A comparison of the fallopian tube's response to overt and silent salpingitis.

We examined two groups of infertile women who underwent microsurgical repair of their fallopian tube(s) for distal tubal obstruction, one with a history of salpingitis (overt pelvic inflammatory disease) (N = 34) and one without (silent pelvic inflammatory disease) (N = 25). Nine women with normal tubes undergoing hysterectomy and salpingectomy served as controls. Tubal biopsy specimens were studied by light, scanning, and transmission electron microscopy to assess tubal damage. Morphologic damage was scored 0-9, with 0 representing normal tubal architecture and 9 assigned to severe tubal damage. The mean score (+/- SEM) in women with overt pelvic inflammatory disease was 4.2 +/- 0.4; in women with silent pelvic inflammatory disease, 4.3 +/- 0.4; and in the control group, 0.76 +/- 0.2 (P less than .001). Fallopian tube abnormalities seen in women with overt and silent pelvic inflammatory disease included flattened mucosal folds, extensive deciliation, and degeneration of secretory epithelial cells, morphologic changes that are similar to the cellular changes observed in our experimental Chlamydia trachomatis infections in monkeys. Laser light-scattering spectroscopy was used to measure the ciliary activity of the epithelial cells. Ciliary beat frequency was significantly reduced in women with overt pelvic inflammatory disease (N = 13; f = 6.4 +/- 1.2 Hz) and in women with silent pelvic inflammatory disease (N = 11; f = 7.2 +/- 1.2 Hz) as compared with the controls (N = 5; f = 23.4 +/- 1.5 Hz) (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)