Study design and population
The study was a prospective cohort study, performed at the Soroka University Medical Center, an 1100-bed tertiary hospital in southern Israel, and was authorized by the institutional research ethics committee (0228-17-SOR). All women who planned to undergo elective salpingectomy at our center were offered the opportunity to participate in this study. Women receiving immunosuppressive treatments were excluded from the study, and women with overt, active infections were excluded from the control group. After obtaining informed consent from willing participants, a vaginal swab was taken before local cleansing in the operating room following anesthesia. All women were treated with prophylactic antibiotics 30-60 minutes before the surgical incision. Samples were obtained by introducing nylon flocked swab (ESwab, Copan, Italy) to the vagina up to 5 cm from the introits via a speculum and rotational swabbing of the vaginal walls for 5-10 seconds. After performing the salpingectomy procedure, the fallopian tube was sagittally incised using a strict aseptic technique and a swab was taken from each of the tube’s lumen at the ampullary region. Samples were immediately refrigerated and then frozen at -80°C within 24 hours of sampling until further analysis. Metadata including: age, ethnicity, menopausal status and prior antibiotic treatments were extracted form patients’ medical records.