Infectious Disease Compendium



Infection of the uterus, usually after a surgical intervention. Patients have fever, leukocytosis, purulent vaginal discharge, and painful uterus.

Pyometra occurs when there an accumulation of pus in the uterine cavity due to a cervical block.

Epidemiologic Risks

Usually after surgical procedures including C section.


Variable. Group A and B streptococci, enterococci, other streptococci, G. vaginalis, E. coli, and anaerobes. In the old days (and perhaps in the not too distant future) backstreet abortions were associated is C. perfringens uterine myonecrosis. Actinomycosis of the uterus can occur with prolonged IUD use, the one I saw left the IUD in for 20 years. But at least she didn't get pregnant.

Empiric Therapy

Clindamycin AND gentamicin have been the mainstay for decades, as the infections are usually simple and young people are not prone to aminoglycoside toxicity. Me? Based on local resistance patterns I suggest a third generation cephalosporin AND metronidazole. Other options include a quinolone AND metronidazole OR a carbapenem alone. I, of course, never use the penicillin/beta-lactamase inhibitors, but they are also recommended.


Patients usually respond rapidly, if not look of an abscess or consider resistant organisms.

Last Update: 06/27/18.