Treatment of acute salpingitis--with special reference to Chlamydia trachomatis

Conservative treatment of acute salpingitis should be the rule, surgery the exception. Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, are common etiological agents in pelvic inflammatory disease, particularly in women below the age of 25 years. In women above that age as well as in those with two or more episodes of acute salpingitis, there is a higher proportion of tubal infections caused by aerobic and facultatively anaerobic bacteria. Apart from some resistant strains, tetracycline generally has an effect on all three of the above-mentioned agents of sexually transmitted diseases (STD). We recommend that this drug be chosen if the results of etiological studies are not known when therapy is started. If there is reason to believe that anaerobic bacteria may be involved, tetracycline may be combined with nitroimidazole. The short-term effects of various antibiotic drugs in acute salpingitis suggest that women with gonococcal salpingitis will respond sooner than will women with non-gonococcal salpingitis, regardless of which antibiotic regimen is given. The long-term effect of several different antibiotics on the post-salpingitic fertility does not differ. Glucocorticosteroids do not seem to positively influence the prognosis for fertility. To help prevent salpingitis, it is important to advise patients on appropriate contraceptive usage and to examine and treat both patients and consorts for STD.