Observations concerning the microbial etiology of acute salpingitis.

OBJECTIVES: The specific aims of this study were (1) to describe the microbiologic characteristics of patients with acute salpingitis and (2) to determine the incidence of bacterial vaginosis in patients with acute salpingitis and whether bacterial vaginosis microorganisms were common upper-genital-tract isolates in these patients. STUDY DESIGN: Women with pelvic inflammatory disease underwent laparoscopy to confirm the diagnosis of acute salpingitis and for culture of the fallopian tubes and cul-de-sac. Endometrial and minute fimbrial biopsies were performed, and specimens were evaluated for evidence of inflammation. Bacterial vaginosis was diagnosed by vaginal Gram stain. RESULTS: Eighty-four patients had visually confirmed acute salpingitis. Neisseria gonorrhoeae or Chlamydia trachomatis was isolated from 65 (77.4%) patients. Vaginal microorganisms were isolated from the endometrium in 16 (31.4%) of 51 cases and from the cul-de-sac in 12 (14.3%) of 84 cases. Bacterial vaginosis was present in 61.8% of patients with acute salpingitis, and 100% of anaerobes isolated from the upper genital tract of patients with acute salpingitis were bacterial vaginosis microorganisms. These anaerobes were isolated from the upper genital tract in the absence of a concurrent gonococcal, chlamydial, or Haemophilus influenzae infection in only two cases. CONCLUSIONS: The initiation of acute salpingitis is predominantly due to the ascending spread of sexually transmitted microorganisms. Bacterial vaginosis is a common concurrent disorder of women with acute salpingitis, and bacterial vaginosis microorganisms are commonly isolated from the upper genital tracts of patients with pelvic inflammatory disease.

Microbial etiology of urban emergency department acute salpingitis: treatment with ofloxacin.

OBJECTIVES: We attempted to define the microbiologic characteristics of acute salpingitis in women presenting to an urban emergency department with pelvic inflammatory disease and to determine the effectiveness of ofloxacin in treating this disease. STUDY DESIGN: Women with pelvic inflammatory disease underwent laparoscopy to confirm the diagnosis and to culture the fallopian tubes and cul-de-sac. All patients (n = 36) were treated with parenteral ofloxacin and discharged on a regimen of oral ofloxacin to complete a 10- to 14-day course. RESULTS: Neisseria gonorrhoeae was isolated from at least one site in 25 patients (69.4%) including the fallopian tube or cul-de-sac in 12 of them. Chlamydia trachomatis was isolated from the endocervix and/or endometrium in 6 patients (16.7%); concomitant Neisseria gonorrhoeae was present in 4 patients (66.6%). A polymicrobial infection was identified in only one patient. All patients responded to antibiotic therapy with ofloxacin. CONCLUSIONS: Acute salpingitis in our urban emergency department population is related primarily to upper genital tract infection with Neisseria gonorrhoeae. Ofloxacin is effective therapy for this disease.

The importance of wound infection in antibiotic failures in the therapy of postpartum endometritis.

A prospective, randomized, double-blind trial was done to compare the efficacy of cefoxitin (2 grams given intravenously every six hours) with ceftizoxime (2 grams given intravenously every 12 hours) in the treatment of postpartum endometritis. Thirty-eight patients received cefoxitin and 43 received ceftizoxime. Demographic variables (age, gravidity, parity and estimated gestational age) and risk factors (cesarean section, operating time, duration of ruptured membranes and labor, number of vaginal examinations and internal monitoring) were not statistically different in the two antibiotic groups. In the cefoxitin group, eight of 38 patients failed initial antibiotic therapy and six of 43 patients in the ceftizoxime group failed (p = 0.399). In the univariate analysis, abdominal wound infection (p = 0.003) and higher gestational age (p = 0.008) were associated with failure of the antibiotic. With multiple logistic regression, only abdominal wound infection was associated with failure of the antibiotic (p = 0.0002). We conclude that cefoxitin and ceftizoxime are equally effective in the therapy of postpartum endometritis and that abdominal wound infection is primarily responsible for persistent fever and, therefore, failure of the antibiotic in patients with postpartum endometritis.

Evaluation of the effects of a female condom on the female lower genital tract.

The purposes of this study were to determine if use of the female condom (Reality) was traumatic to the vaginal mucosa and/or vulvar skin and to determine its effect on resident vaginal bacterial flora. Thirty subjects were randomly assigned to utilize the female condom or diaphragm during the study period. Initially and during 3 follow-up visits, each subject underwent colposcopic examination of the vagina, cervix, and vulva with photographic record, and qualitative fungal, aerobic and anaerobic cultures of the vagina. The two groups were compared with respect to the frequency of abnormal physical findings determined by both macroscopic and colposcopic examination. Visits were compared within each contraceptive group with respect to changes in resident vaginal flora. There was no evidence of significant trauma associated with the use of either contraceptive device during the study period. The resident vaginal flora did not significantly change during the three follow-up visits in patients using the female condom. In diaphragm users, lactobacilli were less frequently isolated at the third (14/15 vs 6/15, P = 0.008) and fourth (14/15 vs 7/15, P = 0.039) follow-up visits when compared to the initial visit. In addition, aerobic gram-negative rods were more frequently isolated during the fourth visit (1/15 vs 9/15, P = 0.021) when compared to the first visit. We conclude that neither the female condom (Reality) nor the diaphragm is associated with trauma to the lower genital tract. Subjects using the diaphragm undergo a significant change in vaginal bacterial flora, becoming more likely to be colonized with coliform microorganisms and less likely to maintain lactobacilli colonization.

PIP: The purposes of this study were to determine if use of the female condom (Reality) was traumatic to the vaginal mucosa and/or vulvar skin and to determine its effect on resident vaginal bacterial flora. 30 subjects were randomly assigned to utilize either the female condom or diaphragm during the study period. Initially and during 3 follow-up visits, each subject underwent colposcopic examination of the vagina, cervix, and vulva with photographic record, and qualitative fungal, aerobic, and anerobic cultures of the vagina. The 2 groups were compared with respect to the frequency of abnormal physical findings determined by both macroscopic and colposcopic examination. Visits were compared within each contraceptive group for changes in resident vaginal flora. There was no evidence of significant trauma associated with the use of either contraceptive device during the study period. Resident vaginal flora did not significantly change during the 3 follow-up visits in those patients using the female condom. In diaphragm users, lactobacilli were less frequently isolated at the 3rd (14/15 vs. 6/15, p=.008) and 4th (14/15 vs. 7/15, p=.039) follow-up visits when compared to the initial visit. In addition, aerobic gram-negative rods were more frequently isolated during the 4th visit (1/15 vs. 9/15, p=.021) when compared to the 1st visit. The authors conclude that neither the Reality condom nor the diaphragm is associated with trauma to the lower genital tract. Subjects using the diaphragm undergo a significant change in vaginal bacterial flora with greater likelihood of colonization with coliform microorganisms and less likelihood of maintenance of lactobacilli colonization.

False-positive cultures of the cul-de-sac associated with culdocentesis in patients undergoing elective laparoscopy.

We studied 21 women undergoing elective laparoscopy to determine whether positive bacterial cultures obtained by culdocentesis were contaminants from the vaginal mucosa. Cultures for aerobic and anaerobic microorganisms were prepared from swabs of the posterior vaginal fornix, laparoscopic cul-de-sac aspirates, culdocentesis aspirates, and repeat laparoscopic aspirates of the cul-de-sac. Cultures were positive from the vaginal fornix in all cases. All cultures from the cul-de-sac before culdocentesis were negative. Five of seven cultures (71.4%) from culdocentesis specimens and seven of nine cultures (77.8%) from repeat laparoscopic cul-de-sac aspirates were positive in women without povidone-iodine vaginal preparation. Five of 12 cultures (41.7%) from culdocentesis specimens and three of 12 cultures (25%) from repeat laparoscopic cul-de-sac aspirates were positive in the women with vaginal preparation. Both aerobic and anaerobic bacteria were recovered. We conclude that false-positive culdocentesis cultures occur and that bacterial contamination of the cul-de-sac following culdocentesis may lead to false-positive cultures of specimens obtained during subsequent laparoscopy.