Bacteriology of acute pelvic inflammatory disease. Suboptimal survival of Neisseria gonorrhoeae in a nonbuffered transport system.

In our earlier study, Neisseria gonorrhoeae was infrequently isolated while Bacteroides fragilis was totally absent from cul-de-sac aspirates of patients with acute pelvic inflammatory disease (PID). Twenty additional women were studied to further elucidate the bacteriology of this disease. Recovery rate of N. gonorrhoeae from cul-de-sac aspirates collected in selective transport medium (Transgrow) was 25 per cent among patients with gonococcal PID, compared to only 8 per cent when specimens were collected in a nonselective transport system (Anaport). In vitro studies confirmed a detrimental effect of the Anaport for survival of N. gonorrhoeae during transport. This suboptimal survival was primarily related to low pH of the transport system under prereduced conditions, and could be corrected when pH of the transport vial was preadjusted and maintained between 6 and 7. B. fragilis was again absent from the cul-de-sac in all patients, while streptococci, peptococci, and peptostreptococci remained the most predominant isolates. These data may explain the empiric observations that penicillin and tetracycline are effective in most cases of acute PID.