Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis.

Chlamydia trachomatis was isolated from 17 (24%) of 71 patients with acute salpingitis (AS) hospitalized for parenteral treatment. For patients with AS, antimicrobial therapy was started immediately on admission and before the availability of culture results. Notable clinical response was seen in 16 of 17 chlamydial-positive cases. Despite apparent clinical cure, posttreatment cultures from the endometrial cavity yielded C trachomatis from 12 of 13 patients treated solely with second- or third-generation cephalosporins as single-agent therapy. The finding of persistent chlamydial infection of the endometrium suggests that some patients treated for AS, despite apparent clinical response, maintain chlamydial infection of the endometrium that might cause relapse or chronic fallopian tube infection with tubal obstruction and infertility, or perhaps reflect a similar tubal persistence of Chlamydia. Treatment of AS should routinely include coverage for C trachomatis, as clinical response and findings may not reflect its presence or persistence.