CLINICAL, LAPAROSCOPIC AND MICROBIOLOGICAL FINDINGS IN ACUTE SALPINGITIS - REPORT ON A UNITED-KINGDOM COHORT

Objective To determine the clinical features and microbial aetiology o f acute salpingitis in women attending an inner city teaching hospital . Design Prospective, longitudinal cohort study. Subjects One hundred and forty-seven women presenting consecutively with acute abdominal pa in and clinical signs of acute salpingitis were evaluated microbiologi cally and laparoscopically. Results One hundred and four women (70.7%) had acute salpingitis diagnosed at laparoscopy. Other pathological co nditions were identified in 20 women (13.6%). No visually identifiable pathology was found in 23 (15.6%). Thirty-five women with acute salpi ngitis had evidence of pelvic adhesions (33.7%). Bilateral tubal occlu sion was present in 6 (5.8%) cases. Chlamydia trachomatis was identifi ed in the genital tract in 40 (38.5%) of the women with acute salpingi tis and Neisseria gonorrhoeae in 15 (14.4%). A dual infection was pres ent in eight cases (7.7%). Serological evidence suggested that a furth er seven women (6.7%) had acute chlamydial infections at the time of d iagnosis. C. trachomatis was identified in the genital tract of 5/23 ( 21.7%) of the women who had no laparoscopic evidence of intra-abdomina l pathology. Conclusions The responsible care of women with suspected acute salpingitis depends on establishing an accurate diagnosis, so th at appropriate therapy can be instigated. This study provides evidence to challenge the outpatient management of acute salpingitis on clinic al grounds alone as potentially inadequate. Early laparoscopy in hospi talised women improves diagnostic precision and accurately determines disease severity, providing prognostic information for future fertilit y. In this urban population, sexually transmitted micro-organisms were the commonest pathogens found in the genital tract of women with acut e salpingitis. The high prevalence of C. trachomatis in these women su ggests that appropriate chemotherapy for acute salpingitis should alwa ys include a specific antichlamydial agent.