Purulent Discharge in Endometritis
Yes, purulent or mucopurulent discharge is a characteristic finding in endometritis and serves as a key diagnostic marker for this condition. 1
Clinical Presentation of Discharge
Abnormal cervical or vaginal mucopurulent discharge is an established supportive diagnostic criterion for endometritis in the context of pelvic inflammatory disease (PID). 1, 2, 3
The discharge is specifically described as "mucopurulent" (containing both mucus and pus), which distinguishes it from normal physiologic discharge. 4, 1
This mucopurulent discharge can be visualized either in the endocervical canal or on an endocervical swab specimen during examination. 4
The presence of white blood cells on saline microscopy of vaginal secretions has 88.9% sensitivity (though only 19.4% specificity) for detecting endometritis, reflecting the inflammatory nature of the discharge. 1
Diagnostic Context
The purulent discharge should be interpreted alongside other clinical findings:
Minimum diagnostic criteria include uterine/adnexal tenderness or cervical motion tenderness, with the mucopurulent discharge serving as additional supportive evidence. 1, 2, 3
When mucopurulent discharge is present with lower abdominal pain and pelvic tenderness, empiric treatment should be initiated immediately without waiting for microbiological confirmation. 2, 3
The discharge reflects underlying infection with organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobes, and other bacteria that characterize endometritis. 3
Postpartum Endometritis Distinction
In postpartum endometritis specifically, the discharge is characterized as foul-smelling lochia (lóquios fétidos) rather than typical mucopurulent discharge. 1
This fetid discharge accompanies fever ≥38.3°C, uterine tenderness, and abdominal pain in the postpartum setting. 1
Common Pitfalls
Do not wait for microbiological test results before initiating treatment when mucopurulent discharge is present with pelvic tenderness—treatment must begin immediately upon presumptive diagnosis. 1, 3
Cultures from non-aseptically collected specimens have limited diagnostic utility, so clinical findings including the discharge pattern should guide initial management. 1
The absence of purulent discharge does not exclude endometritis, as the condition can present with variable symptoms. 1