Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease.

OBJECTIVE: To study the microbiologic findings in relation to the severity of acute pelvic inflammatory disease (PID). STUDY
DESIGN: Of 72 women with acute PID verified and graded by laparoscopy and endometrial histopathology, 37 had mild PID and 35 had severe PID. Cervical, endometrial and tubal cultures were obtained for Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, facultative and anaerobic bacteria and herpes simplex virus.
RESULTS: C. trachomatis was the primary pathogenic agent in 44% of patients with acute PID. C. trachomatis and N. gonorrhoea were as common in both severity groups, although C. trachomatis was isolated significantly more frequently from the fallopian tubes among cases with severe PID. Where aerobic or facultative bacteria other than C. trachomatis or N. gonorrhoeae were concerned, Escherichia coli and Haemophilus influenzae were the most important aerobic bacteria isolated from the fallopian tubes. Anaerobic bacteria were recovered from the fallopian tubes significantly more frequently in cases with severe PID than in those with mild PID, whereas their presence in the endometrium was not related to the severity of PID.
CONCLUSIONS: The role of C. trachomatis as the leading cause of PID was confirmed in both laparoscopically mild and severe PID. Severe PID with abscess is invariably a polymicrobial infection with anaerobic bacteria involved, whereas their role in affecting the outcome of mild PID as well as the need of antianaerobic antimicrobial therapy in mild PID remains questionable.