Anaerobic infections of the pelvis.

In normal nonpregnant women anaerobes predominate in the cervicovaginal flora. The frequency of Bacteroides fragilis isolation ranges up to 16%. In pregnancy anaerobic prevalence falls progressively from the first to the third trimester and increases precipitously immediately after delivery. Anaerobes are often responsible for infections from vulva to ovaries, but the microbial etiology of post-cesarean section endometritis remains unclear. Risk factors for pelvic infection include cesarean delivery as contrasted with vaginal delivery; among those undergoing cesarean section, risk factors for infection are prolonged labor, prolonged membrane rupture, excessive numbers of vaginal examinations, and perhaps age of less than 17 years. Gonorrhea is also a risk factor for subsequent pelvic infection. The use of an intrauterine contraceptive device is associated with increased risk of pelvic actinomycosis. Anaerobic disease often is associated with a putrid odor and may present as 1 or more pulmonary emboli. Optimal treatment of pelvic anaerobic infections is not yet agreed upon. Clindamycin and chloramphenicol are the 2 documented first-line agents. Penicillin is often effective but a substantial percentage of B fragilis strains resist it; this is also true of carbenicillin. The data on cefoxitin look encouraging, but more data are needed on both the efficacy and the frequency of superinfection.