METHODS
Patients undergoing total hysterectomy for benign indications at our academic institution in Morgantown, West Virginia, between October 1, 2020, and March 31, 2021, were recruited to participate. The technique for the hysterectomies was required to have utilized a minimally invasive approach, including laparoscopic, robotic-assisted laparoscopic, or vaginal approaches. Exclusion criteria were presence of malignancy at time of surgery, use of open approach, and supracervical hysterectomy. Once patients were recruited, the objective of the study was explained, and they were given the choice to participate. Informed consent was reviewed and obtained. Fifty patients met appropriate criteria and elected to participate in this study.
No Infection 61 %
FIGURE 1: Infections Detected
To screen for BV prior to hysterectomy, patients were allowed to undergo induction of anesthesia on the day of surgery. Prior to surgical prepping with application of the vaginal scrub, two vaginal swabs were collected: a genital culture and wet mount. The swabs were sent to the laboratory for processing. If BV was detected, metronidazole was administered, either with intravaginal gel or orally with a five-day prescription upon discharge. The results of the genital culture were available within two to three days of collection. If BV was detected, patients were contacted and prescribed a five-day prescription of metronidazole postoperatively. The incidence of vaginal infection detected and occurrence of post-operative SSI were recorded in our patient population, and 95 % confidence intervals were calculated for collected
Bacterial Vaginosis 25 %
Candida 14 %
Haemophilus Parainfluenzae 0 %
Types of infection detected from vaginal swab and genital culture collected at time of hysterectomy. variables within our data set. This study was approved by the West Virginia University Institutional Review Board( Protocol Number 2001871015).
RESULTS
Of the 50 patients enrolled in the study, six cases were not included due to improper collection of vaginal swabs prior to the vaginal prep. Therefore, 44 patients were included in data collection. Ten different surgeons performed the hysterectomies. The results of types of infection detected in the study are demonstrated in Figure 1. In 61 % of cases( 95 % CI [ 44.6 %, 72.6 %]), no infections were detected by either vaginal swab or genital culture. BV was detected in 25 % of patients( 95 % CI [ 14.3 %, 35.7 %]), who then received appropriate treatment with metronidazole after detection. Other pathogens were incidentally found at time of surgery and included Candida species in 14 % of cases( 95 % CI [ 3.5 %, 23.8 %]). One patient was readmitted post-operatively for pelvic abscess, however BV was not the attributable cause of infection. No patients with detectable BV that were treated with metronidazole orally or intravaginally developed a postoperative surgical site infection in this study.
DISCUSSION
Based on our results, we identified the incidence of BV within our patient population to highlight the significance of asymptomatic infection present at the time of hysterectomy. These patients diagnosed perioperatively with BV then received treatment with intravaginal or oral metronidazole and had no documented cases of postoperative infection. These findings align with the recommendation upheld by ACOG to screen patients preoperatively to hysterectomy and with existing literature supporting the effectiveness of metronidazole in reducing SSIs. 6 Our findings also strongly emphasize the consideration of implementing routine screening at our academic institution in accordance with national guidelines. The implementation of our single-institution pilot study strengthens this hypothesis and supports further research on a larger scale to validate these findings.
West Virginia Medical Journal • September 2026 • 17