**8. Conclusion**

anaerobic bacteria. For instance, parenteral clindamycin is effective against *C. trachomatis* and

The concomitant use of steroids with antibiotics has been thought to reduce the sequelae of salpingitis, but in a prospective study, Falk [77] could show no beneficial effect as judged by hysterosalpingography findings or subsequent laparotomy. Prevention of PID recurrence and its adverse effects on fertility also requires treatment of asymptomatic male sexual partners.In patients with postinflammatory tubal disease, pregnancy outcome has been correlated with the presence or absence of fallopian tube rugaeon hysterosalpingograms. Pregnancy occurred in 61% of patients with moderate to excellent rugal patterns, whereas only 7% of patients with

Today and in the foreseeable future, assisted reproductive technologies (ART), endoscopic surgery, and microsurgery have an important place in the management of infertility that results from tubal disease. There are some tubal causes of infertility for which surgery can offer little or no chance of success, such as after severe bilateral hydrosalpinx, multisite tubal obstruction, or in patients with extensive and dense pelvic adhesions. At the other end of the spectrum are patients who can achieve a 50% to 65% intrauterine pregnancy rate after microsurgical or laparoscopic adhesiolysis when the fimbriae are spared from disease and a male factor is not encountered.[39] In choosing between IVF and tubal surgery, the physician must compare success rates (which can are best defined by the birth of a live baby) and take into account the patient's age, presence of a male subfertility factor, the personal priorities of

The best prevention is to detect and treat early-stage asymptomatic and symptomatic infec‐ tions. This can be achieved by the screening of all sexually active reproductive age women and by educating clinicians and patients on the importance of this testing. The importance of practicing safe sex methods cannot be over emphasized in public. Scholes et al found a 60% reduction in salpingitis prevalence rates when the population was screened for *C.trachomatis*

With the advent of modern DNA amplification tests like Polymerase Chain Reaction (PCR) available very sensitive and specific testing on microbes can be done in a matter of hours. This obviates the need of many organisms as is the case with conventional cultures. Also, the newer tests are also more specific yielding a higher positive predictive value thus avoiding unnec‐ essary treatments. Microbes like *C. trachomatis*[40], *T. vaginalis*[41], and *N. gonorrhoeae*[42] can be detected in samples obtained from the vaginal introitus, and there is no longer a requirement for a speculum examination. There have been efforts to make chlamydial and gonococcal

no demonstrable rugae conceived postoperatively.[38]

the couple, and the availability of expertise.

infections compared to when they were not.5

vaccines, but not met much success.

**7. Early treatment and fertility preservation**

anaerobes.

16 Genital Infections and Infertility

The best hope for reducing the incidence of infertility related to infection lies in prevention and early detection and treatment of newly acquired asymptomatic or mildly symptomatic infections. The importance for the preservation of future fertility of avoiding high-risk sexual behaviour and the mandatory use of condoms must be stressed. Concomitantly, there must be an increased awareness by health care providers and consumers of the need for intensive screening using the latest and most effective molecular techniques followed by early effective treatment if positive.
