Clinical, laparoscopic and microbiological findings in acute salpingitis: report on a United Kingdom cohort.
OBJECTIVE
To determine the clinical features and microbial aetiology of acute salpingitis in women attending an inner city teaching hospital.


METHODS
Prospective, longitudinal cohort study.


METHODS
One hundred and forty-seven women presenting consecutively with acute abdominal pain and clinical signs of acute salpingitis were evaluated microbiologically and laparoscopically.


RESULTS
One hundred and four women (70.7%) had acute salpingitis diagnosed at laparoscopy. Other pathological conditions were identified in 20 women (13.6%). No visually identifiable pathology was found in 23 (15.6%). Thirty-five women with acute salpingitis had evidence of pelvic adhesions (33.7%). Bilateral tubal occlusion was present in 6 (5.8%) cases. Chlamydia trachomatis was identified in the genital tract in 40 (38.5%) of the women with acute salpingitis and Neisseria gonorrhoeae in 15 (14.4%). A dual infection was present in eight cases (7.7%). Serological evidence suggested that a further seven women (6.7%) had acute chlamydial infections at the time of diagnosis. C. trachomatis was identified in the genital tract of 5/23 (21.7%) of the women who had no laparoscopic evidence of intra-abdominal pathology.


CONCLUSIONS
The responsible care of women with suspected acute salpingitis depends on establishing an accurate diagnosis, so that appropriate therapy can be instigated. This study provides evidence to challenge the outpatient management of acute salpingitis on clinical grounds alone as potentially inadequate. Early laparoscopy in hospitalised women improves diagnostic precision and accurately determines disease severity, providing prognostic information for future fertility. In this urban population, sexually transmitted micro-organisms were the commonest pathogens found in the genital tract of women with acute salpingitis. The high prevalence of C. trachomatis in these women suggests that appropriate chemotherapy for acute salpingitis should always include a specific antichlamydial agent.
Bevan
C D
CD
Department of Obstetrics and Gynaecology, University College London School of Medicine, UK.
Johal
B J
BJ
Mumtaz
G
G
Ridgway
G L
GL
Siddle
N C
NC
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000150:complications; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D015331:Cohort Studies; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012488:Salpingitis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D012749:Sexually Transmitted Diseases / Q000382:microbiology; D000267:Tissue Adhesions / Q000473:pathology