AbstractsThe etiology of salpingitis has changed in the last decade because of the increased incidence of Chlamydia trachomatis and the decreased incidence of Neisseria gonorrhoeae. The aim of the present investigation was to analyze the basis for a possible change of diagnostic approach according to the current bacteriological environment.During 4 consecutive years (1981–1984), 359 patients were admitted to the Department of Obstetrics and Gynecology at Danderyd Hospital for suspected salpingitis. Upon admission, cervical cultures were taken, and diagnostic laparoscopy was performed within 24 hours and before the initiation of therapy. Laparoscopy made it possible to distinguish salpingitis from other diseases and from normal conditions. The results are given in Table 1, showing that in about one-half of the examined cases, the laparoscopic diagnosis was not salpingitis. Normal internal genitalia were found in more than one-third of the cases.The classical picture of pelvic inflammatory disease (PID) includes onset of symptoms coincident with the menstrual period (symptoms of urethritis and proctitis). None of these symptoms turned out to be significant for cases in which laparoscopy revealed acute salpingitis.Each patient had a genital examination by an experienced gynecologist, who decided whether there was a palpable mass indicating an adnexal illness. This turned out to be an unreliable means of diagnosing salpingitis because the examination had a sensitivity of only 29 per cent and a specificity of 74 per cent. On the basis of information gained from medical history, laboratory tests, clinical symptoms and signs, and gynecological examination, each patient was assigned to one of two groups: 1) those with clear cases of salpingitis and 2) those with suspected salpingitis. When checked by laparoscopy, the sensitivity and specificity of the clinical diagnosis of a clear case of salpingitis showed even less impressive figures, displaying a sensitivity of 24 per cent and a specificity of 82 per cent.Samples for bacterial isolation were taken in order to evaluate the etiology of each case. They were obtained from the cervical canal, the fimbrial end of the oviduct, or the pouch of Douglas. Potentially pathogenic microorganisms were isolated from the cervical canal and the oviduct in 95 per cent of the cases. There were no detectable isolates from the pouch of Douglas. On the other hand, 52 per cent of those who had no laparoscopically verified salpingitis had potentially pathogenic bacteriae isolated from the cervix. Cervicitis was diagnosed in 39 per cent of the patients. In the majority of the cases, more than one bacterial isolate was identified. Patients with previous histories of salpingitis (N = 24; 12.8 per cent) showed no significant difference in etiology of their current disease, except for N. gonorrhoeae. This organism was detectable in only 8.3 per cent of those with histories of salpingitis, as compared with 19.8 per cent of the group with no history of the disease. This was also the case with Bac-teroides (20.8 and 33.1 per cent, respectively). No bacterial growth was found in samples from the abdominal cavity in non-PID cases.In the salpingitis cases, 24 per cent (N = 44) had positive oviductal cultures: C. trachomatls was found in 12 per cent (N = 22), Bacteroides in 5 per cent (N = 9), N. gonorrhoeae in 2 per cent (N = 4), Actinomyces israeli in 2 per cent (N = 4), Gardnerella vaginalis in approximately 1 per cent (N = 3), and Ureaplasma urealyticum in 1 per cent (N = 2).Serological samples, drawn on admission and 2 to 3 weeks later, indicated chlamydial infection in 51 per cent. An acute titre of one/64 or greater was found in 37 per cent, and seroconversion (×4) in 14 per cent. In 19 per cent, there was serological evidence of chlamydial infection (one/64 or greater in 16 per cent and seroconversion (×4) in 3 per cent) despite negative cultures.The degree of salpingitis varied from mild to severe. Extragenital spread of the intraabdominal infections was not totally correlated with the degree of salpingitis. In the eight cases showing perihepatitis at laparoscopy, five cases were grade II and three were grade III. N. gonorrhoeae from the cervix was detected in one case, and C. trachomatis from the same source was detected in three. One patient was C. trachomatis positive from both the cervix and the oviduct. In seven patients, laparoscopy revealed periappendicitis. C. trachomatis was isolated from the cervix in five of the patients and N. gonorrhoeae in one. Three patients were operated on because laparoscopy revealed appendicitis, the infection having spread to the appendix from the affected oviduct. Four showed signs of perisigmoiditis, one in the grade II group and three in the grade III group. All four harbored C. trachomatis in the cervix, and one of them had this organism in the oviduct as well. Two patients in the grade III group were operated on because of a mechanical ileus, and C. trachomatis was detected in both (in one, from the cervix only; in the other, from the cervix and the oviduct).