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Pyometra

Pyometra is a serious and potentially life-threatening bacterial infection of the uterus that primarily affects unspayed female dogs and, less commonly, cats, characterized by the accumulation of pus (purulent exudate) within the uterine lumen due to hormonal influences and bacterial proliferation.^[1]^[2] The condition typically develops in the luteal phase of the estrous cycle, 2–4 months after estrus, when elevated progesterone levels cause endometrial changes such as cystic endometrial hyperplasia, creating an environment conducive to bacterial overgrowth, most often from Escherichia coli (responsible for 28–90% of cases), which ascends from the vagina or spreads hematogenously.^[2] Risk factors include repeated estrous cycles without pregnancy, advanced age (median diagnosis at 9 years), and exposure to progestational hormones or incomplete ovariohysterectomy; breeds like Rottweilers, Bernese Mountain Dogs, and Cavalier King Charles Spaniels may show higher susceptibility.^[2] Pyometra manifests in two forms: open pyometra, where the cervix is dilated allowing pus to drain vaginally (appearing as bloody or purulent discharge), and closed pyometra, where the cervix remains shut, leading to rapid uterine distention, systemic toxemia, and higher risk of complications like uterine rupture, peritonitis, or sepsis.^[1]^[2] Clinical signs often include lethargy, depression, anorexia, excessive thirst and urination (polydipsia/polyuria), vomiting, fever, and pale mucous membranes, though early symptoms can be subtle and mimic other illnesses.^[1] Diagnosis relies on a combination of history (recent estrus in an intact female), physical examination, bloodwork revealing leukocytosis, anemia, and elevated inflammatory markers (e.g., C-reactive protein), along with imaging such as abdominal ultrasound to visualize the fluid-filled, enlarged uterus.^[1]^[2] Treatment is an emergency, with ovariohysterectomy (surgical removal of the uterus and ovaries) as the standard and most effective approach, offering 80–100% survival rates if performed before severe sepsis or organ failure develops; supportive care includes intravenous fluids, antibiotics, and pain management.^[1] For valuable breeding animals, medical management using prostaglandins (e.g., cloprostenol) or antiprogestins (e.g., aglepristone) combined with antibiotics may be attempted to preserve fertility, though success rates are lower (around 70–90%) and recurrence is common.^[2] Prevention is straightforward and highly effective through early spaying (ovariohysterectomy) before the first heat cycle, which eliminates the hormonal triggers entirely.^[1] Recent advances highlight the role of specific E. coli phylogroups (e.g., B2) in pathogenesis and potential dietary influences on gut microbiota to reduce colonization risks, underscoring ongoing research into non-surgical prevention strategies.^[2]

Overview

Definition

Pyometra is a potentially life-threatening uterine infection, characterized by endometritis accompanied by the accumulation of pus, primarily affecting intact female dogs and cats due to bacterial overgrowth that results in purulent exudate within the uterus.^[3]^[2]^[4] This condition involves the overproliferation of opportunistic bacteria in a hormonally primed uterine environment, leading to inflammation and fluid buildup.^[5] In pyometra, the uterus becomes distended with a mixture of bacteria, toxins, dead tissue, and pus, which can rupture or leak into the bloodstream, causing systemic illness such as sepsis if left untreated.^[3] The infection typically arises in the diestrus phase of the estrous cycle, when progesterone levels remain elevated, predisposing the endometrium to bacterial invasion.^[4] The term "pyometra" originates from the Greek roots pyo- (pus) and metra (uterus), literally meaning "pus in the uterus." This condition has been recognized in veterinary medicine for over a century, with early descriptions appearing in the literature by the early 20th century.

Epidemiology

Pyometra is one of the most common reproductive disorders in intact female dogs, with studies indicating that approximately 15-25% of unspayed bitches develop the condition by 10 years of age.^[6]^[7] In regions with lower spaying rates, such as parts of Europe, the lifetime risk can approach 20-25% for sexually intact females.^[8] The disease is less prevalent in cats, where the incidence is estimated at about 2% of intact queens by 13 years of age, with an annual rate of roughly 17 cases per 10,000 cat-years at risk.^[9]^[10] Cases of pyometra predominantly occur in middle-aged to older animals, with the majority of affected dogs diagnosed between 5 and 10 years of age, peaking around 7-9 years; it is rare in dogs under 1 year old.^[2] In cats, the median age at diagnosis is younger, typically around 4 years, though the condition can affect queens of any age post-puberty.^[10] Breed predispositions in dogs include higher risks for Rottweilers, Bernese Mountain Dogs, Golden Retrievers, Cavalier King Charles Spaniels, and rough-coated Collies, potentially due to genetic factors influencing uterine susceptibility.^[11]^[12] There is no pronounced geographic variation in incidence, but prevalence is closely tied to local spaying practices, with higher rates observed in areas where routine ovariohysterectomy is less common.^[13] While canine and feline pyometra are the most studied, the condition also occurs in other species, such as postpartum cows where it affects 2-5% of cases involving uterine infections, and in ferrets, often linked to prolonged estrogen exposure in intact females.^[14]^[15] Overall trends show a decreasing incidence in populations with increasing spay/neuter rates, such as in the United States and Western Europe, though veterinary data through 2023 indicate stable patterns among unspayed animals in low-intervention regions.^[13]^[8]

Pathogenesis

Hormonal Influences

Pyometra development is strongly influenced by reproductive hormones, particularly progesterone, which plays a central role in predisposing the uterus to infection. In dogs, progesterone is secreted by the corpus luteum during the diestrus phase, the post-ovulation period lasting approximately 2-3 months, where it induces endometrial glandular hyperplasia known as cystic endometrial hyperplasia (CEH). This hormonal action leads to thickening of the uterine lining through proliferation and secretory activity of endometrial glands, creating a nutrient-rich environment that supports bacterial growth while simultaneously suppressing local immune responses, such as reducing leukocyte activity and myometrial contractions.^[16]^[17]^[2] Estrogen contributes to this process by priming the uterus during the initial estrus (heat) phase, increasing vascular permeability, endometrial blood flow, and the expression of progesterone receptors, thereby enhancing the subsequent effects of progesterone in diestrus. Pyometra typically manifests 4-8 weeks after the end of estrus, coinciding with peak progesterone levels and potential cervical closure, which traps secretions and prevents natural uterine clearance.^[16]^[17]^[18] Exogenous administration of progesterone-based hormones significantly elevates the risk of pyometra by mimicking or extending the diestrus phase; for instance, progestin injections such as medroxyprogesterone acetate, commonly used as "mis-mating shots" to prevent unwanted pregnancies, promote prolonged endometrial hyperplasia and immune suppression. In cats, which are induced ovulators without spontaneous luteal phases unless mating occurs, the hormonal influences are similar but less predictable due to irregular estrus cycles and lower baseline progesterone exposure, though elevated progesterone levels have been observed in affected queens, and exogenous progestins also increase susceptibility. Recent studies have identified molecular factors, including altered gene expression in immune pathways, contributing to feline pyometra pathogenesis.^[2]^[17]^[19]^[20]

Bacterial Infection

The primary bacterial pathogen in pyometra is Escherichia coli (E. coli), which accounts for 28–90% of cases and typically originates from the normal vaginal flora or gastrointestinal microbiota, ascending into the uterus during the progesterone-influenced diestrus phase.^[2] Opportunistic pathogens, including Staphylococcus spp. (2–42%), Streptococcus spp. (4–25%), Klebsiella pneumoniae (2–33%), and various anaerobes, are isolated in the remaining 10–72% of infections, often as secondary invaders.^[2] This microbial ascent exploits the hormonally altered endometrial environment, where progesterone suppresses local immune responses, allowing initial colonization to establish.^[2] In the pathophysiology of infection, bacteria proliferate rapidly within the thickened, cystic endometrium, forming an abscess and accumulating purulent exudate that distends the uterus and risks rupture if unchecked.^[2] Gram-negative bacteria like E. coli release endotoxins during replication, which damage endometrial tissue and trigger an inflammatory cascade leading to systemic illness.^[21] The infection's progression varies with cervical patency: in open-cervix pyometra, pus drains externally, mitigating some pressure buildup, whereas in closed-cervix cases, retained exudate elevates intrauterine pressure, intensifying toxemia and sepsis risk due to unvented bacterial products.^[22] Systemically, bacterial endotoxins and other toxins translocate into the bloodstream, inducing septicemia and endotoxemia that manifest as widespread inflammation and multi-organ dysfunction, particularly stressing the kidneys and liver through hemodynamic instability and toxin-mediated injury.^[21] Virulence factors enhance E. coli's pathogenicity; for instance, the fimH gene encodes type 1 fimbriae that promote adhesion to endometrial epithelial cells, facilitating persistent colonization.^[23] Additionally, biofilm formation by these strains contributes to chronicity in recurrent or untreated cases, shielding bacteria from host defenses and antimicrobial clearance.^[24]

Clinical Presentation

Signs and Symptoms

Pyometra manifests through a range of systemic and local clinical signs in affected animals, primarily unspayed female dogs and cats, often appearing 2–8 weeks following estrus and progressing over several days.^[18] Systemic signs include lethargy, depression, anorexia, vomiting, increased thirst (polydipsia), and excessive urination (polyuria), which result from bacterial endotoxins affecting kidney function; additional features may involve fever or hypothermia, abdominal pain or distension, and rapid weight loss, with severe cases progressing to shock due to systemic inflammatory response.^[18]^[1]^[25] Local signs are more evident in open-cervix pyometra, which accounts for the majority of cases, and include purulent, bloody, or mucoid vaginal discharge that owners may notice on bedding or fur; in contrast, closed-cervix cases lack discharge but present with a painful, enlarged abdomen mimicking an acute abdominal crisis.^[26]^[18]^[2] Species variations influence presentation: dogs typically exhibit more pronounced vaginal discharge and systemic illness, while cats often display subtler signs such as hiding, reduced appetite, and lethargy without obvious discharge.^[25]^[27] Owners frequently report initial observations resembling false pregnancy behaviors, such as nesting or mammary enlargement, which can mask early pyometra until more severe symptoms emerge.^[28]^[29]

Classification

Pyometra is primarily classified into open-cervix and closed-cervix subtypes based on cervical patency, which influences clinical presentation and severity. Open-cervix pyometra occurs when the cervix is dilated, permitting drainage of purulent uterine contents, often manifesting as visible vaginal discharge. This subtype accounts for approximately 65% of cases in dogs and is generally less acute, allowing for potential chronic persistence or recurrence without immediate systemic compromise.^[22] In contrast, closed-cervix pyometra involves a progesterone-mediated cervical closure that traps exudate within the uterus, resulting in rapid distension and heightened risk of complications. Representing about 35% of cases, this form is linked to more severe illness, including higher rates of sepsis (77% versus 51% in open cases), leukocytosis, and overall depression in general condition.^[22] It carries a greater mortality risk due to potential uterine rupture and peritonitis if not addressed urgently.^[2] Stump pyometra represents a rare variant, developing in the residual uterine tissue (stump) following incomplete ovariohysterectomy, typically in conjunction with ovarian remnant syndrome that sustains hormonal stimulation. This condition affects a small subset of spayed females, often presenting similarly to standard pyometra but requiring identification of surgical remnants for diagnosis.^[1]^[30] Further subclassification considers complications and progression, distinguishing septic from non-septic pyometra based on systemic inflammatory response syndrome (SIRS) criteria, with septic cases exhibiting widespread bacterial toxemia. Staging differentiates early-stage (pre-rupture, characterized by uterine distension) from late-stage (post-rupture, involving peritoneal contamination and acute peritonitis). Prognostically, closed-cervix and septic forms necessitate immediate intervention to mitigate life-threatening escalation, whereas open-cervix cases may permit slightly delayed management without equivalent urgency.^[31]^[2]

Diagnosis

Diagnostic Approaches

Diagnosis of pyometra typically begins with a detailed history and physical examination to identify risk factors and clinical clues. The history should confirm the patient's intact reproductive status, recent estrus (often 1-3 months prior), and vaccination history to assess overall health and potential comorbidities. Owners frequently report polydipsia, polyuria, lethargy, anorexia, or vaginal discharge in open-cervix cases, which prompts suspicion in unspayed females. On physical examination, gentle abdominal palpation may detect uterine enlargement, while a vaginal exam can reveal purulent or mucopurulent discharge; systemic signs such as fever, tachycardia, or dehydration are also evaluated.^[32]^[18]^[2] Laboratory tests provide supportive evidence of infection and systemic effects. A complete blood count commonly demonstrates leukocytosis with neutrophilia and a left shift, reflecting the inflammatory response, along with possible mild anemia or neutropenia in severe cases. Serum biochemistry often shows elevated globulins, azotemia from dehydration or renal compromise, and increased alkaline phosphatase or alanine aminotransferase due to hepatic involvement. Urinalysis may indicate pyuria, bacteriuria, proteinuria, or isosthenuria secondary to polydipsia and polyuria.^[16]^[32]^[18] Imaging is crucial for definitive visualization of uterine abnormalities. Ultrasonography serves as the gold standard, revealing a distended, fluid-filled uterus with thickened, hyperechoic walls and luminal hypoechoic or anechoic fluid, while ruling out pregnancy or other masses. Abdominal radiography can identify a tubular, fluid- or gas-opacified uterine silhouette, cranial displacement of intestinal loops, or free abdominal fluid, particularly in closed-cervix pyometra where enlargement is more pronounced.^[1]^[16]^[32] Advanced tests are selectively used to further characterize the infection. Bacterial culture from vaginal discharge (via guarded swab) or uterine aspirate identifies common pathogens such as Escherichia coli and provides antibiotic sensitivity for targeted therapy, though cultures from discharge may reflect vaginal flora rather than uterine isolates. Serum progesterone measurement confirms elevated diestrus levels, reinforcing the hormonal predisposition. Emerging biomarkers, such as KC-like chemokine in dogs and Testican-1 in cats, show promise for detecting sepsis associated with pyometra (as of 2025).^[33]^[2]^[34]^[35]^[36] Severity staging employs tools like the Acute Patient Physiologic and Laboratory Evaluation (APPLE) score, which integrates variables such as mentation, lactate, platelet count, albumin, and creatinine to stratify illness in hospitalized dogs and predict prognosis.

Differential Diagnosis

The differential diagnosis for pyometra encompasses a range of conditions that present with similar clinical features, such as abdominal distension, vaginal discharge, lethargy, and systemic signs like polyuria and polydipsia, particularly in intact female dogs and cats. Accurate differentiation is essential, as pyometra requires urgent intervention to prevent life-threatening complications like sepsis or uterine rupture. Common mimics include reproductive and non-reproductive disorders, with diagnosis relying on a combination of history, physical examination, laboratory tests, and imaging.^[37]^[38] Reproductive mimics primarily involve uterine or ovarian abnormalities that can cause distension or discharge. Pregnancy, including pseudopregnancy, is a key differential, often presenting with abdominal enlargement 4-6 weeks post-estrus; ultrasound can rule it out by identifying or excluding fetuses as early as 20-24 days post-ovulation. Metritis, a postpartum uterine infection, features purulent discharge and fever shortly after whelping, distinguished by recent parturition history and cytology showing acute inflammation. Abortion may mimic closed-cervix pyometra with abdominal pain and discharge, but is differentiated by evidence of fetal expulsion and serial ultrasonography. Ovarian cysts can lead to hormonal imbalances causing similar systemic signs, identified via ultrasound revealing cystic structures and hormone assays. Other uterine conditions like mucometra (sterile mucoid accumulation), hydrometra (watery fluid), or hematometra (bloody fluid) lack bacterial infection and are confirmed by imaging showing fluid-filled uterus without inflammatory markers on cytology. Uterine neoplasia, such as leiomyomas or adenocarcinomas, presents with irregular masses and chronic discharge, differentiated by histopathology or advanced imaging like contrast-enhanced ultrasound.^[37]^[38]^[39] Non-reproductive mimics often overlap with pyometra's systemic effects. Urinary tract infections (e.g., cystitis) cause polyuria, polydipsia, and dysuria, but lack vaginal discharge and are confirmed by urinalysis showing bacteriuria without pyuria from uterine origin. Acute abdomen conditions like peritonitis (from ruptured uterus or other causes) or splenic torsion present with severe pain and distension; free abdominal fluid on ultrasound and cytology aid differentiation from intact uterine involvement. Diabetes mellitus induces polydipsia and lethargy via hyperglycemia, ruled out by blood glucose testing and absence of uterine changes on imaging.^[37]^[38] Species-specific considerations refine the differential list. In cats, pyelonephritis may mimic systemic illness with polyuria and fever, differentiated by urine culture and renal ultrasound showing pelvic dilation; hyperthyroidism can cause polydipsia and weight loss, confirmed by elevated T4 levels without reproductive signs. In dogs, brucellosis or leptospirosis present with fever, lethargy, and reproductive issues, identified via serology or PCR testing for bacterial antigens, alongside negative uterine cytology. Ovarian remnant syndrome, post-spay stump pyometra, is a unique mimic in both species, suggested by history of incomplete ovariohysterectomy and confirmed by hormone levels or exploratory surgery.^[38]^[26]^[37] Key differentiators include the presence of purulent vaginal discharge in open-cervix pyometra, absent in closed-cervix cases or mimics like pregnancy; ultrasound is pivotal, revealing hypoechoic fluid in distended uterine horns with thickened walls, versus fetal structures or cysts in alternatives. Bloodwork distinguishes infection (leukocytosis, elevated CRP) from endocrine issues (e.g., normal white cell count in diabetes but hyperglycemia). Lack of discharge in closed pyometra shifts focus to abdominal imaging to exclude peritonitis or torsion. A diagnostic algorithm begins with thorough history (e.g., recent estrus, breeding) and physical exam for abdominal palpation and discharge assessment, followed by complete blood count, serum biochemistry, and urinalysis; if inconclusive, proceed to abdominal radiography (for uterine silhouette) and ultrasonography to exclude mimics, with cytology or culture for confirmation.^[39]^[37]^[38]

Management

Surgical Treatment

The standard surgical treatment for pyometra in non-breeding female dogs is ovariohysterectomy (OHE), which involves the complete removal of the ovaries and uterus through a midline celiotomy incision. This procedure is curative, eliminating the source of infection and preventing recurrence, with reported survival rates exceeding 95% in uncomplicated cases when performed promptly after diagnosis. Intraoperative management is critical, particularly in septic or dehydrated patients, and includes intravenous fluid therapy to stabilize hemodynamics and broad-spectrum antibiotics to address bacterial dissemination.^[16]^[8]^[40] Surgery is considered an emergency in cases of closed-cervix pyometra or systemic sepsis, where delays can lead to peritonitis or organ failure, whereas open-cervix cases may allow brief stabilization if the patient is hemodynamically stable. Potential complications include uterine rupture during manipulation, resulting in intra-abdominal spillage of purulent material and heightened risk of peritonitis; anesthesia-related risks in volume-depleted animals; and postoperative issues such as wound infections or suture reactions. The overall perioperative mortality rate remains low at around 1-5%, influenced by the severity of preoperative illness.^[40]^[8] Postoperative care emphasizes supportive measures, including continued intravenous fluids, analgesic administration for pain control, and antibiotic therapy for 10-14 days to resolve any residual infection. Close monitoring for signs of sepsis resolution, such as normalized vital signs and appetite return, is essential, with most patients discharged within 2-3 days if stable. Histopathological examination of the excised uterus is routinely performed to confirm the diagnosis and rule out concurrent neoplasia. For valuable breeding animals, ovary-sparing subtotal hysterectomy may be considered rarely to preserve fertility, though it is not recommended due to the potential risk of stump pyometra recurrence if the procedure is incomplete.^[16]^[40]^[41]

Medical Treatment

Medical treatment of pyometra is reserved primarily for valuable breeding bitches where preservation of fertility is desired, as it offers a non-surgical alternative to ovariohysterectomy but carries risks of recurrence and complications.^[42] The standard protocol involves the administration of prostaglandin F2α, such as dinoprost tromethamine, to induce luteolysis, regress the corpora lutea, and promote cervical relaxation, thereby facilitating uterine contraction and expulsion of purulent material.^[43] This is combined with broad-spectrum antibiotics, selected based on uterine culture and sensitivity results, such as amoxicillin-clavulanate or enrofloxacin, to address the underlying bacterial infection, typically Escherichia coli.^[2] Supportive care is essential, including intravenous fluid therapy to correct dehydration and electrolyte imbalances, as well as antiemetics to manage nausea and vomiting associated with the disease or treatment.^[44] The prostaglandin regimen typically employs escalating doses of dinoprost (starting at 0.025 mg/kg subcutaneously and increasing to 0.25 mg/kg) administered once or twice daily over 5 to 7 days, or until uterine involution is confirmed via ultrasonography, to ensure effective contraction of the uterus and expulsion of pus while minimizing side effects.^[16] Close monitoring is required for adverse effects, which may include transient salivation, abdominal pain, defecation, tachycardia, and, in pregnant animals, abortion due to luteolytic action.^[42] Antibiotic therapy is continued for 10 to 14 days or longer based on clinical response and culture results, with hospitalization often necessary for the initial phase to stabilize the patient.^[2] Success rates for medical treatment vary by pyometra type, achieving 75% to 90% resolution in open-cervix cases where drainage is possible, but only 25% to 40% in closed-cervix cases due to limited expulsion of exudate.^[45] However, recurrence rates are high, ranging from 50% to 75% within one to two subsequent estrous cycles, often necessitating eventual ovariohysterectomy to prevent repeated episodes.^[45] Medical treatment is contraindicated in bitches with closed-cervix pyometra accompanied by systemic signs of sepsis, such as fever, hypothermia, leukopenia, or evidence of peritonitis, as well as in those with low breeding value where surgical intervention is safer and more definitive.^[2]^[46] It is not considered first-line therapy due to these risks and the potential for incomplete resolution.^[42] Adjunctive measures may include uterine lavage with sterile saline if the cervix is open and accessible, to aid in removing residual pus and bacteria.^[47] Recent advances, particularly in Europe up to 2023, incorporate aglepristone, an antiprogestin administered at 10 mg/kg subcutaneously on days 1, 2, 7, and sometimes 14, either alone or combined with low-dose prostaglandins like cloprostenol (1-5 µg/kg), demonstrating improved efficacy with success rates exceeding 80% across open and closed cases by blocking progesterone receptors and enhancing cervical dilation without severe prostaglandin side effects.^[48] Alternative options include cabergoline, a dopamine agonist that suppresses prolactin and reduces progesterone levels, preferred in some protocols for its fewer adverse effects.^[16]

Outcomes and Prevention

Prognosis

The prognosis for pyometra is generally favorable with prompt intervention, particularly surgical ovariohysterectomy (OVH), which yields survival rates of 90-100% in uncomplicated cases without uterine rupture or sepsis. In dogs, survival to hospital discharge following OVH is reported at 97%, while in cats, rates range from 97% to 100%. However, outcomes decline in closed-cervix pyometra or septic presentations, where mortality can reach 8-20%, with one retrospective study noting an overall mortality of 12.2% across cases.^[8]^[9]^[49]^[50]^[48]^[39] Several factors influence prognosis, including early diagnosis, which significantly improves survival by preventing progression to sepsis or endotoxemia; absence of systemic instability, such as in younger animals without comorbidities, correlates with lower complication rates. Advanced age increases mortality and postoperative issues, with older dogs experiencing higher rates of complications. Breed size may indirectly affect outcomes, as larger dogs face elevated pyometra risk and potentially more severe presentations, though specific prognostic data vary. In cases with sepsis or uterine rupture, peritonitis and renal failure from endotoxins can lead to 20% mortality, underscoring the need for rapid assessment.^[51]^[2]^[1]^[52] Outcomes are comparable between dogs and cats, though dogs often present earlier, potentially yielding slightly better overall survival; recent 2020s studies highlight improved prognosis through rapid ultrasound diagnostics, enhancing early detection in both species. Medical treatment in cats shows high short-term resolution (up to 95%) but carries risks of infertility and recurrence. Post-treatment follow-up involves routine veterinary checks to monitor for complications or recurrence, with spaying recommended to eliminate future risk in surviving animals.^[9]^[53]^[54]^[55]

Prevention

The primary method of preventing pyometra in female dogs is elective ovariohysterectomy (spaying), which removes the uterus and ovaries and thereby eliminates the risk entirely while also substantially reducing the incidence of mammary tumors.^[16]^[26] Spaying before the first estrus cycle is recommended to maximize protection against both pyometra and mammary cancer, as the risk of pyometra increases with the number of estrous cycles and age in intact females.^[56] For pyometra avoidance specifically, earlier spaying is prioritized over waiting for cancer-related benefits, though guidelines suggest performing the procedure after the first heat in some cases to balance reproductive maturity; breed-specific recommendations advise delaying spaying in large breeds until skeletal growth is complete, typically beyond 2 years of age, to avoid orthopedic risks.^[57]^[3] For breeders intending to use intact females, alternatives to spaying include strict monitoring of estrus cycles to identify early signs of uterine issues, avoidance of mis-mating injections (such as progestins, which can exacerbate cystic endometrial hyperplasia or CEH), and annual reproductive examinations incorporating vaginal cytology, progesterone assays, and ultrasound to detect CEH before it progresses to pyometra.^[16]^[58] Breeding the female at the next estrus after any uterine treatment is advised to clear potential residues, though recurrence remains a concern without eventual spaying.^[16] Public health initiatives emphasize educating owners on the benefits of spaying, including pyometra prevention, to promote widespread adoption and reduce the overall incidence in the canine population.^[26] While no direct vaccine exists for pyometra, routine vaccinations against bacterial infections and general hygiene practices support overall reproductive health, though their indirect role is limited. Emerging research highlights genetic screening for susceptible breeds, such as Golden Retrievers, where variants in the ABCC4 gene on chromosome 22 have been associated with increased pyometra risk, potentially allowing for selective breeding to mitigate susceptibility.^[12] As of 2025, no preventive vaccines are available, but ongoing studies explore hormonal modulators like antiprogestins to inhibit progesterone-driven endometrial changes without suppressing fertility, though these remain experimental for prevention.^[59]

References

[1]
Pyometra - American College of Veterinary Surgeons
Pyometra is a uterine infection in dogs and cats, often filled with pus, triggered by bacteria during hormonal cycles, and can be life-threatening.
[2]
Canine Pyometra: A Short Review of Current Advances - PMC - NIH
Pyometra is a common reproductive disease in dogs that often begins with mild symptoms, but if not promptly treated, it can turn into a threat to life.
[3]
Pyometra | Cornell University College of Veterinary Medicine
Pyometra is a serious, potentially life-threatening uterine infection in unspayed, middle-aged to older female dogs, caused by bacteria and hormonal changes.
[4]
Promoting access to care in pyometra treatment - AVMA Journals
Pyometra, a hormonally driven infection of the uterus caused by opportunistic bacteria, presents a significant health risk to intact female dogs and cats. In ...
[5]
[PDF] Canine Pyometra - College of Veterinary Medicine
Nov 4, 2016 · Pyometra is defined as an accumulation of purulent material within the uterus and is a potentially life-threatening condition.4 It is a ...
[6]
Breed Variations in the Incidence of Pyometra and Mammary ...
Dec 24, 2012 · In all breeds, the overall proportion of the bitches that developed disease by 10 years of age was for pyometra 19%, MTs 13%, and either or both ...Contents · Introduction · Materials and Methods · ResultsMissing: unspayed female
[7]
A breed-matched case-control study of potential risk-factors for ...
Apr 15, 2011 · The objective was to evaluate plausible risk-factors for pyometra, a common disease affecting almost 25% of all (unspayed) female dogs before 10 years of age.Missing: prevalence | Show results with:prevalence
[8]
Findings and prognostic indicators of outcomes for bitches with ...
May 21, 2022 · Identifying clinical signs that are associated with postoperative morbidity and death in bitches with pyometra would help veterinarians ...<|control11|><|separator|>
[9]
Findings and prognostic indicators of outcomes for queens with ...
May 21, 2022 · Our findings indicated that OHE for pyometra in queens was highly successful even when performed in a nonspecialty hospital with high-quality basic supportive ...
[10]
Incidence of pyometra in Swedish insured cats - PubMed
Jul 1, 2014 · The mean incidence rate (IR) for pyometra was about 17 cats per 10,000 cat years at risk (CYAR). Cats with pyometra were diagnosed at a median ...
[11]
Canine Pyometra: New Approaches to an Old Disease - VIN
In a colony of Beagles, 15.2% of the bitches more than 4 years of age were affected, whereas the mean age was 9.4 + 0.4 years at the time of clinical signs(2).
[12]
The ABCC4 gene is associated with pyometra in golden retriever dogs
Aug 17, 2021 · On average one in five female dogs are diagnosed with the disease before 10 years of age. The proportion of affected bitches diagnosed varies ...
[13]
Behavioural risks in female dogs with minimal lifetime exposure to ...
Dec 5, 2019 · In contexts where spaying is common, a reduction in the rate of spaying is associated with increased rates of pyometra. For example, in a ...
[14]
Pyometra in Production Animals - Reproductive System
Pyometra is characterized by the accumulation of purulent or mucopurulent exudate in the uterus. In cows, it is invariably accompanied by the persistence of ...Missing: ferrets | Show results with:ferrets
[15]
Uterine Infection and Pus in Ferrets - PetMD
Jun 21, 2010 · Pyometra is a life-threatening uterine infection that develops when bacterial invasion of the endometrium (wall of the uterus) leads to an accumulation of pus.Missing: cows | Show results with:cows
[16]
Cystic Endometrial Hyperplasia–Pyometra Complex in Small Animals
Cystic endometrial hyperplasia (CEH) is a progressive pathological change of the uterine lining. CEH is associated with poor fertility.
[17]
The Role of Progesterone in the Development of Pyometra in Dogs ...
In dogs and cats, progesterone initiates endometrial hyperplasia by increasing the number and secretory function of the endometrial glands.
[18]
Pyometra in Dogs | VCA Animal Hospitals
Pyometra is a serious and life-threatening infection in the uterus. The condition must be treated quickly and aggressively.
[19]
Pyometra in the queen - Fiona Hollinshead, Natali Krekeler, 2016
Jan 5, 2016 · Pyometra is a commonly occurring uterine disease in cats that often leads to loss of breeding potential and, in some cases, can be life threatening.
[20]
Pyometra in Bitches Induces Elevated Plasma Endotoxin and ... - NIH
The results confirm significantly increased plasma levels of endotoxin in bitches with pyometra and support previous reports of endotoxin involvement.Endotoxin Sampling And... · Results · Plasma Endotoxin, Blood...
[21]
Closed cervix is associated with more severe illness in dogs with ...
Jan 5, 2017 · In closed cervix pyometra, pus and bacterial products accumulate in the uterus, which is thought to induce a more severe illness. The aim of ...
[22]
Uropathogenic virulence factor FimH facilitates binding of ...
The objective of this study was to investigate whether FimH facilitates the binding of E. coli to canine endometrial epithelium. The E. coli strain P4, isolated ...
[23]
Canine Pyometra: A Short Review of Current Advances - MDPI
Collectively, these studies strongly suggest that certain E. coli strains, possessing specific virulence traits, may be more likely to cause canine pyometra by ...<|separator|>
[24]
Pyometra in Small Animals - PubMed
Pyometra is a common disease in dogs and cats. Hormones and opportunistic bacteria are fundamental in the development, with progesterone playing a key role.
[25]
Pyometra in Dogs and Cats
### Conditions Mimicking Pyometra in Dogs and Cats, Differentiators, and Diagnostic Steps
[26]
Pyometra in Cats: What Is It and How Do Vets Treat It? - PetMD
Feb 25, 2025 · Pyometra in cats is a bacterial infection that occurs when a feline has a pus-filled uterus. This condition is a medical emergency.
[27]
Reproductive Disorders of Female Dogs - Merck Veterinary Manual
Pyometra. Pyometra is a bacterial infection of the uterus due to hormonal changes in unspayed dogs. It is reported primarily in dogs more than 5 years old ...<|control11|><|separator|>
[28]
Conditions That Can Be Mistaken for Pyometra in Dogs - PetsCare
What can be mistaken for pyometra? Conditions like phantom pregnancy, urinary tract infections, and metritis can closely mimic the symptoms of pyometra in dogs.<|separator|>
[29]
Ovarian remnant syndrome and uterine stump pyometra in ... - NIH
This study reveals that ORS and stump pyometra can result in severe disease and can be fatal. Introduction Spaying is performed to avoid over-population of ...
[30]
KC-like chemokine as a biomarker of sepsis in dogs with pyometra
Sep 13, 2024 · Dogs with pyometra were classified as having sepsis based on two different criteria for systemic inflammatory response syndrome (SIRS), ...Missing: late | Show results with:late
[31]
Canine pyometra: Early recognition and diagnosis | dvm360
### Summary of Canine Pyometra Diagnosis
[32]
Medical Management of Pyometra in Dogs: Treatment & Best Practices
Pyometra results from the translocation of vaginal bacteria through the cervix into a progesterone-primed uterus, and it often leads to systemic inflammation ...
[33]
Bacteria associated with canine pyometra and concurrent bacteriuria
32 distinct bacterial species were found in pyometra and concurrent bacteriuria. Mixed growth was detected in 15% of culture positive uterine specimens.
[34]
None
### Differential Diagnosis List for Pyometra
[35]
Clinical Signs Approach to Differential Diagnosis - PMC
Clinical Signs Approach to Differential Diagnosis · Abdominal Distension · Abdominal Effusions and Ascites · Abdominal Pain, Acute · Aggressive Behavior · Alopecia.
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[PDF] A review of pyometra in small animal medicine
Pyometra is a common reproductive disorder involving an acute or chronic bacterial infection of the uterus, with accumulation of purulent exudate in the lumen.
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Postoperative complications and antibiotic use in dogs with pyometra
Mar 6, 2023 · Multiple complications associated with pyometra have been reported, including peritonitis and cervical stump abscessation, wound infection, ...
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Canine laparoscopic-assisted ovary-sparing hysterectomy does not ...
Apr 28, 2023 · Laparoscopic-assisted ovary-sparing spay appears to provide a safe and reliable method of sterilization, with no observable increased risk of pyometra with ...<|control11|><|separator|>
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Surgical and medical treatment of pyometra - DVM360
May 1, 2012 · Pyometra is a serious and potentially life-threatening disease of the canine uterus. Patients presenting with pyometra should be stabilized, and ...Initial Treatment · Surgical Management · Medical Management
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Prostaglandin F2 alpha treatment of canine pyometra - PubMed
Immediate and long-term outcomes of prostaglandin F2 alpha treatment for canine pyometra were studied in 10 bitches. Examination of pretreatment uterine ...
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Medical Management of Pyometra - WSAVA 2019 Congress - VIN
Ovariohysterectomy is generally offered as a primary recommendation for pyometra management. Ovariohysterectomy is considered curative.2 For medical treatment, ...
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Pyometra: Causes, Diagnosis and Treatment | Sanford Vet Blog
For open pyometra, it has a success rate of 75-90%, but for closed pyometra, the success rate is between 25-40%. Also, there is a high chance of reoccurrence ...
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Medical Treatment for Pyometra in Dogs - Wiley Online Library
Indications for Medical Treatment surgery. Medical treatment is contraindicated for pyretic or hypothermic bitches with suspected peritonitis. The efficacy of ...
[44]
Canine Pyometra: Pathogenesis, Therapy and Clinical Cases - VIN
Canine pyometra is a diestrual disease typical of adult intact bitches whose development is strongly influenced by sequential progestational stimulations.
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Effectiveness of a Modified Administration Protocol for the Medical ...
Sep 22, 2022 · Aglepristone is a progesterone receptor blocker and its use proved to be effective for the medical treatment of pyometra in bitches and queens.
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A retrospective study of bitches with pyometra, medically treated with ...
Pyometra is a common and life-threatening disease of intact bitches caused by hormonal influence of the uterus in combination with bacterial infection.Missing: literature | Show results with:literature
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[PDF] Pyometra | MSPCA-Angell
Pyometra is the most prevalent reproductive disease in both dogs and cats. It is estimated that up to one in four intact female dogs are affected by ...
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A Retrospective Study of Pyometra in Canines - ResearchGate
Aug 10, 2025 · Ovariohysterectomy is the treatment of choice in most caseloads (86.6%). The overall incidence of mortality due to pyometra was 12.2 percent.
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Owner-reported long-term outcomes, quality of life, and longevity ...
May 21, 2022 · ... intact female cats (queens) by the age of 13. Pyometra can be life-threatening and lead to severe complications such as sepsis and peritonitis.
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Pyometras: Infection of Dog's Uterus - Veterinary Medicine at Illinois
Aug 15, 2017 · Pyometra is a uterine infection in dogs, a veterinary emergency, caused by hormonal changes and can be open or closed. It does not occur in ...Missing: definition | Show results with:definition
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Do cats get pyometra and what are the symptoms? - Vet Help Direct
May 18, 2021 · However, the prognosis for survival is good with early treatment (92% survival rate for cats with pyometra). The prognosis is poorer if the ...Isn't pyometra a dog thing? · Is my cat at risk of pyometra? · How is feline pyometra...
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Understanding Pyometra: Part II. Diagnosis, Treatment and Prognosis
Mar 8, 2019 · In queens with pyometra, sepsis is a complication present in approximately 86% of cases, while sepsis is identified in only 60% of affected ...
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Follow-up examinations after medical treatment of pyometra in cats ...
In our study, 9/10 cats completely recovered by day 21 after the start of the treatment (healing rate of 90%). No recurrence was observed in a follow-up period ...<|separator|>
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Current perspectives on the optimal age to spay/castrate dogs and ...
It is believed that if a female dog is spayed after the second estrus cycle or after reaching 2.5 years of age, the relative risk of developing mammary ...
[55]
Assisting Decision-Making on Age of Neutering for 35 Breeds of Dogs
Jul 6, 2020 · Neutering at <6 mo. raised the incidence to 15 percent for males and to 18 percent for females, which did not reach significance for either. The ...Missing: trends | Show results with:trends
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Pyometra: Preventing & Addressing A Common Issue In Breeding ...
“Over a bitch's lifetime, the cumulative effect of the cyclic exposure to these hormones predisposes her to develop pyometra. From there, bacteria seize the ...<|control11|><|separator|>