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Acute pelvic inflammatory disease: current concepts of pathogenesis, etiology, and management.

In summary, acute salpingitis is an extremely common disease with much morbidity and is undoubtedly increasing in incidence as a result of the increasing incidence of gonorrhea; the increasing use of the IUD as a means of fertility control almost certainly also contributes to the problem. It is remarkable that research concerning the pathogenesis, etiology, diagnosis, and treatment of salpingitis has been all but nonexistent in the United States until recently. We believe that evidence implicating IUD usage in salpingitis now makes it obligatory that individuals involved in family planning research determine the actual morbidity associated with IUD usage. Prospective cohort studies comparing the subsequent morbidity in patients randomly assigned to IUD versus other contraceptive methods are long overdue. The morbidity due to salpingitis associated with specific types of devices should also be compared. Other factors responsible for the breakdown in local antimicrobial defense mechanisms in women who develop salpingitis require further study. Clinical gynecologists must determine in the future the optimal method for the treatment of nongonococcal salpingitis, for which no clear-cut therapeutic recommendations are available at the present time. Such therapeutic studies should be conducted in conjunction with innovative studies concerning the etiology of nongonoccal salpingitis. The need for removal of an IUD from patients with salpingitis should be determined. Public health officials appear to have largely ignored the problem of salpingitis in patients attending public VD clinics and have not been notably successful in making the public aware of the nature of the early manifestations of salpingitis, of the need to seek early treatment in order to preserve fertility, and of the need to treat sexual partners of women with gonococcal infections. Investigations of infectious diseases in general, and pelvic inflammatory disease in particular, must increasingly enter the mainstream of research in the future if this disease is to be effectively treated and/or prevented in gynecologic patients.