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  • Title: Polymicrobial etiology of acute pelvic inflammatory disease.
    Author: Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS, Wang SP, Wentworth BB, MacCormack WM, Holmes KK.
    Journal: N Engl J Med; 1975 Jul 24; 293(4):166-71. PubMed ID: 806017.
    Abstract:
    We studied 204 women with acute pelvic inflammatory disease to delineate further the causes of that illness. Gonococci were recovered from 91. Gonococcal pili antibody rose or fell significantly in 12 of 18 patients with positive cultures and only two of 19 who had negative cultures and smears for Neisseria gonorrhaoea(P smaller than 0.005). N. gonorrhoeae was found in peritoneal exudate from eight of 21 patients with, and none of 33 without, cervical gonococcal infection. Among patients with severe disease, other bacteria were recovered from peritoneal exudates from five of 16 with, and 19 of 22 without, cervical gonococcal infection (P smaller than 0.025). Mixed anaerobic and aerobic bacterial peritoneal infection was common in nongonococcal pelvic disease. The most common species recovered were Bacteroides fragilis, peptostreptococci, and peptococci. Tuboperitoneal gonococcal infection probably causes pelvic inflammatory disease in most patients with cervical gonococcal infection, whereas polymicrobial tuboperitoneal infection probably causes most nongonococcal cases. A series of 204 women with acute pelvic inflammatory disease (PID) were studied to determine the microorganisms responsible for infection. Endocervical and blood cultures were performed. 91 of the 204 had gonococci recovered from cervical material. Among those whose cultures grew Neisseria gonorrhoeae, gonococcal pili rose or fell significantly in 12 of 18 patients with positive cultures and in only 2 of 19 who cultured negative (P .005). Peritoneal exudated bore N. gonorrhoeae in 8 of 21 patients with, and none of 33 without, cervical gonococcal infection. Other bacteria, including Bacteroides, peptostreptococci, and peptococci, were cultured from peritoneal exudates in 5 of 16 with and 19 of 22 without cervical gonococcal infection (P .025). When cervical gonococci are found, PID is probably caused by tuboperitoneal gonococci infection, whereas nongonococcal cases are probably caused by mixed, polymicrobial infections of the tuboperitoneum.
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