Salpingitis

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

(IUD), biopsy of the lining of the uterus, or a dilatation and curettage (D&C)

·         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:

• N. gonorrhoeae
• Chlamydia trachomatis
• Mycoplasma
• Staphylococcus
• Streptococcus

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.