Women who are sexual contacts of men with urethritis will be identified to determine the prevalence of silent endometritis, its """"""""natural history"""""""", and its response to medical therapy. (""""""""Natural history"""""""" is defined here as the course of silent endometritis treated as uncomplicated cervicitis.) We will enroll a subgroup of the core patient group, as epidemiologically defined in Core 2 - female contacts of male patients with urethritis of known cause. The natural history component will compare these women documented to have cervical infection with N. gonorrhoeae and/or C. trachomatis (study group) to a demographically similar group who are uninfected (control group). We will determine the prevalence of endometritis diagnosed histopathologically in each group and the rate of resolution of endometritis after identical treatment. After endometrial biopsy, both groups of patients will receive regimens of ceftriaxone and seven days doxycycline. Using two follow-up biopsies - one at 4 weeks and one at 8 weeks, we will determine whether the rate of resolution of endometrial inflammation and secondary pathologic changes are different in the two groups. The treatment trial will compare the same group of patients with documented cervical infection (study group) receiving standard treatment for cervicitis with ceftriaxone and doxycycline, to a similarly infected group who will receive ceftriaxone and 14 days (instead of 7) of doxycycline (extended therapy group). Assignment to the two groups will be randomized and double blinded. Extent of improvement and frequency of cure defined by rigorous histopathologic criteria will be compared in each group. Patients' response to therapy will be assessed by repeat endometrial biopsies and follow-up cultures at 4 and 8 weeks after entry. The role of non-chlamydial, non-gonococcal bacterial infection in the persistence of endometrial infection and inflammation and the role that primary pathogens such as N. gonorrhoeae and C. trachomatis play in persistence of endometritis with other organisms, will also be determined for the three groups.
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