Objective To determine the clinical features and microbial aetiology of acute salpingitis in women attending an inner city teaching hospital.Design Prospective, longitudinal cohort study.Subjects One hundred and forty‐seven women presenting consecutively with acute abdominal pain and clinical signs of acute salpingitis were evaluated microbiologically and laparoscopically.Results One hundred and four women (70.7%) had acute salpingitis diagnosed at laparoscopy. Other pathological conditions were identified in 20 women (13.6%). No visually identifiable pathology was found in 23 (15.6%). Thirty‐five women with acute salpingitis had evidence of pelvic adhesions (33.7%). Bilateral tubal occlusion was present in 6 (5.8%) cases. Chlamydia trachomatis was identified in the genital tract in 40 (38.5%) of the women with acute salpingitis and Neisseria gonorrhoeae in 15 (14.4%). A dual infection was present in eight cases (7.7%). Serological evidence suggested that a further seven women (6.7%) had acute chlamydial infections at the time of diagnosis. C. trachomatis was identified in the genital tract of 5/23 (21.7%) of the women who had no laparoscopic evidence of intra‐abdominal pathology.Conclusions The responsible care of women with suspected acute salpingitis depends on establishing an accurate diagnosis, so that appropriate therapy can be instigated. This study provides evidence to challenge the outpatient management of acute salpingitis on clinical grounds alone as potentially inadequate. Early laparoscopy in hospitalised women improves diagnostic precision and accurately determines disease severity, providing prognostic information for future fertility. In this urban population, sexually transmitted micro‐organisms were the commonest pathogens found in the genital tract of women with acute salpingitis. The high prevalence of C. trachomatis in these women suggests that appropriate chemotherapy for acute salpingitis should always include a specific antichlamydial agent.

Objective-To determine the sensitivity and specificity of ligase chain reaction (LCR) analysis ofcervical and urine specimens from women compared with cell culture ofcervical and urethral specimens for the diagnosis of genitourinary chlamydial infection. Methods-Women (n = 624) attending the Genitourinary Medicine Clinic at University College London Hospitals, were enrolled. Patients who had received antibiotics within the previous two weeks were excluded. Specimens were obtained from the urethra and cervix for chlamydial culture, and from the cervix for LCR. A specimen of first void urine was also obtained for LCR. Discrepancies were resolved by direct immunofluorescence or a major outer membrane protein targeted LCR, or both. Results-The prevalence of Chlamydia trachomatis in 600 patients, using an expanded standard of a positive cell culture or two confirmed positive non-culture tests, was 13-2% (79/600). Cervical culture detected 68-4% and urethral culture 62% of all positive results compared with 81% detected by cervical LCR and 69% by urine LCR. Cervical and urethral culture combined detected 87-3% whereas cervical and urine LCR combined detected 911% of positive cases. Specificity ofLCR was 100% in the cervix and 99-8% in urine. Conclusion-This study demonstrates that LCR analysis of cervical and urine specimens is a reliable method for the diagnosis of chlamydial genital infection in women. However, the study also demonstrates that no single test will detect all chlamydial infections. Conventional non-culture tests and cell culture may grossly underestimate the prevalence of chlamydial infection. LCR analysis of a cervical specimen was superior to conventional cell culture without blind passage as a single test for diagnosing chlamydial infection in women, followed by LCR of a urine specimen.

Ciprofloxacin was found to be the most active of a group of 4-quinolone antibiotics tested against the SA2 f strain of Chlarnydia trachomatis (MBC and MIC 1.0 rag/l). Against genital isolates of Chlamydia trachomatis, ciprofloxacin was twice as active as rosoxacin.Ciprofloxacin showed similar activity to that of oxytetracycline against clinical isolates of Mycoplasma hominis and Ureaplasma urealyticum, and was 8-fold more active than rosoxacin against the latter.Recently, a number of new 4-quinolones have become available. In comparison with chemically similar, older agents such as nalidixic acid, the new agents have a wider spectrum and greater activity.Their activity against Neisseria gonorrhoeae is particularly marked (1), including high activity against beta-lactamase producing strains. In view of their potential use in the treatment of gonorrhoea, we examined the activity of four second generation 4-quinolone derivatives, nalidixic acid and oxolinic acid against the SA2 f strain of Chlamydia trachomatis in cell culture. The 4-quinolones examined were norfloxacin (Thomas Morson), rosoxacin and WIN49375 (Sterling Winthrop) and ciprofloxacin (Bayer). The activity of ciprofloxacin and rosoxacin against ten recent clinical isolates of Chlamydia trachomatis and Ureaplasrna urealyticum and the activity of ciprofloxacin against ten recent clinical isolates ofMycoplasma hominis were also investigated. Materials and MethodsChlamydia trachomatis. The minimum inhibitory concentration (MIC) of nalidixic acid, oxolinic acid, rosoxacin, norfloxacin, WIN 49375, and ciprofloxacin were first determined against a standard strain of Chlamydia trachomatis. This strain, designated SA2f, is an LGVII serotype which serologically cross-reacts widely with the genital serotypes D-K. The activity of eiprofloxacin was further investigated by determining the minimum bactericidal concentration (MBC) against the SA2f strain. The MICs of rosoxacin and ciprofloxacin against ten recently isolated strains of Chlamydia traehomatis were then investigated. All ten strains were isolated from specimens obtained from the genital tract of patients attending a clinic for sexually transmitted diseases.1Department of Clinical Microbiology and 2Genito-Urinary Medicine University College Hospital, London WC1, England. Determination of MIC.The method used has been described elsewhere (2). Doubling dilutions of the antimicrobial agents were prepared in antimicrobial-free Chlamydia growth medium. One ml of each dilution was added to a flatbottomed plastic tube containing a cover slip monolayer of 5-iodo-2-deoxyuridine (IUDR) treated MCCoy ceils. A suspension of chlamydiae containing approximately 200 inclusion-forming units per ml was added to each tube. After centrifugation at 3,000 Xg for 1 h, the tubes were incubated for 38-40 h at 35 ~ The cover slips were removed, and the cell monolayer fixed with methanol and stained with either Giemsa for examination of autofluorescence using darkfield illumination, or iodine for examination of stained inclusions by b...

Enzyme immunoassays for the detection of chlamydial antigens are commonly used to diagnose Chlamydia trachomatis infection. As is true for ail nonculture methods, the specificities of these tests are a concern. A confirmatory blocking assay (Abbott Laboratories, North Chicago, Ill.) was evaluated at four sexually transmitted disease test sites. This assay is designed to confirm true-positive Chlamydiazyme (CZ) specimens and to identify false-positive CZ reactions caused by cross-reacting bacteria. Cervical specimens were collected from 2,891 women. Chlamydia prevalence by tissue culture (TC) was 9.2% (266 of 2,891 specimens). Compared with TC, the sensitivity and specificity of CZ were 78.9% (210 of 266 specimens) and 98.2% (2,577 of 2,625 specimens), respectively. There were 48 CZ false-positive reactions. The direct fluorescent-antibody test (DFA) was positive for 31 of 48 false-positive reactions, indicating culture misses. Thus, when the standard was both TC and DFA, CZ sensitivity was 81.1% and CZ specificity was 99.3%. Of the 17 CZ-positive patients who were negative by both TC and DFA, 3 were negative on repeat CZ and Il of 14 were identified as false positive by the confirmatory assay. The confirmatory test was positive for CZ-positive women who were positive by TC or DFA. Use of the confirmatory test, which increased the specificity to 99.9%, would increase confidence in positive CZ results and make the test more useful for screening populations with a low prevalence of C. trachomatis infection.