection due to a breakdown in their uterine defense mechanisms

• prone to persistent post-mating endometritis, chronic endometritis
• 15% of mare population are “susceptible”

Question 7

Mating induced endometritis

Answer 7

Inability to clear uterus of fluid after breeding

• 15% of broodmare population affected
• must examine mares after breeding, observe fluid

Question 8

Bacterial causes of endometritis

Answer 8

• streptococcus zooepidemicus
• e coli
• pseudomonas aeruginosa
• klebsiella pneumoniae

Question 9

Yeast/fungi causes of endometritis

Answer 9

• candida
• aspergillus
• mucor

Question 10

Diagnosis of endometritis

Answer 10

• external signs
• speculum findings
• endometrial swabs
• endometrial biopsy
• small volume uterine lavage/cytology

Question 11

Treatment options

Answer 11

• correct underlying problem
• antimicrobials
• ecbolic agents
• uterine lavage
• intrauterine antiseptics

Question 12

How to correct conformational defects

Answer 12

• caslick’s (pneumovagina)
• urethral extension (urine pooling)
• cervical injuries

Question 13

Local antibiotics

Answer 13

Intrauterine vs infusion

• penicillins, ceftiofur, gentamicin, ticarcillin
• use caution “resistance”

Question 14

Systemic antibiotics

Answer 14

Some antibiotics reach therapeutic level in the uterus after systemic administration
- baytril, amikacin, TMS/SMZ

Question 15

When do you use antibiotics?

Answer 15

Treat concurrently during same cycle they are bred

Question 16

Uterine lavage

Answer 16

Large bore catheter placed in uterus

• lavage with large volumes of LRS or saline (3 liters)
• add antiseptics (5cc of betadyne/liter)
• physically flushes uterus of contamination and stimulates influx of neutrophils

Question 17

Fungal metritis

Answer 17

Secondary to repeated antibiotic administration

• chronic
• hyphae seen on cytology/biopsy
• cultured from uterus
• guarded prognosis

Question 18

Fungal metritis - treatment

Answer 18

• correct any conformational defects
• antifungal agents
• other

Question 19

Ecbolic agents

Answer 19

Stimulates myometrial contractions, which expel fluid from the uterus

• oxytocin: immediate response
• cloprostenol (synthetic prostaglandin): prolonged response (2-4 hrs), can cause mild colic

Question 20

Newer therapies

Answer 20

• acetyl cysteine
• DMSO
• buffered chelating agents
• corticosteriods

Question 21

Managing susceptible mare

Answer 21

• use minimal contamination breeding
• uterine lavage prior to max inflammation
• ecbolics as needed
• follow-up exam to verify fluid has been evacuated

Question 22

Venereal disease - route of transmission

Answer 22

• coitus
• contaminated instruments
• personnel can act as mechanical vector
• common in natural mating situations (prevalence is low in situation of AI use)

Question 23

Contagious equine metritis

Answer 23

Taylorella equigenitalis

- gram neg microaerophilic coccobacillus

Question 24

Transmission of CEM

Answer 24

• coitus
• careless handling of genitalia
• contaminated instruments: breeding roll, artificial vagina, speculum
• many mares are infected, but few become carriers
• clitoral fossa is preferential site of colonization

Question 25

Clinical signs of CEM

Answer 25

- copious vaginal discharge (grey, 8-10 days after breeding) - no clinical signs in stallions - mares go unnoticed

Question 26

Diagnosis of CEM

Answer 26

- culture: most reliable, amies transport media w/ charcoal or chocolate agar + 10% horse blood - serologic testing (mares only)

Question 27

CEM - mare treatment

Answer 27

- antibiotics for 3-5 days - pack clitoral fossa: nitrofurazone, chlorhexadine, silver sulfadiazine - clitoral sinusectomy - culture to confirm clearance

Question 28

CEM - stallion treatment

Answer 28

- thorough cleaning of penis and prepuce (chlorhexidine) - apply nitrofurazone dressing - repeat for 5 days - culture to confirm clearance - treatment/control is highly regulated by USDA

Question 29

Control of CEM

Answer 29

- strict hygiene - ID of positive animals and treatment - use of sterile disposable equipment - quarantine of imported animals with testing protocol - reportable disease

Question 30

Pseudomonoas and Klebsiella

Answer 30

Venereal route of infection - sexual transmission depends on balance of organisms on the penis of stallions --> discourage vigorous cleaning of stallion penis - need for normal commensal organisms --> compete with pathologic bacteria

Question 31

E coli and Strep zoo

Answer 31

Seen in mares with marginal to poor perineal conformation - not thought to be transmitted by venereal route - treat and manage like routine endometritis

Question 32

Retained endometrial cups

Answer 32

- formed at 35-45 days of pregnancy | - remain until day 120-140 of pregnancy, even if fetus dies

Question 33

Cups produce _____

Answer 33

eCG - retained cups cause erratic and frustrating cycles with pregnancy never occurring - dx with US/endoscopy and eCG testing