Current views of the etiology of salpingitis are widely divergent, partly because of epidemiologic and clinical differences in various studies. Of all genital pathogens, Neisseria gonorrhoeae has been the best documented as a cause of salpingitis, yet even the role of gonococci in salpingitis has been controversial. The proportion of salpingitis cases attributable to N. gonorrhoeae has been influenced by contraceptive usage patterns and by the racial composition of the population studied. Gonococcal strains also may vary in propensity to cause salpingitis. For example, among white women we have found that Arg−Hyx−Ura− strains accounted for 32 (42%) of 76 isolates associated with salpingitis vs. 38 (72%) of 53 associated with uncomplicated gonorrhea (p = 0.0001). There is little doubt Chlamydia trachomatis also causes salpingitis, although the role of chlamydiae is uncertain in culture-negative patients who have high serum antibody titers against this agent. Other organisms, including facultative pathogens, such as coliforms, Haemophilus influenzae, groups B and D streptococci, and Mycoplasma hominis, and anaerobes, such as peptococci, peptostreptococci, and Bacteroides species, often have been implicated, particularly in recurrent or severe salpingitis or in intrauterine device-associated cases, usually but not always in the absence of gonococcal infection. Comprehensive microbiologic study of tuboperitoneal specimens obtained at laparoscopy or laparotomy must be combined with comprehensive serologic studies in patients with salpingitis who are well characterized clinically and epidemiologically in order to resolve which organisms are involved, in what combination, and in which type of patient.