Acute
salpingitis is one of the most common acute
gynecologic diseases and occurs in approximately 750,000 women each year in the United States. Use of laparoscopy to confirm the diagnosis of acute
salpingitis has shown that the signs and symptoms classically ascribed to this disease are not specific to it.
Fever,
leukocytosis, elevated ESR and adnexal masses or swelling are not necessary to make a diagnosis of acute
salpingitis. Lower
abdominal pain and adnexal tenderness are the most consistent findings. Microbiologic data obtained by laparoscopy and culdocentesis have raised questions about the role of N. gonorrhoeae in
salpingitis and have demonstrated that, as in
pelvic infections generally, acute
salpingitis is associated with mixed aerobic-anaerobic bacterial flora. Good results in the treatment of acute
salpingitis depend upon: (1) early diagnosis, (2) hospitalization and
bed rest, (3) the use of
antibiotic therapy that takes into account the polymicrobial etiology of acute
salpingitis, (4) prevention of recurrent episodes of
salpingitis through efforts at patient education and identification and treatment of sexual partners. Most important, we must remember that what is at stake is often the future reproductive potential of a young woman. It must be weighed against both patient and physician convenience and cost. Further investigative efforts are essential to determine the role of IUDs in
pelvic infections, discover the true microbiologic etiology of
salpingitis and establish appropriate antimicrobial treatment as determined by prospective, microbiologically controlled investigations.