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A case of perihepatitis-salpingitis syndrome is described in a woman from whose cervix Shigella sonnei was isolated. Her sexual practices included anal, then vaginal, intercourse, which may account for the pathogenesis.
The application of sophisticated anaerobic technology coupled with culdocentesis has radically altered out concepts of endometritis-salpingitis-peritonitis (ESP). The demonstration of a polymicrobial predominantly anaerobic peritonitis in selected cases of ESP polarized conceptual thought into gonococcal and nongonococcal etiology. The data that substantiated the concept of anaerobic infection following initial infection by Neisseria gonorrhoeae are reviewed. Therapy studies utilizing doxycycline have indicated that there is an anticipated therapeutic response when dealing with monoetiologic disease (gonococcal ES or gonococcal ESP). When polymicrobial infection ensues with or without the concomitant presence of N gonorrhoeae, an alternate therapeutic response may evolve. It is currently postulated that the significance of an altered therapeutic response is due to augmented structural damage to the fallopian tubes by superinfecting anaerobes. The current goal of therapy is to reproduce as closely as possible the anticipated therapeutic response observed with monoetiologic disease.
Endometrial contents collected by a protected aspiration method from 18 women with acute salpingitis were studied by culture. Chlamydia trachomatis was recovered from the endometrial samples of eight women and from the cervix of six of them. C. trachomatis was isolated from the cervix, but not from the endometrium, of seven women. Twelve of the 15 patients who harbored C. trachomatis in the genital tract developed a significant antibody response to the organism. The study suggests that C. trachomatis spreads canalicularly from the cervix to the fallopian tubes and that this organism can cause endometrial infection.
The effect of tetracycline X HCl, administered for 14 days starting before or after intraovarian bursa inoculation of the mouse pneumonitis biovar of Chlamydia trachomatis, was examined in mice. Mice that received no antibiotic developed acute salpingitis and subsequent hydrosalpinx. Only one of ten mated mice at 42-51 days after inoculation showed a normal, bilateral pregnancy. Initiation of tetracycline treatment two days prior to inoculation completely prevented the pathology associated with tubal chlamydial infection and fertility was as high (eight of ten) as in mice inoculated with sterile tissue culture supernate (eight of 11). Initiation of treatment one week after inoculation prevented permanent tubal damage (two of 20 vs. 12 of 20; P = .001) and infertility (bilateral pregnancies, six of ten vs. one of ten; P = .027) in some, but not all, infected mice. Therapy began two weeks after inoculation resulted in a marginal improvement in the frequency of apparently normal oviducts (16 of 24 vs. eight of 20; P = .053) but not in fertility (bilateral pregnancies, four of 12 vs. one of ten; P = 0.19). This model may be of value in studies of the treatment of upper genital tract infection with C. trachomatis.
Female guinea pigs were given daily doses of a combination of oral contraceptive (OC) agents, consisting of mestranol and norethynodrel suspended in sesame oil or distilled H2O, and were infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis (GPIC). Counts of chlamydial inclusions in cells of vaginal smears collected during infection, showed prolongation and enhancement of infection in OC-treated animals as compared with controls. Appearance of IgG and IgA antibodies to GPIC in genital secretions, as determined by enzyme-linked immunosorbent assay (ELISA), was also delayed in OC-treated animals as compared with controls. OC-treated infected animals were killed on days 15 and 43, and gross pathological evidence for ascending infection culminating in salpingitis was found in all of five and four of five animals, respectively. On the other hand, among untreated infected controls on each sacrifice day, only one of five animals had any evidence for ascending infection. Chlamydiae were detected by light and electron microscopy in fallopian tube tissue collected on day 15 following OC-treatment but not in tissue from control animals.
Pelvic inflammatory disease (PID), one of the major sequelae of the current epidemic of sexually transmitted diseases, has been shown to be a polymicrobial infection. This study compares the efficacy and safety of two broad-spectrum combination drug regimens, cefotetan with doxycycline and cefoxitin with doxycycline, in the treatment of PID. A total of 108 patients with acute salpingitis were hospitalized and randomized into two treatment groups: cefotetan/doxycycline (N = 54) and cefoxitin/doxycycline (N = 54). Before antibiotic administration, Chlamydia trachomatis was identified in 17 (16%) of the patients, Neisseria gonorrhoeae from 72 (67%), and anaerobic and aerobic bacteria were identified from the endometrial cultures of 86 (80%). There were seven tubo-ovarian abscesses (TOAs) that were diagnosed in the cefotetan group, and six in the cefoxitin group. Clinical cure was achieved in 51 of 54 (94%) patients in each group. Of the six patients whose treatment failed, all had positive cultures for N. gonorrhoeae and facultative/anaerobic bacteria, whereas none had C. trachomatis. Two patients from each study arm whose treatment failed were diagnosed with TOAs and responded subsequently to clindamycin plus an aminoglycoside. Cultures that were obtained after the completion of inpatient treatment showed the eradication of C. trachomatis and N. gonorrhoeae in all patients. Also, both regimens were effective in reducing aerobic and anaerobic pathogens. Finally, both regimens were well tolerated, with few side-effects.
AIM: We describe the unusual association of fallopian tubal prolapse and herpetic infection, an occurrence not previously reported to our knowledge. METHODS AND RESULTS: A 37-year-old woman presented with a small polypoid mass of the vaginal vault, 3 months after abdominal hysterectomy and abdominoplasty. The vaginal mass proved to be the fimbriated end of a fallopian tube, herniated into the vagina. Reintervention 3 months later with resection of a small vaginal 'polyp' revealed a residual portion of fallopian tube, with superimposed herpes simplex virus (HSV) infection and marked cytological atypia of surface epithelial cells. HSV-2 immunostaining of viral nuclear inclusions and of atypical cells confirmed the herpetic nature of the infection. CONCLUSION: Involvement of the genito-urinary tract by HSV may occur via an ascending infection from the cervix, but the fallopian tube, deeply located in the pelvis, is generally spared from herpetic infection. In the setting of fallopian tubal prolapse, direct exposure of the herniated fallopian tube to various pathogens in the vagina provides an unique clinical model for salpingitis. In herpetic tubal infections, special attention must be paid to cytological atypia of probable viral cytopathogenic origin, to avoid a misdiagnosis of malignancy.
A patient with co-existent carcinoma and tuberculosis of the Fallopian tube is described. Tuberculosis was diagnosed by the finding of numerous typical granulomata throughout the uterus, tubes and ovaries, and by exclusion of other possible causes of these; and carcinoma by the finding of solid tumour, with a marked anisocytic appearance, invading submucosa. Despite the well recognised epithelial hyperplasia seen in tuberculous salpingitis, there remains no evidence that the occurrence of carcinoma in such cases is other than fortuitous.
To determine the microbiological causes of pelvic inflammatory disease, 43 women with acute salpingitis (AS) and 160 controls were studied. Amongst AS women there were significantly higher endocervical isolation rates of Neisseria gonorrhoeae (54% vs 6%), Chlamydia trachomatis (40% vs 13%), Mycoplasma hominis (60% vs 19%), enterobacteria (26% vs 11%) and anaerobic bacteria (58% vs 29%). A polymicrobial pathogenic endocervical flora was present in both gonococcal and non-gonococcal AS. Laparoscopic sampling of the fallopian tubes rarely provided useful microbiological data but did reveal the inaccuracy of clinical diagnosis of AS. Thirty-four male consorts of AS women were investigated; 20 had gonorrhoea and 27 had non-gonococcal urethritis (NGU). A high proportion of infected men had asymptomatic gonorrhoea (35%) and/or asymptomatic NGU (56%). These findings had implications for the management of AS.
We used a mouse model of acute chlamydial salpingitis to evaluate the efficacy of roxithromycin in preventing irreversible inflammatory damage leading to tubal infertility. Female C3H/He mice were genitally inoculated with a human strain of Chlamydia trachomatis and then treated with roxithromycin glutamate subcutaneously. Treatment was initiated either 7 or 10 days postinfection (p.i.) and continued for 7 days at a dosage of 50 or 100 mg/kg of body weight per 24 h. The course of the disease was monitored serologically, bacteriologically, and histologically. At the end of the treatment, the mice were encaged with males and their reproductive capacity was recorded over a 19-week period. The protective effect of roxithromycin was assessed in terms of fertility parameters in comparison with values for noninfected control mice. When treatment was initiated on day 7 p.i. and given in twice-daily 25-mg/kg doses, all the mice remained fertile and the total number of offspring was similar to that of sham-infected mice (17.3 +/- 3.3 versus 17.2 +/- 2.3). When treatment was initiated on day 10 p.i. and given in a single daily dose of 50 or 100 mg/kg, 90 and 70% of the mice, respectively, remained fertile; however, in terms of total offspring, fertility was lower in the group treated with the lower dose (5.6 +/- 1.4 versus 13.0 +/- 3.8). Roxithromycin was found to be effective against C. trachomatis in the mouse genital tract, but fertility was only partially preserved when the time between infection and treatment was prolonged.
Neisseria gonorrhoeae strains which cause acute salpingitis are presumed to ascend the genital tract from the cervix. Previous studies utilized isolates obtained from endocervical canal cultures, although it was not known if the isolates truly represented the organisms present in the fallopian tubes. In this study, we compared N. gonorrhoeae isolates from endocervical canal cultures with fallopian tube or peritoneal cul-de-sac isolates or isolates from both sites obtained at laparoscopy. Potential virulence markers were studied, including colony phenotype, auxotype, antimicrobial agent susceptibility, protein patterns on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and susceptibility to normal human serum. Six of seven cervical isolates had the same antibiograms and molecular weight for major outer membrane proteins as those of the corresponding peritoneal isolates. Auxotypes also were the same and included prototrophic, proline-requiring, and proline-and-arginine-requiring isolates. The isolates as a group appeared to be very susceptible to the bactericidal action of pooled serum from normal women. Colony phenotypes varied between sites; the fallopian tubecul-de-sac isolates were predominantly of transparent phenotype and piliated. The cervical isolates were either mixtures of equal quantities of opaque and transparent phenotypes or predominantly opaque phenotype. By these markers, patients' N. gonorrhoeae cervical isolates appeared to be the same as their isolates from fallopian tubes except for a difference or shift in colony phenotype.
A role for both the cellular and humoral components of the immune response has been established for chlamydial infection. The significance of helper (L3T4) T cells was evaluated by using a Chlamydia trachomatis murine salpingitis model for upper genital tract chlamydial infection. Mouse oviducts were inoculated with C. trachomatis by using the mouse pneumonitis agent (MoPn) or control medium. Mice depleted of L3T4-bearing lymphocytes had significantly higher (P less than 0.05) numbers of organisms recovered at day 7 postinoculation. The rate of hydrosalpinx formation was significantly higher in the mice depleted of L3T4-bearing lymphocytes (27 of 31 [87%] ) than in the infected undepleted group (8 of 16 [50%] ) (P less than 0.01). The geometric mean antichlamydial immunoglobulin G titers at day 54 postinoculation were significantly higher in the L3T4-depleted mice (mean titer, 2,030) than in the undepleted group (mean titer, 776; P less than 0.05). The rate of fertility was lower in the L3T4-depleted group (2 of 31 [6%]) than in the infected, undepleted mice (2 of 16 [13%]), but this difference did not reach statistical significance. In conclusion, the greater persistence of organisms in the oviduct and higher rates of hydrosalpinx formation in mice depleted of L3T4-bearing cells suggests that these cells play a role in the clearing of organisms following infection and thus in reducing the degree of oviduct obstruction and damage.
Chlamydial delayed-type hypersensitivity antigens were analyzed by using the subcutaneous salpingeal autotransplant model of Macaca nemestrina infected with Chlamydia trachomatis serovar E. Heat shock protein 60 was the only antigen shown to induce delayed-type hypersensitivity among other antigens tested, including UV-inactivated organisms, recombinant major outer membrane protein, purified outer membrane proteins, and heat shock protein 10.
Campylobacter fetus was isolated from the blood of a nonpregnant young woman who had a clinical diagnosis of salpingitis. A description of the isolate of C. fetus is given. An increasing awareness of human infections and capability of growing this microaerophilic organism should contribute to our understanding of the incidence and virulence of this bacterium.
Recent isolation studies have shown Chlamydia trachomatis to be an important aetiological agent in acute salpingitis in women. The present serological study indicates that C. trachomatis is the probable aetiological agent in two-thirds of 143 women with pelvic inflammatory disease (PID). In general, high levels of chlamydial antibody were found in sera and fluids aspirated from the pouch of Douglas and such antibody titres were shown to correlate with the severity of clinically graded tubal inflammation.
Salpingitis isthmica nodosa (SIN) is thought to be an inflammatory condition of the fallopian tubes and is strongly associated with infertility and an increased risk of ectopic pregnancy. The diagnosis is best made radiographically at hysterosalpingography (HSG), where the characteristic finding consists of multiple nodular diverticular spaces in close approximation to the true tubal lumen. We reviewed 1,194 HSGs performed over a five year period and identified 45 patients who had SIN (4%). There was a high rate of primary infertility (37.5%) and ectopic pregnancy (9.4%). Of 70 involved tubes, 62 (89%) had evidence of associated inflammation on historic, radiologic, surgical, or histologic grounds. We conclude that SIN is a disorder most likely acquired during the fertile years, and that the lesion is either a direct consequence of infection or that--once present--it predisposes the patient to subsequent infections.
Excised tubal segments from 94 infertile women with tubal obstruction, with a mean infertility duration of 5.3 years, and 40 women with ectopic tubal pregnancy were studied histopathologically to evaluate the association with salpingitis isthmica nodosa (SIN). The mean age of the 94 infertile women with tubal obstruction was 24.5 years. Hysterosalpingographies and laparoscopy were performed on all of them. Only the women with ectopic pregnancies we performed salpingectomy on were included in the present study. The incidence of SIN in women with tubal obstruction was 7.4%, in women with ectopic tubal pregnancy 10%, and in the control group the incidence was 0.2%. In 60% of the cases, SIN was present in both of the tubes. Based on this study, we conclude that SIN is significantly associated with infertility and ectopic tubal pregnancy.
Increased mortality (1.5% per week) and low egg production (5-10% lower than normal) were observed in a flock of domestic breeding Pekin ducks (Anas platyrhynchos). At necropsy, salpingitis and peritonitis were the most significant findings. Histologically, there was accumulation of necrotic debris in the lumen of the oviduct. Numerous bacteria and trichomonads were observed histologically in the lumen of the vagina and occasionally in the shell gland. Escherichia coli and a trichomonad were isolated from the oviduct. The trichomonads were oval (6-8 microm long, 4.5-6 microm wide) and had 4 anterior flagella and an undulating membrane extending over the entire length of the body, finishing in a long posterior flagellum. Morphology was consistent with trichomonads of the genus Tetratrichomonas. Comparative sequence analysis of the 5.8S ribosomal RNA gene and the flanking internal transcribed space regions of the trichomonad isolate did not closely match with available sequences of the same region of other trichomonadid protozoa.