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  • Title: The bacteriology of acute pelvic inflammatory disease.
    Author: Chow AW, Malkasian KL, Marshall JR, Guze LB.
    Journal: Am J Obstet Gynecol; 1975 Aug 01; 122(7):876-9. PubMed ID: 807109.
    Abstract:
    The bacteriology of acute pelvic inflammatory disease (PID) was studied in 20 patients by simultaneous cul-de-sac, cervical, and blood cultures with aerobic and fastidious anaerobic techniques. Cul-de-sac cultures were positive in 18 of 20 patients, while all 8 normal control subjects yielded negative results (p less than 0.0005, chi-square analysis). Anaerobic bacteria (predominatly Peptococcus and Peptostreptococcus) were present in 10 patients (59 per cent), and they were the exclusive isolates in 3 patients. N. gonorrhoeae was isolated only once from the cul-de-sac despite its presence in cervical specimens. There was poor correlation between cul-de-sac and cervical cultures. Cervical cultures yielded a variety of aerobic and anaerobic bacteria with an average of 3.8 organisms per specimen. N. gonorrhoeae was isolated in 13 patients (65 per cent). Only 19 per cent of cervical isolates were recovered by culdocentesis; similarly, only 31 per cent of cul-de-sac isolates were simultaneously isolated from the cervix. Blood cultures were uniformly negative. These data suggest that: (1) culdocentesis is a reliable technique for the bacteriologic diagnosis of acute PID, and (2) whereas the gonococcus may be important in initiating acute PID, its primary role appears to be paving the way for secondary invaders from the normal vaginal flora to gain access to the upper genital tract. Simultaneous cervical, cul-de-sac, and blood cultures were taken from 20 patients with acute pelvic inflammatory disease (PID) in order to study the micro-biology of this disease. To determine the value of cul-de-sac cultures, they were also obtained from 8 healthy controls. The cultures were carefully collected, transported, and processed in order to maximize the recovery of of aerobes and anaerobes. Positive cul-de-sac cultures in 90% of the cases yielded 48 microorganisms. Anaerobes were isolated from 10 of the cases (predominately Peptococcus and Peptostreptococcus) and were exclusive isolates in 3, whereas aerobes (predominately Streptococcus) were exclusive in 8 patients. Only 1 cul-de-sac culture yielded N. gonorrhoeae, and the 8 control cultures were all negative. On the other hand, cervical culture yielded 77 microorganisms (only 15 of which were found in simultaneous cul-de-sac cultures), and N. gonorrhoeae was found in 13 patients. All blood cultures were negative. It is concluded that the primary role of gonococcus may be to allow normal vaginal flora to gain access to the upper genital tract. Confirmation of this possibility would mean that cervical gonococci isolates are not necessarily responsible for upper genital tract symptoms, and erradication of this organism may, therefore, not be adequate therapy for PID. Culdocentesis is of great value in diagnosing the specific microbes in acute PID and can be safely performed after the possibility of unsuspected tuboovarian abscesses has been eliminated by careful bimanual examination.
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