The bacteriology of acute pelvic inflammatory disease

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.