Etiology of acute pelvic inflammatory disease proven by laparoscopy.

Abstract

Only a few studies have investigated the etiology of acute pelvic inflammatory disease (PID) in laparoscopy-proven cases using pelvic samples for culture. Most of these studies were conducted in North America and Scandinavia. To study the microbial etiology of laparoscopy-proven acute pelvic inflammatory disease in Israeli women. A prospective survey of women admitted to a hospital for treatment of acute pelvic inflammatory disease. All diagnoses were laparoscopy confirmed. Specimens for culture were obtained from the pelvic cavity via the laparoscope, and two serum samples were sent for serologic studies. Forty patients were studied. Their mean age was 34.4 years of age, and 27.5% had a history of PID. Chlamydia trachomatis infection was diagnosed in 14 (35%) patients (group A). Facultative and/or anaerobic bacteria were isolated from pelvic specimens of 7 (17.5%) patients (group B), one of these patients also had positive chlamydial serology. Mycoplasma hominis was cultured from a pelvic specimen of one woman, and herpes simplex virus grew from a pelvic sample of another patient in whom C. trachomatis was also found. In 19 (47.5%) women, the microbial etiology could not be determined (group C). In no case was Neisseria gonorrhoeae isolated. Stage I (mild) PID was diagnosed most often in group A (75% vs. 14% in group B [P < 0.02]), whereas the opposite was true for stage III (severe) PID (71.4% in group B vs 25% in group A [P = 0.07]). Tubal abscess was mainly diagnosed in group B patients (57% vs 16.6% in group A [P = 0.09]). In Israel, C. trachomatis is the most common cause of PID, while gonococci are rarely involved in this infection.