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intrauterine therapy. However, due to the widespread use of fluconazole, resistance is common and it is not


recommended for treatment of fungal endometritis caused by moulds with septated hyphae, which have been shown to be 100% resistant (Beltaire et al. 2012). Chronic or recurrent cases of fungal endometritis often


require multi-modal and repeated treatment and since concurrent bacterial infection is common, anticipation and subsequent management of bacterial endometritis is often indicated.


Conclusion


The prognosis for future fertility following fungal endometritis is guarded. Stout (2008) reported a resolution rate of approximately 20% per treatment cycle. Treatment failure and recurrence of the fungal organism


are common, as is recontamination and concurrent bacterial endometritis. Unsuccessful treatment may result following inappropriate dose/duration and selection of antifungal agent, failure to treat reservoirs of infection and failure to correct predisposing conditions. Experience would suggest that early detection and treatment when the fungal organisms are still actively dividing increases the chance of treatment success. Attempts should be made following the resolution of


infection to correct any anatomical defects, instigate minimal contamination breeding techniques, to reduce the risk of iatrogenic infection and to limit pre/post-mating antibiotic treatment to prevent altering the normal vaginal flora. In the event of treatment failure, a prolonged period of


sexual rest may allow re-colonisation of the caudal reproductive tract with commensal flora and spontaneous resolution.


Author’s declaration of interests No conflicts of interest have been declared.


Acknowledgements


The author gratefully acknowledges Alastair Foote, Kevin Grimes and Sidney Ricketts for providing images.


Manufacturers' addresses 1Baxter Healthcare, Miami, Florida, USA. 2Elanco Animal Health, Basingstoke, Hampshire, UK. 3Molecular Therapeutic LLC, Athens, Georgia, USA.


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