International Journal of STD & AIDS > Volume 20, Number 10 > Pp. 712-718

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Original research articles

Further observations, mainly serological, on a cohort of women with or without pelvic inflammatory disease

D Taylor-Robinson MD FRCP ^* , C M Stacey MD FRCOG , J S Jensen MD PhD , B J Thomas BSc PhD  and P E Munday MD FRCOG ^**

^* Division of Medicine, Imperial College London, St Mary's Campus, Paddington, London W2 1NY; Community Sexual Health Services, City and Hackney Teaching Primary Care Trust, St Leonard's Primary Care Centre, Nuttall Street, London N1 5LZ, UK; Mycoplasma Laboratory, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark; Immunisation Department, Centre for Infection, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ; ^** Watford Sexual Health Centre, Watford General Hospital, Vicarage Road, Watford WD18 0HB, UK

Correspondence to: Professor D Taylor-Robinson Email: dtr{at}vache99.freeserve.co.uk

An analysis was undertaken of data pertaining to over 100 women with lower abdominal pain who were laparoscoped. Prior to laparoscopy, 11 of the women were considered to almost certainly have salpingitis, of whom six (55%) had salpingitis at laparoscopy; 17 to probably have salpingitis, of whom six (35%) did; 28 to possibly have salpingitis, of whom five (18%) did; and 56 to be very unlikely to have salpingitis, of whom five (9%) did. Of the 22 women who had salpingitis at laparoscopy, 14 (64%) had a Chlamydia trachomatis IgG antibody titre of 1:128 and might reasonably be regarded as having chlamydial disease on this basis; six without such a titre probably did not have chlamydial disease as C. trachomatis could not be detected at any genital site. At laparoscopy, 18 women had adhesions without obvious tubal inflammation; clinically, 15 of them had been regarded as possibly having salpingitis or unlikely to have it, with 12 having chronic pelvic pain. Twelve (67%) of the 18 women had a chlamydial IgG antibody titre of 1:128. IgM antibody was also detected most often in the ‘salpingitis’ group. Of 49 women without any abnormality detected at laparoscopy, nine (18%) had a high chlamydial IgG antibody titre. Overall, a woman who had a high titre of chlamydial IgG antibody and acute pelvic pain, together with a clinical picture of pelvic inflammation, was more likely to have salpingitis than adhesions alone. Likewise, a woman who had a high titre of chlamydial IgG antibody and chronic pelvic pain, together with a clinical picture suggesting that salpingitis was unlikely, was more likely to have adhesions alone than acute chlamydial salpingitis. However, while antibody measurement and seeking cervical C. trachomatis may help in formulating a diagnosis, there seems no simple way of detecting the small proportion of women who are infected by C. trachomatis in the upper genital tract but whose laparoscopic findings indicate normality. So far as patient care is concerned, the only way of preventing damage to the upper genital tract is to treat early on the basis of suspicion.

Key Words: pelvic inflammatory disease • salpingitis • adhesions • laparoscopy • Chlamydia trachomatis • serology

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