Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis
R. L. Sweet, J. Schachter and M. O. Robbie
Chlamydia trachomatis was isolated from 17 (24%) of 71 patients with acute
salpingitis (AS) hospitalized for parenteral treatment. For patients with
AS, antimicrobial therapy was started immediately on admission and before
the availability of culture results. Notable clinical response was seen in
16 of 17 chlamydial-positive cases. Despite apparent clinical cure,
posttreatment cultures from the endometrial cavity yielded C trachomatis
from 12 of 13 patients treated solely with second- or third-generation
cephalosporins as single-agent therapy. The finding of persistent
chlamydial infection of the endometrium suggests that some patients treated
for AS, despite apparent clinical response, maintain chlamydial infection
of the endometrium that might cause relapse or chronic fallopian tube
infection with tubal obstruction and infertility, or perhaps reflect a
similar tubal persistence of Chlamydia. Treatment of AS should routinely
include coverage for C trachomatis, as clinical response and findings may
not reflect its presence or persistence.
