Cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis and gonococcal endocervicitis

Abstract

Neisseria gonorrhoeae was cultured from the cul-de-sac in 11 of 17 patients with bacteriologically documented gonococcal endometritis-salpingitis and identified by Gram stain in one other instance. In five, N. gonorrhoeae was the only isolate. In six other patients, the presence of other aerobic (two) and anaerobic bacteria (three), as well as N. gonorrhoeae, was documented. In the remaining six patients, only aerobic and anaerobic organisms were isolated. The data are interpreted as supporting the concept of anaerobic superinfections following initial infection with N. gonorrhoeae late in the course of this disease entity.

PIP: Bacteriologic observations derived by culdocentesis in 17 women with gonococcal endometritis-salpingitis from whom 1 or more bacteria were isolated are reported. Neisseria gonorrhoeae was cultured from the cul-de-sac in 11 cases and identified by Gram stain in 1 additional case. N. gonorrhoeae was the only isolate in 5 of these patients. Concomitantly with N. gonorrhoeae, aerobic bacteria were recovered in 2 cases and multiple anaerobic bacteria in 4 cases. In the remaining 6 cases, only aerobic and anaerobic organisms were isolated. Analysis of the Gram stain of the endocervix revealed the presence of intracellular gram-negative diplococci in 10 of 11 smears where N. gonorrhoeae was isolated. Diplococci were not demonstrated when N. gonorrhoeae was absent from the culdocentesis fluid. The data tend to refute the concept of a polymicrobial etiology for pelvic inflammatory disease, suggesting instead progressive anaerobic superinfection with nonrecovery and probable elimination of N. gonorrhoeae. The presence of aerobic/facultative anaerobes with obligatory anaerobes argues against an end-stage anaerobic environment.