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Prevalence of cervicitis in dairy cows and its effect on reproduction

Article  in  Theriogenology · September 2015

DOI: 10.1016/j.theriogenology.2015.09.029

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 Theriogenology xxx (2015) 1–7

Contents lists available at ScienceDirect

Theriogenology
journal homepage: www.theriojournal.com

Prevalence of cervicitis in dairy cows and its effect on

reproduction
D. Hartmann a, *, J. Rohkohl b, S. Merbach c, T. Heilkenbrinker b,
H.P. Klindworth b, H.A. Schoon c, M. Hoedemaker a
a
Clinic for Cattle, University of Veterinary Medicine, Hannover, Germany
b
Animal Health Department, Chamber of Agriculture Lower Saxony, Oldenburg, Germany
c
Faculty of Veterinary Medicine, Institute of Veterinary Pathology, University of Leipzig, Germany

a r t i c l e i n f o a b s t r a c t

Article history: The objective of this study was to determine whether cervicitis in dairy cows is an inde-
Received 16 February 2015 pendent disease or occurs concomitantly with inflammation of the uterus, and to clarify
Received in revised form 9 September 2015 possible effects of cervicitis on reproductive performance. Dairy cows (n ¼ 416) from 33
Accepted 14 September 2015
dairy farms were examined by rectal palpation and vaginoscopy between 42 and 50 days
postpartum. Inclusion criteria for this study were absence of abnormal vaginal discharge
Keywords:
and abnormalities of the uterus (fluctuation) at rectal palpation. Cervicitis was diagnosed
Cervix uterus
when the second cervical fold was swollen and prolapsed with (C2) or without (C1)
Endometritis
Cattle reddening. Cytobrush samples from the uterus (n ¼ 370) and the cervix (n ¼ 402) were
collected, and the percentage of neutrophils in the uterus (PMNU) and the cervix as in-
dicators of inflammation (threshold: 5%) was determined. In addition, endometrial bi-
opsies for histology were collected, 300 of which were suitable for evaluation. Cervicitis
(C1/C2) was diagnosed in 253 of 416 (60.8%) of cows. Of these, the prolapsed cervical
mucosa was hyperemic (C2) in 29.1% of cases. Of 370 available uterine cytology samples,
221 cows had a clinical cervicitis; however, 170 (76.9%) had PMNU less than 5%. Of 300
uterine histologic examinations, 82 (27.3%) did not reveal any abnormalities; the
remaining cows either had uterine inflammation and/or degenerative uterine changes
such as endometriosis and angiosclerosis. Furthermore, of 300 biopsied animals, 184
revealed a cervicitis (C1/C2); however, 30.4% of these animals had no histopathologic
uterine findings. For further analysis, only animals either without histopathologic findings
and normal uterine cytology or with solely endometritis (defined as PMNU  5% and/or
positive histopathology of the uterine tissue) were evaluated (n ¼ 157). Of these, 95 cows
had cervicitis. Unexpectedly, 63 of 95 (66.3%) cows had cervicitis without endometritis.
With regard to reproductive performance, days to first service were not affected by
cervicitis. Number of days open in animals with cervicitis but without endometritis tended
to be lower than in cows with cervicitis plus endometritis (P ¼ 0.092). Also, number of
days open relative to percentage of neutrophils greater than 5% was lower when the
cervical compared to the uterine mucosa was affected (P < 0.05). Total conception and
pregnancy rates of animals 200 days into lactation decreased significantly in cows with
severe cervical inflammation (C2). In conclusion, the results of this study suggested that
cervicitis occurs independent of endometritis, and a higher degree of cervicitis is associ-
ated with poorer reproductive performance.
Ó 2015 Elsevier Inc. All rights reserved.

* Corresponding author. Tel.: þ44 7721 127522; fax: þ44 1296 340017.
E-mail address: desireehartmann@hampdenvets.co.uk (D. Hartmann).

0093-691X/$ – see front matter Ó 2015 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.theriogenology.2015.09.029
2 D. Hartmann et al. / Theriogenology xxx (2015) 1–7
1. Introduction
Good fertility is a prerequisite for a high-producing
dairy cow. In recent years, the main focus has been on
diseases of the uterus and their effects on reproductive
performance. Therefore, basic research on inflammation
and/or degenerative endometrial diseases is well advanced
[1–4]. An often unnoticed structure is the cervix uteri. It is a
self-contained organ in the reproductive tract, which rep-
resents the anatomic and functional barrier between the
vagina and the uterus [5]. However, little is known about
inflammation or bacterial contamination of the cervix and
the subsequent influence on reproduction in dairy cows. In
the past 5 years, there have been three basic studies on the
histologic structure of the bovine cervix [6] and its role in
dystocia [7] and the postpartum involution process [7,8].
Studies on inflammation of the cervical canal date from the
70s, but these were carried out on slaughtered animals or
animals repeatedly treated for sterility. Only one recent
study investigated the prevalence of cervicitis and its effect
on days to conception in dairy cows [9].
Therefore, the aim of this study was to determine the
prevalence of cervicitis in Lower Saxon dairy herds and to
evaluate the relationship between inflammation of the
cervix and the endometrium. Furthermore, possible effects
on fertility were analyzed to evaluate the importance of
cervicitis in dairy cows.
2. Material and methods
2.1. Animal care and approval
Study design, examination of cows, uterine cytobrush,
and biopsy samples were approved according to guidelines
for ethical animal treatment by the local authority (LAVES
Az: 06A421).
2.2. Animals and study design
A total of 416 Holstein Friesian dairy cows from 33 dairy
farms in Lower Saxony, Germany were examined between
August 2006 and May 2007. The average herd size was 85
(19–156) animals per farm, with an average milk yield of
9416 (7493–10977) kg milk per year. The parity of cows
ranged from 1 to 10. Depending on herd size, farms were
visited for reproductive examinations every 2 to 8 weeks.
2.3. Clinical examinations
Cows were examined by rectal palpation and vagino-
scopy between 42 and 50 days postpartum. Transrectal
palpation served to assess uterine size and symmetry of the
uterine horns as well as uterine fluctuation according to
Grunert [10]: uterus retractable and horn diameter less
than 2 cm (score 1), 2 to 5 cm (score 2), or greater than 5 cm
(score 3), uterus not retractable but greater curvature
palpable (score 4), uterus not retractable and greater cur-
vature incompletely palpable (score 5), and uterus not
retractable and greater curvature poorly outlined (score 6).
After the vulva was cleaned with dry paper towels, a tube
speculum and flashlight were used for vaginoscopy. Form
and color of the Portio vaginalis cervicis were evaluated.
Vaginal discharge was categorized as clear or translucent
mucus (0), mucus with flecks of white or off-white pus (1),
exudate containing less than 50% purulent material (2),
exudate containing greater than 50% purulent material (3;
4, modified). Inclusion criteria for further examinations
were absence of abnormal vaginal discharge and abnor-
malities of the uterus (fluctuation) at rectal palpation. Cows
that did not meet these criteria were excluded from the
study. Cervicitis was diagnosed when the second cervical
fold was swollen and prolapsed with (C2) or without (C1)
reddening. Cervices without abnormality were designated
as C0 (Fig. 1). All examinations were made by the same
skilled veterinarian.
2.4. Cytology
Cytobrush samples from the endometrium (n ¼ 370)
and the cervical mucosa (n ¼ 402) were collected using a
modified swab collecting instrument (MERKT, Leisegang
GmbH, Berlin, Germany) with an attached sterile brush
(Cytobrush Plus GT, Medscand Medical, Malmö, Sweden).
Using rectal guidance, the cytobrush was directed through
the cervix, then exposed and rolled into the endometrium
or cervical mucosa, and then covered again with a protec-
tive sheath. Once outside the vagina, the cytobrush was
rotated on a paint-coated microscopic slide and fixed with
Merckofix (Merck KGaA, Darmstadt, Germany). Smears
were evaluated under a microscope at 400 and 1000
magnification. A total of 200 cells were counted and
differentiated. Subsequently, the percentage of poly-
morphonuclear neutrophils (PMN) was determined by
evaluation of endometrial and cervical cells and PMN. To
assess the repeatability of PMN estimates, slides were
counted and differentiated by two independent persons.
The correlation between the two individual persons was
high (r ¼ 0.86; P < 0.0001). Positive cytology was defined
as PMN greater than or equal to 5%, and PMN less than 5% as
negative cytology.
2.5. Endometrial biopsy
A total of 416 animals were biopsied using a Kevorkian
biopsy instrument (Hauptner, Solingen, Germany), and 300
were suitable for evaluation. A remaining 116 samples could
not be evaluated due to material artifacts and collecting dif-
ficulties. Usable specimens were immersed in a 4% neutral
phosphate-buffered formaldehyde solution for 24 hours and
then embedded in Paraplast (Vogel, Gießen, Germany) using
a tissue embedding machine (Shandon Hypercenter XP,
Frankfurt, Germany). For histology, sections that were 3 to 4
mm thick were produced and stained with hematoxylin.
Sections were evaluated [11,12] using an Olympus Light Mi-
croscope (Olympus Europa GmbH, Hamburg, Germany).
2.6. Reproductive performance
The influence of cervicitis and endometritis on repro-
duction indices was investigated. Indices included: days to
first service, days open (period between calving and
conception), first service conception rate (number of
 D. Hartmann et al. / Theriogenology xxx (2015) 1–7 3

Fig. 1. (A) Cervix without abnormality of the Portio vaginalis cervicis (C0). (B) Cervix in which the second cervical fold of the Portio vaginalis cervicis was swollen
and prolapsed without reddening (C1). (C) The second cervical fold of the Portio vaginalis cervicis was swollen and prolapsed with reddening (C2).

pregnant cows after first insemination: number of first
inseminations  100), total conception rate (number of
pregnant animals: number of total insemination  100),
and total pregnancy rate up to 200 days into lactation
(number of pregnant animals  200 days into lactation:
number of inseminated animals) [13].
Breslow–Gehan–Wilcoxon test. Differences were consid-
ered statistically significant when P values were less than
or equal to 0.05. A value of P greater than 0.05 and less than
0.10 was considered a trend toward significance.
3. Results

2.7. Statistical analysis 3.1. Transrectal palpation

Statistical analysis was carried out using SAS (SAS Inst.
Inc., version 9.1; Cary, NC, USA) and applying routine sta-
tistical procedures [14]. Correlation coefficients were
determined with Pearson’s correlation coefficient (r). Re-
sults with positive or negative correlation coefficients of
less than or equal to 0.20 were interpreted as low or no
correlation; between 0.21 and 0.50 as weak correlation;
between 0.51 and 0.80 as moderate correlation; and greater
than or equal to 0.81 as good correlation. Days to first
service and number of days open with regard to cervicitis
were compared using Kruskal–Wallis one-way ANOVA.
Frequencies of occurrence were calculated using the chi-
square test. In cases of a small number of observations,
Fisher’s exact test was used. Number of days open related to
cervical and uterine polymorphonuclear cells (PMN), as
well as cytology and histologic findings of the uterus
related to cervicitis, was plotted using Kaplan–Meier
curves, and curves were compared using the Mantel–Cox or
Uterine size ranged between scores 1 and 4. In 32 of 416
(7.7%) cows, the uterus was retractable and horn diameter
less than 2 cm (score 1), 247 of 416 (59.4%) had a uterine horn
diameter of 2 to 5 cm (score 2), and in 135 of 416 (32.4%), horn
diameter was greater than 5 cm (score 3). Two animals (0.5%)
had a uterus that was not retractable but with the greater
curvature palpable (score 4). Of 416 cows, 242 (58.2%) had a
symmetrical uterus, whereas in 166 of 416 (39.9%) cows, a
slight uterine asymmetry and in 8 of 416 (1.9%), a medium to
high asymmetry were found. No significant differences
among the cervicitis groups relating to uterine size and
symmetry of the uterine horns could be found.
3.2. Vaginoscopy
In total, 163 of 416 (39.2%) cows had a cervix without
abnormality (C0). Cervicitis without reddening (C1) was
diagnosed in 132 of 416 (31.7%), and 121 of 416 (29.1%) cows
4 D. Hartmann et al. / Theriogenology xxx (2015) 1–7

Table 1
Frequency of polymorphonuclear leukocytes greater than or equal to 5% and less than 5% with regard to cervicitis rating.

Cervicitis rating Endometrial cytology (in %, n ¼ 370) Cervical cytology (in %, n ¼ 402)

<5% 5% <5% 5%

C0 72.5 (n ¼ 108) 27.5 (n ¼ 41) 88.7 (n ¼ 141) 11.3 (n ¼ 18)
C1 80.2 (n ¼ 89) 19.8 (n ¼ 22) 86.8 (n ¼ 112) 13.2 (n ¼ 17)
C2 73.6 (n ¼ 81) 26.4 (n ¼ 29) 90.4 (n ¼ 103) 9.6 (n ¼ 11)

Abbreviations: C0, cervix without abnormality; C1, swollen and prolapsed Portio vaginalis cervicis without reddening; C2, swollen and prolapsed Portio
vaginalis cervicis with reddening.

displayed cervicitis with reddening of the second cervical
fold of the Portio vaginalis cervicis (C2). Six animals showed
reddening of the Portio vaginalis cervicis without a pro-
lapsed second cervical fold. These cases were assigned to
group C2. Vaginal urine pooling was found in 10 cows; of
these, two had a normal cervix, two were evaluated as C1,
and six as C2.
3.3. Endometrial and cervical cytology
In all, 370 endometrial and 402 cervical cytology slides
were assessed successfully (Table 1). Altogether, 92 of 370
(24.9%) cows had PMN greater than or equal to 5%, and 278
of 370 (75.1%) had PMN less than 5% in the uterus. In
comparison, 46 of 402 (11.4%) had PMN greater than or
equal to 5%, and 356 of 402 (88.6%) had PMN less than 5% in
the cervix. No significant differences among the cervicitis
groups and PMN could be found. Of 370 cows with available
uterine cytology, 221 had cervicitis; however, 170 of these
(76.9%) had percentage of neutrophils in the uterus less
than 5%.
3.4. Histology of uterine biopsy
A total of 416 uterine biopsies were collected, and 300 of
them could be evaluated. Thus, the following diagnoses
were made: either no abnormalities, endometritis, bovine
endometriosis, perivasculitis, or angiosclerosis.
Angiosclerosis is characterized by perivascular and
intimal sclerosis [15]. To date, the diagnosis of bovine
endometriosis is not established in buiatrics. It is equiva-
lent to endometrial periglandular fibrosis in cattle and re-
sembles endometriosis in the mare [16].
Although no palpable uterine or vaginal abnormalities
were detectable, histologically 72.7% of cows either had
uterine inflammation and/or degenerative uterine changes
(Table 2). However, no significant associations could be
found between the occurrence of cervicitis and histopath-
ologic abnormalities of the uterine tissue, nor between
endometritis and degenerative uterine diseases such as
endometriosis and angiosclerosis. Of 300 biopsied cows,
184 had cervicitis (C1/C2); remarkably, among these 184
animals, 56 (30.4%) had no uterine histopathologic
abnormalities.
3.5. Uterine cytology and histology in relation to cervicitis
To analyze the relationship between uterine cytology
and histology in relation to cervicitis, only animals with no
histopathologic findings and with solely histologic endo-
metritis (without other pathologic endometrium findings)
were evaluated. The number of cows where uterine
cytology was also available amounted to n ¼ 157. Of these,
95 cows had cervicitis (Table 3). Furthermore, 29 of 157
(18.5%) cows showed neither cervical (C0) nor uterine ab-
normalities and could, therefore, be designated as incon-
spicuous animals. Among cows with cervicitis (C1/C2), 63
of 95 (66.3%) had no pathologic abnormalities and negative
cytology of the uterine tissue. Therefore, these animals had
an isolated cervicitis without uterine involvement. Only 13
of 157 (8.3%) cows had both positive cytology of the uterine
tissue and histologically diagnosed endometritis.
3.6. Cervicitis and reproductive performance
For analyses of reproductive performance with regard to
degree of cervicitis, only animals with no histopathologic
and cytologic findings as well as animals with solely
endometritis (positive histology and/or cytology) were
evaluated (n ¼ 157, Table 4). Of these, 11 cows had left the
farm for an unknown reason and were not considered.
Neither days from calving to first insemination nor number

Table 2
Association between histopathologic uterine diagnosis and degree of cervicitis.

Histopathologic diagnosis Total (n ¼ 300) C0 (n ¼ 116) C1 (n ¼ 90) C2 (n ¼ 94)

n % n % n % n %
No histopathologic abnormalities 82 27.3 26 22.4 30 33.3 26 27.7
Endometritis 111 37.0 47 40.5 33 36.7 31 33.0
Bovine endometriosis 133 44.3 51 44.0 43 47.8 39 41.5
Intercaruncular angiosclerosis 50 16.7 20 17.2 16 17.8 14 15.0
Caruncular angiosclerosis 39 13.0 18 15.5 13 14.4 8 8.5
Perivasculitis 19 6.3 9 7.8 5 5.6 5 5.3

More than one diagnosis was possible within an animal.

Abbreviations: C0, cervix without abnormality; C1, swollen and prolapsed Portio vaginalis cervicis without reddening; C2, swollen and prolapsed Portio
vaginalis cervicis with reddening.
 D. Hartmann et al. / Theriogenology xxx (2015) 1–7
Table 3
Relationship between degree of cervicitis and cytologic and pathohistologic endometrial findings.
Cervicitis degree Endometrial findings (in %, n ¼ 157)
Cytology ve
Pathohistology ve
C0 (n ¼ 62) 46.8 (n ¼ 29)
C1 (n ¼ 45) 82.2 (n ¼ 37)
C2 (n ¼ 50) 52.0 (n ¼ 26)
Abbreviations: C0, cervix without abnormality; C1, swollen and prolapsed Portio vaginalis cervicis without reddening; C2, swollen and prolapsed Portio
vaginalis cervicis with reddening; cytology ve, PMN < 5%; cytology þve, PMN  5%; pathohistology ve, uterine biopsy without histopathologic findings;
pathohistology þve, endometritis (without other pathologic endometrial findings); PMN, polymorphonuclear neutrophils.
of days open differed significantly among the cervicitis
groups. However, in consideration of survival analysis,
there was a trend (P ¼ 0.092) toward a shortened interval of
days open in animals with cervicitis (C1/C2) but without
endometritis compared with cows that had cervicitis as
well as endometritis (Fig. 2). Also, with regard to poly-
morphonuclear cells, a significantly shortened interval of
days open was found in cows that had increased PMN
content in the cervical mucosa but not in the uterus (Fig. 3).
Cows with or without endometritis and a cervix rated as
C0 or C1 had a higher total conception rate than animals
with C2 (P < 0.05). No differences were found within the
cervicitis groups relative to animals with and without
endometritis. Similarly, total pregnancy rate at 200 days
into lactation was significantly lower in cows with C2 than
in animals with C0 or C1; this result was independent of
cytologic and/or histologic findings in the uterus.
4. Discussion
After clinical, cytologic, and histologic examinations, we
concluded that cervicitis in dairy cows is an independent
disease and could have negative effects on reproductive
performance.
Clinically, cervicitis was diagnosed when the second
cervical fold was swollen and prolapsed with (C2) or
without (C1) reddening of the Portio vaginalis cervicis [10].
Based on this classification, 60.8% of cows examined had a
cervicitis between 42 and 50 days postpartum. Previous
studies have estimated the prevalence of cervicitis as
ranging from 15.6% to 56.9% [9,17–20]. However, the defi-
nitions of cervicitis were different. Kumbhar et al. [19]
examined the cervices of slaughtered animals for a pro-
lapse of cervical rings and inside contents. Other studies
defined an inflammation of the cervix via PMN content [9]
or by edema of the cervical os with mucosal congestion,
enlargement and hardening of the cervix, and presence of
flecks of pus in the vagina [18].
It is known that an inflammatory process in the uterus
causes migration of PMNs into the endometrial tissue
[1,21,22]. In previous studies, a threshold of greater than or
equal to 5% PMN was used to define endometritis
[1,9,17,23]. In the present study, we adopted the threshold
to define an endometrial inflammation. Therefore, of 370
endometrial cytology slides, 92 (24.9%) had a PMN
content greater than or equal to 5%, and 278 (75.1%) were
negative. With regard to cervicitis, no significant differ-
ences among the cervicitis groups and PMN could be found.
5
Cytology þve Cytology ve Cytology þve
Pathohistology ve Pathohistology þve Pathohistology þve
17.7 (n ¼ 11) 22.6 (n ¼ 14) 12.9 (n ¼ 8)
2.2 (n ¼ 1) 11.1 (n ¼ 5) 4.4 (n ¼ 2)
22.0 (n ¼ 11) 20.0 (n ¼ 10) 6.0 (n ¼ 3)
However, of the cows with cervicitis (n ¼ 221), 170 animals
(76.9%) were without positive cytology of the uterus.
Comparison of the mean PMN content in the cervical and
uterine mucosa in the present study did not reveal any
significant differences among cervicitis groups (data not
shown). However, a significant difference was detected
between PMN content in the cervical and uterine mucosa
relative to number of days open (Fig. 3). This difference
suggests that higher PMN content in the uterus is associ-
ated with extended days open, whereas increased cervical
PMN content seems to play a minor role in this reproduc-
tive measurement of reproductive performance.
Histologically, 218 of 300 (72.7%) animals in the present
study displayed one or more pathologic findings in the
uterine tissue with predominantly degenerative changes
(bovine endometriosis and angiosclerosis) or, less frequently,
inflammatory diseases (endometritis and perivasculitis).
Surprisingly, 56 of 82 (68.3%) cows without histopathologic
findings of the uterus had cervicitis. A previous study simi-
larly found that purulent vaginal discharge did not neces-
sarily indicate metritis or endometritis, but could be a
separate inflammatory disease of the cervix [9]. Conversely,
the high prevalence of cervicitis and uterine pathologic al-
terations of cows in the present study without abnormal
vaginal discharge was unexpected. A previous study found
that vaginal urine pooling caused severe pathologic conges-
tion of the external cervical os, indicating vaginitis and
cervicitis [24]. In the present study, just a small number of
animals were found with urovagina (n ¼ 10); but of these,
eight had a cervicitis. Therefore, vaginal urine pooling seems
to play a crucial role in the development of cervicitis.
It is generally accepted that inflammation of the endo-
metrium has negative effects on reproductive measure-
ments [2,25–27]. However, little is known about cervicitis
and its effects on reproductive performance. In the present
study, no significant relationship could be observed be-
tween cervicitis and the number of days to first service as
well as between days open and first service conception
rate. However, analyses revealed a trend (P ¼ 0.092) toward
a shortened interval of days open in animals with cervicitis
(C1/C2) and without endometritis compared with cows
that had cervicitis and endometritis (Fig. 2). Also, with re-
gard to polymorphonuclear cells, cows with increased PMN
content in the cervical mucosa had a significantly shorter
interval of days open than animals with high PMN content
in the uterus (Fig. 3). Thus, we inferred that inflammation
of the uterus has a marked negative effect on the success of
insemination.
6 D. Hartmann et al. / Theriogenology xxx (2015) 1–7

Abbreviations: C0, cervix without abnormality; C1, swollen and prolapsed Portio vaginalis cervicis without reddening; C2, swollen and prolapsed Portio vaginalis cervicis with reddening; PMNU, percentage of
(15/52)2
(15/23)3
(23/46)
(15/31)
(8/23)
84.9  35.7
117.1  44.0
34.8
28.8
65.2
þve
Cytology þ pathohistolgoy

(16/47)B
(16/23)B
(23/46)
(16/31)
(11/23)
86.7  28.8
105.6  40.1
47.8
34.0
69.6
Fig. 2. Survival curves for days open up to 200 days postpartum based on
cervicitis with either positive (þ) or negative () cytology and pathohis-
tology of the endometrium. C0, cervices without abnormality; C1, the
ve
C2
Relationship between reproductive performance and degree of cervicitis without (ve) and with (þve) endometritis (defined as PMNU  5% or pathohistology).

second cervical fold was swollen and prolapsed without reddening; C2, the
second cervical fold was swollen and prolapsed with reddening. C1/2,
Cytology and Pathohistology  (d) and C1/2, Cytology and
(7/7)b,2
(7/15)1

Pathohistology þ (.) show a trend (P ¼ 0.092).

(7/42)
(7/37)
(2/7)
76.4  18.6
105.0  28.6
28.6
46.7
100.0

A significantly higher total conception rate could be

found in cows with C0 and C1 compared with cows with
þve

C2. Notably, this difference was independent of inflam-

mation of the uterus. Correspondingly, total pregnancy
Cytology þ pathohistology

rate at 200 days into lactation was significantly higher in

(30/34)a,A
(30/58)A

animals without endometritis and with cervicitis ratings

(35/42)
(30/37)
(19/35)

of C0/C1 compared with C2. In case of concurrent endo-

metritis, total pregnancy rate at 200 days into lactation
84.5  26.4
98.8  30.3
54.3
51.7
85.7

was significantly different among C0, C1, and C2. However,

the number of animals in group C1 with endometritis was
ve

very low, indicating that these values should be viewed

Values with different lower case letters in a row differ significantly within the cervicitis group (P < 0.05).
C1

Values with different capital letters in a row differ significantly between the cervicitis groups (P < 0.05).

with caution. These findings are in accordance with

Values with different numbers in a row differ significantly between the cervicitis groups (P < 0.05).

another study [9], which also found negative effects of

(25/60)1
(25/31)1
(31/58)
(25/49)
(11/31)

endocervical inflammation on the number of days to

conception.
In conclusion, the results of this study suggest that
85.9  30.7
102.8  36.5
35.5
41.7
80.6

cervicitis occurs independent of endometritis and that a

higher degree of cervicitis is associated with poorer
þve

reproductive performance. The conception rate and

Cytology þ pathohistology

number of pregnant animals at 200 days into lactation

seem to be especially affected by a swollen and prolapsed
(24/50)A
(24/27)A
(27/58)
(24/49)
(13/27)

Portio vaginalis cervicis with reddening (C2). Consequently,

91.8  32.4
111.8  34.8
48.1
48.0
88.9
ve
C0

neutrophils in the uterus; SD, standard deviation.

Conception rate in % (n/total inseminations)
Days to 1st service  SD

% Pregnant/1st service

days into lactation

Days open  SD

% Pregnant/200

Fig. 3. Survival curves for days open up to 200 days postpartum, based on
Reproductive

content of cervical (percentage of neutrophils in the cervix [PMNC]) and

measures

uterine (percentage of neutrophils in the uterus [PMNU]) poly-

Table 4

morphonuclear cells and both parameters together (PMNC þ PMNU) in

cervical and uterine mucosa. PMNC ( ) and PMN (.) differ significantly
1,2,3
A,B
a,b

(P < 0.05).
 D. Hartmann et al. / Theriogenology xxx (2015) 1–7
repeat breeder cows with normal uterine findings should
have a more comprehensive breeding soundness exami-
nation with evaluation of the external genitalia, perineal/
vulva conformation, and the internal genitalia examined by
vaginoscopy for the presence of cervicitis because of the
potential causal relationship between cervicitis and
infertility.
Acknowledgments
The authors Hartmann and Rohkohl contributed equally
to this work.
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