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PubMed1977

Diagnosis and treatment of acute salpingitis.

Acute salpingitis is one of the most common acute gynecologic diseases and occurs in approximately 750,000 women each year in the United States. Use of laparoscopy to confirm the diagnosis of acute salpingitis has shown that the signs and symptoms classically ascribed to this disease are not specific to it. Fever, leukocytosis, elevated ESR and adnexal masses or swelling are not necessary to make a diagnosis of acute salpingitis. Lower abdominal pain and adnexal tenderness are the most consistent findings. Microbiologic data obtained by laparoscopy and culdocentesis have raised questions about the role of N. gonorrhoeae in salpingitis and have demonstrated that, as in pelvic infections generally, acute salpingitis is associated with mixed aerobic-anaerobic bacterial flora. Good results in the treatment of acute salpingitis depend upon: (1) early diagnosis, (2) hospitalization and bed rest, (3) the use of antibiotic therapy that takes into account the polymicrobial etiology of acute salpingitis, (4) prevention of recurrent episodes of salpingitis through efforts at patient education and identification and treatment of sexual partners. Most important, we must remember that what is at stake is often the future reproductive potential of a young woman. It must be weighed against both patient and physician convenience and cost. Further investigative efforts are essential to determine the role of IUDs in pelvic infections, discover the true microbiologic etiology of salpingitis and establish appropriate antimicrobial treatment as determined by prospective, microbiologically controlled investigations.

Acute Disease↗

PubMed1978

Changes in the incidence of acute gonococcal and nongonococcal salpingitis. A five-year study from an urban area of central Sweden.

The incidence of acute gonococcal and nongonococcal salpingitis for a five-year-period (1970--74) was studied retrospectively in an urban area of central Sweden. The investigation was undertaken to see if the reported decrease of gonorrhoea in Sweden had been followed by a change in the incidence of gonococcal salpingitis--the most common complication of gonorrhoea. The study showed that the relative incidence of acute gonococcal salpingitis had decreased even more than urogenital gonorrhoea and these findings thus indicate a real decrease of gonorrhoea. At the same time there were more patients with nongonococcal salpingitis. During the period of the study the gonococcal complement-fixation test (GCFT) gave positive results in 40% to 80% of the patients with gonococcal salpingitis. The yield with this test was only 4% in patients with nongonococcal salpingitis during 1970 but it increased successively and was 23% in 1974. This increase was statistically highly significant (P less than 0.001).

Acute Disease↗

PubMed1979

Experimental acute salpingitis in grivet monkeys provoked by Chlamydia trachomatis.

Chlamydia trachomatis is a common cause of sexually transmitted diseases. Recently it has been shown that chlamydiae are also responsible for complications to such lower genital tract infections. In this study, isolates of C. trachomatis from the fallopian tubes of patients with acute salpingitis were inoculated direct into the fallopian tubes of two, and through the cervical canal into the uterine cavity of one grivet monkey. The experimental infections resulted in a self-limited acute salpingitis in the three animals. C. trachomatis was recovered from the monkeys 2 and 3 weeks post inoculation. As found at laparotomy, the infected tubes were swollen and reddened, and there was watery exudate in the abdominal ostia. Microscopically, cellular infiltrates--mainly lymphocytes--were seen in the mucosa, muscularis and subserosa of the tubes. Serologically, a primary antibody response with an IgM to IgG conversion was found. Salpingitis did not occur in a control monkey inoculated in the tubes with a medium lacking Chlamydia. The histological changes in the fallopian tubes of the infected monkeys were reminiscent of those described as being characteristic of "gonococcal" salpingitis in man. The fulfilment of Koch's postulates in the animal model used adds to the earlier evidence that C. trachomatis is capable of causing acute salpingitis in humans.

Acute Disease↗

PubMed1979

The intrauterine contraceptive device and acute salpingitis: a multifactor analysis.

From an indigent population hospitalized with acute salpingitis, 163 patients were compared with 222 control patients from the minor trauma section of the emergency room. Four factors were significantly different between cases and controls: race, type of contraception, number of sex partners, and previous history of salpingitis. A discriminate analysis based on a linear logistic equation demonstrated that each risk factor was independent rather than a reflection of another risk factor. Thus factors associated with race, IUD use, multiple sexual partners, and previous salpingitis increase the risk of salpingitis in the population studied.

Acute Disease↗

PubMed1978

Salpingitis in ovarian endometriosis.

A histologic study of 87 cases of ovarian endometriosis with salpingectomy revealed 29 cases (33%) in which the removed fallopian tubes showed chronic salpingitis. Tubal obstruction could be demonstrated in only one of these patients. Tubo-ovarian adhesions were found in 15 patients (17%) and in only 7 of these in association with salpingitis. Although the patients in the present series did not consult their physicians because of infertility, but rather for other symptoms related to pelvic endometriosis, the finding of chronic salpingitis in 33% of the cases suggests that salpingitis may play a role in the infertility associated with endometriosis, possibly through altered tubal secretion.

Acute Disease↗

PubMed1977

Chlamydia trachomatis infection in patients with acute salpingitis.

We examined the prevalence of Chlamydia trachomatis in the cervix and the fallopian tubes of patients with acute salpingitis. Cycloheximide-treated McCoy cells were used as the growth medium. For purposes of comparison, women with infections confined to the lower genital tract and women without signs of genital infections were also studied. C. trachomatis was isolated from the cervix in 19 of 53 patients with acute salpingitis, in one of 18 lower-genital-tract infections and in none of 12 without signs of genital infection. C. trachomatis was recovered from six of the 20 valid specimens from the fallopian tubes of the patients with acute salpingitis. Our results indicate that chlamydia is a common etiologic agent in acute salpingitis.

Acute Disease↗

PubMed1979

Bacteroides fragilis in acute salpingitis.

The bacteriology of acute salpingitis was studied in 87 patients. Gonococci were recovered from 18 patients. Lower yields of bacteria were isolated in the peritoneal fluid than from the vaginal cultures, and a poor correlation was observed between the peritoneal fluid and vaginal cultures. Anaerobic bacteria dominated in both sites. Staphylococci, streptococci, enterobacteria, peptostreptococci, peptococci, lactobacilli and bacteroides normally present in the vagina were the predominant isolates recovered from the culdocentesis. Paired acute and convalescent-phase sera obtained from patients with isolates of Bacteroides fragilis were assayed for antibody response to the polysaccharide antigen of B. fragilis. Significant titer increases were observed in sera from only two out of eight patients with non-gonococcal salpingitis and no titer changes were noticed in two patients with gonococcal. These findings suggest that B. fragilis only infrequently plays an etiologic role in acute salpingitis.

Acute Disease↗

PubMed1977

Clinical response of patients with gonococcal endocervicitis and endometritis-salpingitis-peritonitis to doxycycline.

The clinical response to single-drug therapy with doxycycline was evaluated in 25 patients with gonococcal endoceruicitis and was correlated with the bacterial isolates present within the cul-de-sac. The 10 patients with gonococcal salpingitis salpingitis and the three patients with gonococcal peritonitis exhibited excellent clinical responses. When polymicrobial infection coexisted with gonococcal peritonitis or functioned without the concomitant presence of Neisseria gonorrhoeae, a significantly altered therapeutic response was observed in four of the 12 patients. Four patients in this grouping exhibited either secondary temperature elevations or lack of a significant alteration of the white blood cell count, two features which were not characteristic of the patients with either gonococcal salpingitis or peritonitis. In the cases of polymicrobial peritonitis, there was a poor correlation between ensuing clinical response and in vitro resistance of one or more cul-de-sac isolated to doxycycline. The presence of a resistant organism did not preclude a good or satisfactory clinical response. The absence of a resistant organism correlated well with a good clinical response.

Adolescent↗

PubMed1976

Gonococcal salpingitis in gynaecology--myth or missed?

A series of 25 cases of gonococcal salpingitis were seen in a teaching hospital between October, 1972, and March, 1975. These cases formed 29 per cent of all cases of salpingitis excluding post-abortal cases. The majority were investigated at the bedside by taking films and cultures from the cervix and urethra. The films were stained by Gram's method and specimens for culture were streaked on to prewarmed Gonococcal Selective Medium (Oxoid) and the plates were incubated at once in a CO2-enriched atmosphere at 37 degrees C. A group of cases was identified with minimal symptoms and minimal, or absent, signs; in such cases the diagnosis may be unsuspected. Reasons are advanced for the failure of other gynaecological units to recognize gonococcal salpingitis.

Adolescent↗

PubMed1992

[Histogenesis of isthmic nodular salpingitis].

Nodular salpingitis of the isthmus is a clinicopathological entity related to what is classically referred to as interstitial adenomyosis. These two lesions are due to the same aetiopathogenic process and result from inflammatory proliferation of the tubal epithelium with formation of pseudoglandular ducts. The only difference between the two is that one is ensheathed by a fine network of mesonephric muscle fibres and the other is surrounded by a thick layer of myometrial muscle fibres. These two lesions should be grouped under the same heading: nodular salpingitis. The term adenomyosis is incorrect due to the absence of endometrial glandular ducts and stroma in these lesions. Nodular salpingitis of the isthmus should be distinguished from tubal endometriosis, which is part of the clinical expression of extrauterine endometriosis. In particular, this lesion must be distinguished from interstitial endometriosis which, for some authors, corresponds to colonisation of the tubal mucosa by endometrium and, for others, to metaplasia of the tubal mucosa.

Diagnosis, Differential↗

PubMed1979

Nodular salpingitis and tubal endometriosis. I. Comparative clinical study.

Nodular salpingitis and tubal endometriosis have been referred to in succession as salpingiosis, diverticulosis, adenomyosis of the oviduct, endometrioid conditions, etc. This varied terminology underscores their etiopathogenetic and morphological substratum which is different from that of non specific tubal inflammation, but at the same time this variety of terms has always created confusion in interpretation and diagnosis. We have considered it necessary to carry out a comparative study of nodular salpingitis and tubal endometriosis in 42 cases of sterility operated during the last two years for tubal obstruction and in which histological examination has yielded evidence for the lesions of nodular salpingitis (NS) or endometriosis (EM) in at least one of the oviducts. As for the etiology of the two diseases, we have discussed the role plaid by inflammatory conditions, uterine trauma (curettage) and dystrophic disorders, as well as the importance of hyperandrogenism in NS. Taking into account the diffuse sclerogenic tendency of the tubal wall in NS and the concomitant inflammatory and dystrophic lesions in the peritubal tissues in EM, the postoperative outlook depends on early surgery, to be performed before tubal anatomy has been completely altered.

Adult↗

PubMed1977

Morbidity of appendectomy in patients with acute salpingitis.

Diagnosis of right lower quadrant pain in a woman is frequently confusing. The course of 53 patients who had operation with a normal appendix and no other intra-abdominal pathology is compared with a group of 50 patients with a normal appendix and acute salpingitis. Appendectomies were performed in all cases and there was a lower mortality and morbidity rate in the group of patients with salpingitis. It is, therefore, concluded that appendectomy is a safe procedure in patients with acute salpingitis.

Acute Disease↗

PubMed1976

Amylases of the genital tract. II. Peritoneal fluid isoamylases in acute salpingitis.

The activities of the specific genital isoamylases in peritoneal fluid were diminished or absent in acute salpingitis. The decrease was proportional to the severity of the tubal inflammatory reactions but could not be related to a closure of the abdominal tubal ostia. In women with infections of the lower genital tract in whom the Fallopian tubes were normal at laparoscopy, the peritoneal fluid isoamylase activities were as high as in healthy women. Determination of the activities of specific genital isoamylases in peritoneal fluid obtained by cul-de-sac puncture would seem to constitute a specific diagnostic method for acute salpingitis.

Acute Disease↗

PubMed1979

Use of laparoscopy to determine the microbiologic etiology of acute salpingitis.

To determine the microbiologic etiology of acute salpingitis, laparoscopy was used in 26 patients to obtain specimens for a variety of microorganisms directly from the fallopian tube. Simultaneous culdocentesis was performed to obtain peritoneal fluid for microbiologic analysis. A variety of microorganisms were isolated from the fallopian tubes and cul-de-sac aspirate. However, the organisms isolated from the fallopian tube were not consistent with the cul-de-sac isolates. It appears that direct culture from the fallopian tube may be necessary to determine the microbiologic etiology and pathogenesis of acute salpingitis. N. gonorrhoeae was isolated from the cul-de-sac in 32 per cent of cases and the fallopian tube in 19 per cent. In patients with endocervical gonorrhea, the gonococcus was isolated from the fallopian tube in 38.5 per cent of cases. Aerobic and/or anaerobic bacteria were present in the cul-de-sac aspirate in 46 per cent of patients and in the fallopian tube in 38 per cent.

Acute Disease↗

PubMed1977

Tubal pregnancy in a 'low-risk' population: occasional association with follicular salpingitis.

Long-standing tubal inflammatory lesions occurred in 35 (14%) of 250 tubal pregnancy patients, aged from 14 to 45 yrs, encountered from 1948 to 1969 in an eastern Canadian population where clinically manifest pelvic inflammation is not prevalent and 1/180 is the approximate ratio of ectopic pregnancy to live births. Present in 24 of these 35 patients was follicular salpingitis. For most of the eccyeses, functional derangements appear likely to have been responsible more often than structural alterations of the oviducts; but possible roles for 'physiological salpingitis' in leading to tubal pregnancy may be worthy of investigation.

Adolescent↗

PubMed1979

Experimental chlamydial salpingitis in immunosuppressed guinea pigs infected in the genital tract with the agent of guinea pig inclusion conjunctivitis.

At necropsy indication of spread of infection to fallopian tubes was found in 25 of 41 (60%) female guinea pigs infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis and immunosuppressed with cyclophosphamide. Eighteen were examined histologically, and the diagnosis of acute salpingitis was confirmed in 10, based on inflammatory reaction, detection of guinea pig inclusion conjunctivitis in tissue, and formation of cysts (pyosalpinx and hydrosalpinx). Infection of fallopian tube tissue was confirmed by indirect immunofluorescence and electron microscopy. Infection of endometrial tissue and peritoneum was also recognized. Data suggested that the immunosuppression mediated by cyclophosphamide resulted in a prolonged genital tract infection and concomitant ascending infection leading to salpingitis.

Animals↗

PubMed1976

Meningococcal salpingitis.

In a case of acute salpingitis a cervical smear showed Gram-negative diplococci but culture showed Neisseria meningitidis, which also cultured from the throat swab. It is suggested that N. meningitidis was the cause of the salpingitis in this case.

Adult↗

PubMed1979

Chlamydia trachomatis in acute salpingitis.

In a study to evaluate the possible role of Chlamydia trachomatis and Neisseria gonorrhoeae in acute salpingitis, 26% of 106 patients with severe symptoms had positive culture results for C. trachomatis; 43% of the 72 patients from whom paired sera were obtained had either positive culture results for or seroconversion in the single antigen immunofluorescence test to C. trachomatis. Twenty-six per cent of patients harboured N. gohorrhoeae and 14% had gonococcal complement-fixing antibody titres greater than or equal to 8. Intrauterine devices were used by 48% of patients, no difference being found in the frequency of use between patients harbouring C. trachomatis or N. gonorrhoeae. The possible role of C. trachomatis should be considered in the treatment of acute salpingitis.

Acute Disease↗