Clinical staging of acute bacterial salpingitis and its therapeutic ramifications

The use of single-drug therapy results in an overall 13% to 17% failure rate, and even this figure is misleading, because of the high prevalence of patients with uncomplicated disease. In patients with polymicrobial peritonitis, the failure rate varies between 30% and 60%, depending upon whether Neisseria gonorrhoeae can be concomitantly isolated from the cul-de-sac and the criteria used to define therapeutic cure. THe complexity of disease as we now understand it requires a corresponding degree of therapeutic individualization. In the Gainesville staging, acute salpingitis is subdivided into five stages. Stage I is acute endometritis-salpingitis without peritonitis. Stage II is salpingitis with peritonitis. Stage III is acute salpingitis with superimposed tubal occlusion or tuboovarian complex. Stage IV is where a tuboovarian abscess has ruptured. Stage V is a repository category for different etiologic agents which may emulate acute salpingitis, i.e., Mycobacterium tuberculosis. Each stage of disease differs by virtue of its therapeutic goal and the means by which this goal is achieved.