Definition:
Salpingitis is an infection and inflammation in the fallopian tubes. It is often used synonymously with
pelvic inflammatory disease (PID), although PID lacks an accurate
definition and can refer to several diseases of the female upper genital tract,
such as endometritis,
oophoritis,
myometritis, parametritis
and infection in the pelvic peritoneum. In contrast, salpingitis only refers to
infection and inflammation in the fallopian tubes.
Types: There
are two types of salpingitis: acute and chronic.
In acute salpingitis, the fallopian
tubes become red and swollen, and secrete extra fluid so that the inner walls
of the tubes often stick together. Sometimes the fallopian tubes may stick to
nearby structures such as the intestines. In rare
cases fallopian tube ruptures and causes a dangerous infection of the abdominal
cavity.
Chronic salpingitis usually follows
an acute attack. Chronic salpingitis is milder, longer lasting and may not
produce many noticeable symptoms.
Causes: Often salpingitis is caused by a
bacterial or viral infection that rises from the vagina,
cervix, or uterus to the fallopian tubes.
Possible causes:
· Pelvic inflammatory disease (PID), or widespread infection in the organs of the
pelvis
· Sexually transmitted diseases, often gonorrhoea or Chlamydia infection
·
Medical procedures, such as laparoscopy,
insertion of an Intra-Uterine Disease
·
Childbirth, miscarriage, or abortion
·
Bacteria that are normally found in the vagina
Symptoms: The symptoms
usually appear after a menstrual period. The most common are:
- Abnormal
smell and colour of vaginal discharge.
- Pain
during ovulation
- Pain
during sexual intercourse
- Pain
coming and going in periods
- Abdominal
pain
- Lower
back pain
- Fever
- Nausea
- Vomiting
- Bloating
Causes
and pathophysiology: The infection
usually has its origin in the vagina, and ascends to the fallopian tube from
there. Because the infection can spread via the lymph vessels, infection in one
fallopian tube usually leads to infection of the other.
Risk
factors
It's been
theorized that retrograde menstrual flow and the cervix opening
during menstruation allows the infection to reach the fallopian tubes.
Other risk factors
include surgical procedures which break the cervical barrier, such as:
- endometrial
biopsy
- curettage
- hysteroscopy
Another risk is
factors that alter the microenvironment in the vagina and cervix, allowing
infecting organisms to proliferate and eventually ascend to the fallopian tube:
- antibiotic
treatment
- ovulation
- menstruation
- sexually transmitted disease
(STD)
Finally, sexual
intercourse may facilitate the spread of disease from vagina to fallopian tube.
Coital risk factors are:
- Uterine contractions
- Sperm, carrying organisms upwards.
Bacterial
species
The
bacteria most associated with salpingitis are:
However,
salpingitis usually is polymicrobal, involving many kinds of organisms. Other
examples of organisms involved are:
- Ureaplasma urealyticum
- anaerobic and aerobic bacteria.
Other
complications:
- Infection of
ovaries and uterus
- Infection of sex
partners
- An abscess on the
ovary
Diagnosis:
Salpingitis may
be diagnosed by pelvic examination, blood tests,
and/or a vaginal or cervical
swab.
Treatment:
Salpingitis is most commonly treated with antibiotics.
Prompt treatment and Contact-tracing minimizes
complications, Admission for Blood Culture and Iv Antibiotics if very unwell (e.g.,Cefoxitin 2gr/6hrls slow IV with Doxycyclin 100 mg/12h PO)
initially then Doxycyclin
100 mg /12 h PO with Metronidazole
400 mg 12h PO until 14 days can cover gonorrhea and chlamydia infection.
If less unwell Ofloxacin
400 mg/12 h PO and Metronidazole
400 mg/12 hr PO for 14 days. Trace contacts and ensure the patient and
partner seek treatment is essential.
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