Acute
salpingitis complicating cervical gonococcal
infection is a significant cause of
infertility. Relatively little data are available concerning the pathophysiologic mechanisms of this disease. A cohort of 243 prostitutes residing in Nairobi were followed between March 1985 and April 1988. Gonococcal cultures were performed at each visit, and acute
salpingitis was diagnosed clinically. Serum at enrollment was tested by immunoblot for antibody to gonococcal outer
membrane proteins. 8.6% (146/1689) of gonococcal
infections were complicated by
salpingitis. Increased risk of
salpingitis was associated with younger age, shorter duration of prostitution,
HIV infection, number of gonococcal
infections, and episodes of nongonococcal
salpingitis. Rmp antibody increased the risk of
salpingitis. Antibody to Opa decreased the risk of
salpingitis. By logistic regression analysis, antibody to Opa was independently associated with decreased risk of gonococcal
salpingitis (adjusted odds ratio [OR], 0.35; 95% confidence interval [95%CI], 0.17-0.76);
HIV infection (adjusted OR, 3.5; 95% CI, 0.96-12.8) and episodes of nongonococcal
salpingitis (adjusted OR, 3.4; 95% CI, 1.8-6.4) were independently associated with an increased risk of
salpingitis. Antibody to Opa appears to protect against ascending gonococcal
infection, perhaps by interfering with Opa mediated adherence and endocytosis. The demonstration of natural immunity that protects against upper
genital tract infection in women suggests that a
vaccine to prevent gonococcal
salpingitis is possible.