Anatomic sites of upper genital tract infection

The microbiologic correlates of upper genital tract infection were studied among 36 women with suspected upper genital tract infection and 11 control women undergoing tubal ligation. Laparoscopic evidence of confirmed salpingitis was seen in 25 (69%) of the 36 women. Pathologic evidence of endometritis was present in 26 women (72%), and 22 (85%) of them had salpingitis as well. Thus, four women had endometritis but no salpingitis, three women had salpingitis but no endometritis, and seven women had neither. Among the 25 women with salpingitis, one or more organisms were isolated from the fallopian tubes of nine women (36%) and from the cul-de-sac of six women (24%), versus none and one (9%), respectively, among the 11 cases without salpingitis, and one (9%) and none among the 11 control women. Among the 26 cases with endometritis, one or more organisms were isolated from the endometrium of 19 women (73%) versus 12 (67%) among the 18 women without endometritis. Chlamydia trachomatis was isolated from the uterine cavity of nine women and from the fallopian tubes of three women with upper genital tract infection. The corresponding figures for Neisseria gonorrhoeae were three and two. Other nongonococcal nonchlamydial organisms were commonly isolated from the fallopian tubes and/or culde-sac of women with salpingitis. Bacteria frequently were isolated from the endometrium of both study cases and control subjects, but the latter were more likely to have nonpathogens of low virulence.