Neisseria gonorrhoeae and Chlamydia trachomatis can be isolated in many, if not most, cases of PID, and therapy has traditionally been directed primarily against these organisms. However, newer, more sensitive and specific evaluative tools have become available which have significantly improved our understanding of PID. Polymicrobial infection, including anaerobic and aerobic vaginal flora, has clearly been demonstrated in studies relying on cultural material from the upper reproductive tract.2 Earlier culdocentesis studies suggested that 80 percent of PID was polymicrobial, but there is evidence that this may represent a degree of contamination of the cul-de-sac by the procedure. Laparoscopy cultures more conservatively point to mixed infection in 30 to 40 percent of cases. Pathogenic organisms may include anaerobes, Gardnerella vaginalis, enteric gram-negative rods, Hemophilus influenzae, Streptococcus agalactine, Mycoplasma hominis, and Urea urealyticum. N. gonorrheae and C. trachomatis may often be instrumental in the initial infection of the upper genital tract, while anaerobes, facultative anaerobes, and other bacteria are increasingly isolated as inflammation increases and abscesses form. Gardnerella vaginalis may also play a role in the initiation of ascending infection.3 The microbiology of PID also reflects the predominant sexually transmitted diseases present within a given population.
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