Christina Brihmer

Salpingitis; aspects of diagnosis and etiology: a 4-year study from a Swedish capital hospital.

359 patients underwent laparoscopy to verify the diagnosis of salpingitis. Pelvic inflammatory disease (PID) was found in 187 (52%) cases. Laparoscopy revealed normal conditions in 136 (37%) cases. Other diseases were diagnosed in 36 (10%) cases. Bacteriological cultures from the fimbrial lumen were positive in 24% of the PID cases. Chlamydia trachomatis (CT) was detected in 12%, Bacteroides species (BS) in 5%, Actinomyces israelii (AI) in 3%, Gardnerella vaginalis (GV) in 2%, Neisseria gonorrhoeae (NG) in 1%, and Ureaplasma urealyticum (UU) in 1%. Cervical cultures were positive for NG and/or CT in 71% of the PID cases but only in 19% of the non-PID cases. From these no positive intra-abdominal cultures were detected. Serological tests for CT were carried out. A positive acute titre of greater than or equal to 1/64 was noted in 37%, a seroconversion (X4) 2-3 weeks later was found in 14%. Positive serology despite a negative culture was registered in 19%.

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis

Abstract In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild ( 16 64 ), a moderate ( 26 64 ), or a severe ( 22 64 ) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3–6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36 64 (56%) ( 9 16 with a mild form, 13 26 with moderate form and 14 22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15 64 (23%) ( 5 16 with a mild form, 4 26 with a moderate form and 6 22 with a severe form of the disease). Oviductal cultures for CT were found in 12 64 (19%) ( 1 16 with a mild form, 4 26 with a moderate and 7 25 with severe form of salpingitis). Oviductal isolates for NG were found in 2 64 (13%) ( 2 16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Sexual risk behavior in women with cervical human papillomavirus infection

In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad, oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI, i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI shows most of the epidemiological characteristics of a sexually transmitted disease.

Levels of Trimethoprim and Sulfamethoxazole in Human Oviduct Mucosa and Plasma

Abstract. The oviductal and plasma levels of trimethoprim (TMP) and sulfamethoxazole (SMZ) were studied in 9 women after oral and i.v. administration of a drug combination (EusaprimR, Wellcome Foundation Ltd.). The concentration of TMP in a healthy endosalpinx was found to be twice as high (4.7 μg/g, range 2.8–8.3) as in plasma (2.6 μg/ml, range 2.1–3.6). Conversely, the endosalpingeal level of SMZ (38 μg/g, range 12–65) was about half that in plasma (77 μg/ml, range 58–95). The agar well diffusion method was used for the concentration determinations. The specimens were collected during surgery for non‐infectious genital diseases. The implication of treatment by the given drugs is discussed.

Efficacy and Safety of Azithromycin versus Lymecyline in the Treatment of Genital Chlamydial Infections in Women

To compare the clinical and microbiological efficacy of azithromycin in curing chlamydial infections in women with that of lymecycline, and with a view of the possibility of minimizing the problem of compliance by means of single-dose administration, 146 women with culture-positive Chlamydia trachomatis infections were randomly assigned to treatment with a 1 g bolus dose of azithromycin or a 10-day course of lymecycline 300 mg twice daily. Clinical and microbiological evaluations were performed and adverse effects monitored at check-ups after 15-35 and 40-65 days. Of the 146 patients enrolled in the study, 120 were evaluable. At the second check-up, C. trachomatis was found to have been eradicated in all patients in both treatment groups. Of the 51 patients who had clinical signs and symptoms of genital infection at enrolment, 96% (22/23) of those in the azithromycin group were considered cured (n = 18) or improved (n = 4), as compared with 100% (28/28) of those considered cured (n = 22) or improved (n = 6) in the lymecycline group. Adverse events related, or possibly related, to treatment were reported by 16 (21.6%) of the lymecycline group, but by only 6 (8.3%) of the azithromycin group. The 2 drugs were comparable with regard to microbiological and clinical efficacy in the treatment of genital chlamydial infection in women. The markedly lower rate of side-effects associated with azithromycin may be a feature conducive to patient compliance.

Alpha-fetoprotein and the acute phase response. A study using acute pelvic inflammatory disease as a model system

Alpha-fetoprotein (AFP) is used as a tumor marker for hepatomas and germ cell tumors. In healthy non-pregnant adults the serum concentration (S-AFP) is very low and we examined whether it was affected when the acute phase response was activated, using patients with acute pelvic inflammatory disease (PID) as a model system. In 70 PID patients the median S-AFP was 1.2 kIU/l (range: 0.5-5.9 kIU/l), within the normal range. S-AFP did not correlate with the clinical grade of disease nor with the serum concentrations of acute phase reactants and albumin. Thus, S-AFP is not significantly affected by activation of the acute phase response and presence of infection should not per se interfere with the use of S-AFP as a tumor marker. However, a negative correlation was found with the serum concentration of alpha-2-macroglobulin (P = 0.05), but whether this has any biological significance remains to be clarified.

Levels of Ampicillin and Doxycycline in Human Oviduct Mucosa and Serum

Abstract. A common treatment for salpingitis today includes ampicillin (AMPI) and doxycycline (DC), the former against Neisseria gonorrhoeae and the latter against Chla‐mydia trachomatis. The concentrations of doxycycline in oviduct mucosa were found about equal to that of serum and well above the minimum inhibitory concentrations (MICs) for the bacteriae in question. The concentration of AMPI in the oviduct mucosa was only about 1/40 of that in serum, i.e. 1/10 of the MIC, which jeopardizes the effectivi‐ty of AMPI in the treatment of salpingitis.

DOXYCYCLINE IN HUMAN OVIDUCT MUCOSA AND PLASMA 24–30 HOURS AFTER AN ORAL DOSE OF 100 MG

Abstract. Oviductal and peripheral plasma concentrations 24 hours after the last dose of Doxycycline (DC) were studied in 17 patients. the concentration of DC in healthy oviduct raucosa was 1.3 μg/g (range 0.6–1.7) and 1.1 μg/ml (range 0.6– 1.7) in plasma. One patient with severe chronic salpingitis in acute exacerbation showed 3.6 μg/g in tissue and 2.4 μg/ml in plasma in proliferative phase.

Serum tetranectin in patients with acute pelvic inflammatory disease (PID): Correlation to clinical and laboratory findings

Aim of study. To clarify the impact of the presence of pelvic inflammatory disease (PID) and activation of the acute phase response on the serum level of tetranectin (Se‐TN), a potential new tumor marker for ovarian cancer.

Second Look Laparoscopy: Evaluation of Two Different Antibiotic Regimens after Treatment of Acute Salpingitis

In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3-6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease). Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis). Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).