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PubMed1985

Ectopic pregnancy and antibodies to Chlamydia trachomatis.

Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis seems to be the most common etiologic agent of acute salpingitis. In the present study, we tested whether women with ectopic pregnancy had serologic evidence of a current or past chlamydial infection. Sixty-five percent of the women with ectopic pregnancy had IgG serum antibodies to C. trachomatis, and 21% of women pregnant in utero had such antibodies. Eleven percent of women with infertile husbands, 42% of women with cervicitis, and 69% of women with salpingitis had IgG serum antibodies to C. trachomatis. In women with ectopic pregnancy, there was a correlation between the occurrence of IgG antibodies and a history of salpingitis or gross evidence of a previous tubal inflammation. We conclude that previous chlamydial salpingitis may be a major etiologic factor leading to ectopic pregnancy.

Adult↗
PubMed1984

Postabortal pelvic infection associated with Chlamydia trachomatis and the influence of humoral immunity.

Among 1101 women undergoing legal abortion by vacuum aspiration within 14 weeks of gestation, 69 (6.3%) harboured Chlamydia trachomatis in the cervix and/or urethra. Of the chlamydia-positive women, 16 (23.2%) developed endometritis and 10 (14.5%) developed salpingitis during the first postoperative month. The corresponding figures among the chlamydia-negative women were 59 (5.7%) and 5 (0.6%). These differences are highly significant (p less than 0.001). To study the significance of systemic and local humoral immunity to C. trachomatis in these complications, chlamydial antibodies were determined in serum and cervical secretions. No difference in frequency of local IgA antibodies in chlamydia-positive women was observed between those with and those without complications. On the other hand, there was a strong indication that chlamydia-positive women who developed salpingitis had a lower mean titer (17) of serum IgG chlamydial antibodies than carriers without symptoms (82, p less than 0.02). The group of endometritis patients did not differ in this respect from chlamydia-positive women who were free of infectious complications. These results suggest that C. trachomatis may be an etiologic agent in postabortal salpingitis and probably also in endometritis. Serum antibodies seemed to offer some protection against salpingitis in chlamydia-positive cases, whereas local antibodies did not.

Abortion, Induced↗
PubMed1986

A comparison of piperacillin and clindamycin plus gentamicin in women with pelvic infections.

The efficacy and safety of piperacillin were compared with those of clindamycin plus gentamicin in 74 women with obstetric or gynecologic infections (such as endometritis, salpingitis and septic abortion). Thirty-five of the patients in the group treated with piperacillin and 33 of the patients in the group treated with clindamycin plus gentamicin were clinically cured. Clinical failure occurred in two patients in the group treated with piperacillin (salpingitis in one and endometritis in the other patient) and relapse of salpingitis occurred in one. Three patients who were given clindamycin plus gentamicin (all with salpingitis) did not respond to therapy. The most frequently isolated organisms were Neisseria gonorrhea and Bacteroides species. Adverse clinical experiences and the results of laboratory tests were fewer in the group treated with piperacillin than in the patients who received the combination regimen; in neither instance was treatment discontinued because of these effects. Thus, piperacillin was as safe and effective as a combination of clindamycin plus gentamicin.

Abortion, Septic↗
PubMed1983

[Etiologic factors in tubal sterility].

Between the years 1977 and 1982, laparoscopy was performed on 900 patients where the diagnosis of infertility was made in our department. In the patients' histories events which were considered relevant to subsequent tubal pathology were studied in detail. These potential risk factors were further analyzed and related to the finding of tubal pathology at the time of diagnostic laparoscopy. Patients with moderate or severe endometriosis were excluded from this study, because the high incidence of tubal adhesions in these women rendered it impossible to analyse the relationship between potential risk factors in the patients' histories and the incidence of tubal infertility. The incidence of tubal disease in patients with only one risk factor was compared to patients with no such factors in their history. The incidence of tubal pathology was significantly higher in all categories except the group who had undergone only uncomplicated appendicectomy. Highly significant differences were found after salpingitis, ovarian cystectomy or wedge resection and "complicated" appendicitis. The risk of a low-grade salpingitis was increased after induced abortion and IUD usage. The incidence of tubal pathology (33.7%) in patients without risk factors lends support to the assumption that salpingitis can occur without obvious clinical symptoms and appears to justify laparoscopy and use of antibiotic treatment if salpingitis is suspected in young women, even though clinical symptoms are absent.

Adult↗
PubMed1997

Acute pelvic inflammatory disease: associations of clinical and laboratory findings with laparoscopic findings.

OBJECTIVE: To assess the relation of clinical variables and laboratory data to pelvic laparoscopic observations of tubal occlusion, adnexal adhesions, and peritoneal exudate in women with acute salpingitis. METHODS: Clinical and laboratory evaluations were performed systematically before laparoscopy in 155 women with suspected acute pelvic inflammatory disease (PID), 82% of whom proved to have acute salpingitis confirmed with laparoscopy. Laparoscopic findings were scored in three categories (tubal patency, adhesions, and exudate.) RESULTS: Two general categories of laparoscopic findings were present: 1) tubal occlusion and moderate to severe adhesions in 30 women, and 2) pelvic-abdominal exudate in 27 women. In the remaining 16 women, these laparoscopic findings occurred alone or in other combinations. Among women with acute salpingitis, tubal occlusion was associated positively with older age, palpable adnexal mass, and moderate to severe pelvic adhesions; negative associations were found with abdominal rebound tenderness, mean abdominal-pelvic tenderness score, pelvic-abdominal exudate, and isolation of either Neisseria gonorrhoeae or Chlamydia trachomatis. Moderate or severe pelvic adhesions were associated positively with increased duration of abdominal pain (5 versus 3 days) compared with limited or no pelvic adhesions, but they were associated negatively with mean abdominal-pelvic tenderness score and with pelvic-abdominal exudate (47% versus 73%). Free exudate in the pelvis or abdomen as compared with limited or no exudate was associated positively with abdominal rebound tenderness (86% versus 65%), abdominal-pelvic tenderness score, elevated white blood cell count (83% versus 52%), and recovery of N gonorrhoeae (79% versus 57%). Free exudate was associated negatively with the median duration of pain (3 versus 6 days), oral contraceptive use (4% versus 26%), and palpable adnexal mass (7% versus 25%). Analyses limited to women without a history of PID gave similar results. CONCLUSIONS: Although clinical and laboratory criteria traditionally used to judge the clinical severity of acute PID partially predict the degree of tubal or other pelvic abnormalities among women with acute salpingitis and tend to distinguish those with tubal occlusion or moderate to severe adhesions from those with peritonitis, these criteria have low predictive value and are not reliable in the individual patient.

Acute Disease↗
PubMed2000

Pelvic inflammatory disease after tubal sterilization: a review.

Exceptions ot the common notion that tubal occlusion protects from recurrent pelvic inflammatory disease (PID) do exist. Since 1975, 71 cases of salpingitis and 38 tubo-ovarian abscesses (TOA) in sterilized women have been published. The majority of cases of salpingitis after previous tubal occlusion (SPOT) developed more than a year after either laparoscopic or laparotomy sterilization procedures. For tubo-ovarian abscess after previous tubal occlusion (TOAPOT), this time interval ranged from several weeks to almost two decades. Most cases of salpingitis showed inflammation of both tubal segments. When only one segment was involved, it was generally the proximal segment. The appearance of the TOAPOT at the time of surgery was typical to TOA. The symptoms of salpingitis were not different from symptoms in any other case of PID, and those associated with TOAPOT were typical of TOA. Laboratory findings included leucocytosis and growth of Neisseria gonorrohoea and Chlamydia trachomatis from the cervix, the infected tube, and the peritoneal fluid. Pus cultures obtained from cases of TOAPOT grew mixed or single organisms. Detailed histopathologic studies in tubal specimens after the failure of an occlusion procedure are available from cases with no infection. They have demonstrated distortion, loss of musculature, and loss of lumen configuration, all of which may have been the result of compromised blood supply to the tube. These findings may be extrapolated to cases of SPOT and TOAPOT, assuming similar changes may be present before the development of infection. The mechanisms by which infection may develop in previously occluded tubes are divided into three groups: The first group consists of situations where there is persistence of free passage between the proximal and distal portions of the tube. These include toboperitoneal fistula, spontaneous anastomosis at the occlusion site, recanalization of the occluded site, incomplete tubal occlusion due to a faulty surgical technique or rupture of the weakened tubal wall. The second group consists of infections initiated by the surgical procedure itself, such as introduction of pathogens at surgery, exacerbation of chronic PID, and ascending infection secondary to surgical manipulation. In the third group, the infection is initiated systemically by hematogeneous spread, lymphatic spread, or change in immunologic status.

Chlamydia Infections↗
PubMed1991

Seroepidemiological study of gonorrhoea in Ethiopian women. 1. Prevalence and clinical significance.

OBJECTIVE: To measure the prevalence of gonorrhoea in Ethiopian women attending gynaecologic, obstetric and family planning clinics: to determine the reliability of patient self history of sexually transmitted disease (STD); to correlate the serological diagnosis of gonorrhoea with clinical evidence of pelvic infection in order to define a reliable clinical diagnosis of gonorrhoea in a country where pelvic inflammatory disease is very common but where routine laboratory culture and serological tests for gonorrhoea are unavailable. SUBJECTS: 1851 Ethiopian women: 50% symptomatic, 50% asymptomatic. SETTING: Gynaecological outpatient department, antenatal, postnatal and family planning clinics (Ethiopian Family Guidance Association (EFGA)), in two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia. METHODS: The indirect haemagglutination test with gonococcal pilus antigen as an epidemiological tool was used in a cross-section study to screen 1851 sera for evidence of past or current gonococcal infection. The gonococcal antibody test (GAT) seropositivity was correlated with patient's history of STD, age, clinic attended and the clinical evidence of infection in "gonococcal target organs" urethra, salpinges or Bartholin glands. RESULTS: Fifty nine per cent of the study group were seropositive for the gonococcal antibody test, 22% with titres greater than or equal to 1/320, indicative of current, recent or recurrent infection. Seropositivity indicating past or present gonococcal infection was highest in those who gave a history of having had treated syphilis (85%), in women aged 40-49 (72%), and family planning attenders (EFGA) (66%) of whom 31% had titres greater than or equal to 1/320. Fifty per cent had clinical evidence of past or present infection in the urethra, salpinges or Bartholin glands. Gonococcal antibodies were present in 54% of women with no evidence of clinical infection, compared with 91% of those with pyosalpinx and 86% of those with triple infection of urethra, salpinges and Bartholin glands. CONCLUSION: The high prevalence of gonococcal antibodies in Ethiopian women, especially in asymptomatic clinic attenders must be of concern for all health workers especially those in gynaecology and obstetrics and the related disciplines of family planning and neonatal paediatrics. While seropositivity was highest in those giving a past history of syphilis, the patient's history of STD was unreliable, as of those who denied having any history of STD, fifty per cent were GAT seropositive. Despite a high correlation between GAT seropositivity with pyosalpinx and clinical evidence of infection in urethra, salpinges and bartholin glands, gonococcal antibodies were present in 54% of women with no clinical evidence of infection. Thus we were unable to define a diagnostic clinical picture of gonorrhoea in Ethiopian women.

Adult↗
PubMed1980

Risk of pelvic inflammatory disease among users of intrauterine devices, irrespective of previous pregnancy.

The use of an intrauterine device (IUD) in 690 patients hospitalized for acute salpingitis (pelvic inflammatory disease) was compared with IUD use in a sexually active age-matched control group. Two hundred and twenty (31.9%) of the patients and 114 (16.5%) of the controls were wearing IUDs. Thus, the relative risk of developing acute salpingitis was 2 among IUD users. No significant difference was found in IUD use in the two groups between nulligravid women and women who had been pregnant. It was shown furthermore that the use of the oral contraceptives decreases the risk of salpingitis by two thirds. A lower frequency of gonorrhea among PID patients who were IUD users was revealed also.

Adolescent↗
PubMed1985

Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease.

Twenty-seven women with suspected acute pelvic inflammatory disease were studied by laparoscopy and endometrial biopsy. Overall, 67% (18 of 27) of the women had acute salpingitis at laparoscopy, 70% (19 of 27) had plasma cell endometritis, and 67% (10 of 15) had an inflammatory cytologic pattern of the peritoneal fluid. In comparison to laparoscopically detected salpingitis, endometritis detected with biopsy had a sensitivity of 89%, a specificity of 67%, a positive predictive value of 84%, and a false negative rate of 22% in the diagnosis of pelvic inflammatory disease. The corresponding figures for inflammation of the peritoneal fluid were 75%, 67%, 90%, and 25%. This study demonstrates that nonpuerperal endometritis is an entity associated with pelvic inflammatory disease, most likely representing an intermediate stage between cervicitis and salpingitis. Endometrial biopsy as an office procedure is a good alternative to laparoscopy in the diagnosis of acute pelvic inflammatory disease and may in fact detect early cases not yet visible at laparoscopy.

Acute Disease↗
PubMed1978

Is development of pelvic inflammatory disease in women using intra-uterine device equal regardless of parity? A one year follow-up study.

Seven hundred and fifty women using IUD(TCu 200) were observed for one year after insertion. Sixteen (2.1%) of the women were hospitalized for salpingitis (PID), and the diagnosis was always confirmed by laparascopy. Of these 16 women, 8 belonged to the nulliparous group and 8 to the parous group. In the high-risk age-group (16--25 years), the incidence of salpingitis was 47/1000 women-year in the nulliparous group, and 42/1000 women-year in the parous group. Thus, the rate of development of salpingitis is equal regardless of parity.

Adolescent↗
PubMed1982

Correlation between serum antichlamydial antibodies and tubal factor as a cause of infertility.

Although salpingitis frequently produces tubal damage and infertility, many women with tubal factor as a cause of their infertility do not have a clinical history of salpingitis. In order to investigate whether or not some such cases might be due to subclinical chlamydial infections, we measured antichlamydial antibodies in the serum of 172 women consecutively undergoing evaluation for infertility. Only 16 (9.3%) had a prior history of salpingitis. Sixty-one (35%) had antichlamydial antibodies (S+), and of these 75% had tubal factor as a sole or contributing cause of their infertility, versus 28% of the seronegative (S-) women (x2 - 34, P less than 0.001). There was no association between chlamydial seropositivity and any infertility factor other than tubal factor in multivariant analyses. Subclinical infections with Chlamydia trachomatitis may be a major cause of tubal infertility in the United States, and chlamydial serologic studies may be useful in identifying the subset of infertile women likely to have tubal factor.

Adult↗
PubMed1987

Serologic evidence of prior chlamydial infection in patients with tubal ectopic pregnancy and contralateral tubal disease.

Oviductal damage from infectious salpingitis is a principle cause of ectopic pregnancy. To examine the role of Chlamydia trachomatis in patients with ectopic pregnancy, 24 patients undergoing laparotomy for ectopic pregnancy were evaluated by assessment of chlamydial serology and chlamydial cultures of tubal biopsy specimens. The patients were divided into two groups based on the presence or absence of gross abnormalities in the fallopian tube contralateral to the ectopic gestation. Ten patients in group I showed gross evidence of chronic salpingitis in the contralateral tube; 14 patients in group II had normal-appearing contralateral tubes. Chlamydial cultures were negative in both groups. Chlamydial immunoglobulin M antibodies assayed by indirect microimmunofluorescence were negative in both groups (less than or equal to 1:32). Mean geometric immunoglobulin G titers for C. trachomatis were significantly higher in the patients with evidence of contralateral chronic salpingitis (78.9 versus 13.1). These findings suggest that C. trachomatis may be a major cause of oviductal damage, which predisposes to ectopic pregnancy.

Adult↗
PubMed1992

Midtubal occlusion: etiology, management, and outcome.

OBJECTIVE: To assess the significance of pathological midtubal occlusion in infertility. DESIGN: Retrospective descriptive case review. SETTING: Tertiary referral center. PATIENTS: Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. INTERVENTIONS: Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. MAIN OUTCOME MEASURES: Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. RESULTS: Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. CONCLUSION: Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Adult↗
PubMed1988

[Chlamydia trachomatis--detection of inflammatory diseases of the fallopian tubes].

The prevalence of Chlamydia trachomatis in tubal swabs obtained by laparoscopy was investigated in a prospective study. Specimens were collected from women with salpingitis (group 1), tubal infertility (group 2) and from controls, which were considered as being not infected and subjected to laparoscopy for other reasons (group 3). In the period 12/1980-8/1984 chlamydial infection was diagnosed, by means of the McCoy tissue culture method, in group 1 in 19% (16/85), in group 2 in 4% (10/250) and in group 3 in 0% (0/122). In a second period until 6/1985, positive chlamydial cultures were seen in 2% (1/44), 2% (2/110) and 0% (0/75) respectively, however, a simultaneously used IFT (Micro Trak, Syva Merck) was negative in all cases. In the third period until 12/1986, positive chlamydial cultures were obtained in 12% (9/77), 1% (1/137) and 4% (4/90) respectively. The sensitivity of a simultaneously performed EIA (Chlamydiazyme, Abbott) in women with salpingitis was 67%, the specificity was 97%. The EIA seemed to provide an alternative diagnostic method to culture when evaluating tubal specimens. In an additional trial, chlamydial complement fixation test was positive in 26% of a total of 90 women with tubal infertility (and negative tubal culture) vs. 6% in a control group of pregnant females (p less than 0.001). In conclusion, the reported results support the etiologic role of Chlamydia trachomatis as an important agent in salpingitis as well as in tubal infertility.

Bacteriological Techniques↗
PubMed1987

[Second-look laparoscopy--results and pregnancy rate in patients with a state of laparoscopically assessed acute adnexitis].

A report is given on the findings of second-look-laparoscopy in 229 patients with condition after laparoscopically ascertained and classified inflammations of the adnexes which were treated on the basis of uniform criteria. We also want to report about the pregnancy rate dependent upon the degree of severity of the inflammation in 121 patients. It could be proved with absolute certainty that there was a dependence of the frequency of pathologic changes of the tubes with negative chromopertubation on the degree of severity of the preceding illness and also on the kind of the causative organisms. The most frequent pathologic findings came up after advanced fibrinous-suppurative inflammations as well as after gonorrhoic inflammations of the adnexes, the latter not depending on the degree of severity. The pregnancy rate, 1-5 years after treated salpingitis, for patients having the wish to deliver a child, came to 72.5% after serous salpingitis, 72.2% after operation of the adnex on one side and 59.1% after fibrinous-suppurative salpingitis. In connection with the demand for general laparoscopic diagnostics of the inflammable illnesses of the adnexes it is important to point to the necessity of early registration and treatment as well as to the cultural diagnostics of gonorrhoea. In the case of abscesses of the adnexes on one side and wish to deliver a child immediate operation is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed2001

Racial and economic demographics of couples seeking infertility treatment.

OBJECTIVE: We characterized new infertility patients on the basis of race and economic factors. STUDY DESIGN: A retrospective chart review was performed of all patients seeking infertility evaluation from 1998 to 1999 at two infertility centers in Cincinnati, Ohio. Patients were categorized by race (white, black, or other). Statistics were analyzed by chi2 and logistic regression. RESULTS: Of 756 patients, 85.2% were white, 10.2% were black, and 4.4% were other. Infertility diagnoses were placed into the following 7 categories: ovarian, salpingitis, surgical sterilization, male factor, endometriosis, unexplained, and other. Black women had significantly more salpingitis than did nonblack women (P <.001) regardless of insurance status. However, surgical sterilization was more prevalent in patients without insurance regardless of race (P <.001). CONCLUSIONS: Our findings are consistent with previous studies showing that black women have more risk factors for salpingitis. Surgical sterilization risk factors were concordant with those of the National Center for Health Statistics.

Black or African American↗
PubMed1989

Histopathologic findings in ectopic tubal pregnancy.

In 141 consecutive cases of tubal ectopic pregnancy at Hermann Hospital in Houston, Texas, the histologic appearance of 129 surgically removed fallopian tubes containing ectopic pregnancies was reviewed and compared with an age- and race-matched control population. There was a higher incidence of chronic salpingitis (88 versus 2%) and salpingitis isthmica nodosa (SIN) (43 versus 5%). The ectopic pregnancy patients had a higher incidence of pelvic inflammatory disease, gonorrhea, previous abortions, bitubal ligation, intrauterine device use, and previous abdominal surgery. In our population, chronic salpingitis was the most commonly associated finding. The increase in SIN was associated with postinflammatory changes (89%). We also found that ectopic tubal pregnancies may grow either intratubally or extratubally by villous invasion into the wall and blood vessels; therefore, surgical salvage of the fallopian tube by extracting the products of conception will not always be curative.

Adolescent↗
PubMed1986

Chlamydia trachomatis infection in women with ectopic pregnancy.

Fifty women with ectopic pregnancy and 49 control women with intrauterine pregnancy were interviewed and evaluated for evidence of Chlamydia trachomatis infection. Among women with ectopic pregnancy, 14 women were wearing an intrauterine contraceptive device or had a tubal ligation (group A), and 36 women had no readily identifiable risk factors (group B). Group B women had greater total numbers of sexual partners than did control women with intrauterine pregnancy (P less than .005). Group B women more often had C trachomatis antibody than group A (P = .03) and control women (P = .002). Of 27 C trachomatis cultures from fallopian tube tissue from women with ectopic pregnancy, none were positive. Fallopian tube tissue distant from the site of ectopic implantation was available for histopathology of 41 cases. Nine (22%) had extensive subepithelial plasma cell infiltration. All nine were among group B women (P = .06) and all seven with plasma cell salpingitis who were tested for C trachomatis antibody were seropositive (P = .004). It is concluded that a subset of women with ectopic pregnancy were at increased risk for acquiring a sexually transmitted disease by virtue of their sexual behavior and that women in this subset frequently have serologic evidence of C trachomatis infection and histologic evidence of plasma cell salpingitis. Because few of these women recall having had pelvic infection, the authors speculate that subclinical C trachomatis tubal infection producing plasma cell salpingitis may commonly underly ectopic pregnancy.

Adolescent↗