Significance of polymicrobial bacterial superinfection in the therapy of gonococcal endometritis-salpingitis-peritonitis.

The application of sophisticated anaerobic technology coupled with culdocentesis has radically altered out concepts of endometritis-salpingitis-peritonitis (ESP). The demonstration of a polymicrobial predominantly anaerobic peritonitis in selected cases of ESP polarized conceptual thought into gonococcal and nongonococcal etiology. The data that substantiated the concept of anaerobic infection following initial infection by Neisseria gonorrhoeae are reviewed. Therapy studies utilizing doxycycline have indicated that there is an anticipated therapeutic response when dealing with monoetiologic disease (gonococcal ES or gonococcal ESP). When polymicrobial infection ensues with or without the concomitant presence of N gonorrhoeae, an alternate therapeutic response may evolve. It is currently postulated that the significance of an altered therapeutic response is due to augmented structural damage to the fallopian tubes by superinfecting anaerobes. The current goal of therapy is to reproduce as closely as possible the anticipated therapeutic response observed with monoetiologic disease.