Salpingitis

Acute Salpingitis, Chronic Salpingitis, Fallopian Tube Abscess

What is Salpingitis?

Salpingitis refers to inflammation of the fallopian tube. About three inches in length, the fallopian tubes connect each ovary with the uterus (womb). It is the fallopian tube that transports an egg from the ovary to the uterus. It is also the site of fertilization of the egg. When infected, fallopian tubes often develop scar tissue. This scarring can block an egg, preventing it from reaching the uterus. More than 100,000 women in the US become infertile (cannot become pregnant) each year as a result of scarring in the fallopian tube. Salpingitis also greatly increases the risk of tubal (ectopic) pregnancy. Salpingitis is often seen in pelvic inflammatory disease (PID).

Inflammation of a fallopian tube is usually caused by an infection that has spread upward from the vagina, cervix, or uterus. The most common infections are chlamydia and gonorrhea, both of which are sexually transmitted diseases. Salpingitis can also result from an infection following childbirth, miscarriage, or an abortion. An inflammation of the abdominal lining (peritonitis) or even a blood- borne infection (such as tuberculosis) can also cause salpingitis.

Normally, mucus and other secretions help to prevent the spread of any infections coming from the cervix or vagina. During ovulation and menstruation, these defenses appear to be less effective. Also, if menstrual blood flows backwards from the uterus into the fallopian tubes, it can carry the infectious organisms with it. This may explain why symptoms of salpingitis begin immediately after menstruation more often than at any other time.

How is it diagnosed?

History: Symptoms include severe lower abdominal and pelvic pain on both sides of the body, frequent urination, headache, and a vague feeling of being sick (malaise), nausea with possible vomiting, and often an abnormal vaginal discharge. A fever may or may not be present. Since the abdomen is very tender, the woman may report that she is most comfortable lying on her back with her legs bent at the knee. Even though it can seriously damage the fallopian tubes, infection caused by Chlamydia may produce only minor symptoms or no symptoms at all.

Physical exam: A physical exam is performed to determine the location and nature of the pain. Although a vaginal examination may be very painful, it can reveal the presence of any abnormal vaginal or cervical discharge, and also any evidence of infection on the cervix itself.

Tests: Cultures are done to identify the organisms responsible for the infection. Although quick lab tests done in the doctor's office (using stains, dyes, and microscope) can identify many organisms, they may be slightly less accurate. Also more than one organism may be present simultaneously and could be overlooked. Therefore, many doctors prefer to use both the rapid lab test to get a faster diagnosis, and the cultures to increase the chance of an accurate diagnosis.

The presence of infection may be confirmed by a complete blood test (CBC) indicating a high number of white blood cells. A urinalysis and urine culture may also be done to rule out a urinary tract infection. A pregnancy test may be needed to rule out a tubal pregnancy.

A laparoscopy may be done to confirm the diagnosis and also to rule out conditions that have similar symptoms, such as tubal pregnancy or appendicitis. Laparoscopy is a surgical procedure in which a small, lighted microscope is inserted through a tiny incision into the abdomen. This allows the doctor to visually examine the fallopian tubes and surrounding area.

How is Salpingitis treated?

Treatment usually includes antibiotics, painkillers, increased fluids, and bedrest. Because more than one organism may be responsible for the infection, several antibiotics may be given at the same time. Since the symptoms may go away before the infection is completely cured, it is very important that the complete course of antibiotics is finished as prescribed. Individuals should be re-evaluated by their physician after treatment has begun to be sure that the antibiotics are effective. All sexual partners should be examined for sexually transmitted diseases and promptly treated as well. Untreated salpingitis can further develop into pelvic inflammatory disease.

Surgery may be necessary to correct complications (drain abscesses) or to remove damaged tubes that do not respond to antibiotic therapy (salpingectomy). This sometimes involves removing the uterus and ovaries as well (hysterectomy with salpingo-oophorectomy).

Medications

Information Brand Generic Label Rating
Metronidazole tablets Flagyl Metronidazole Off-Label
Levaquin Levaquin Levofloxacin Off-Label
http://www.nmihi.com/c/ciprofloxacin.html Cipro Ciprofloxacin Off-Label
Principen Medication Principen Ampicillin Off-Label
http://www.nmihi.com/c/co-amoxiclav.html Augmentin Co-amoxiclav Off-Label
http://www.nmihi.com/a/azithromycin.html Zithromax Azithromycin Off-Label
Doryx Doxycycline Off-Label
Cleocin Clindamycin Off-Label

What might complicate it?

Pus may collect within the fallopian tube (pyosalpinx). This can sometimes be followed by fluid collecting in the fallopian tube (hydrosalpinx). Pus collecting within the abdominal cavity can cause a pelvic abscess. Abscesses may need to be surgically drained.

Predicted outcome

A favorable outcome is directly related to the promptness with which appropriate treatment is begun. Infections sometimes persist despite treatment. This can result in persistent backache, frequent heavy menstrual periods, and pain during sexual intercourse. Infertility can occur in up to twenty percent of women who have had salpingitis. The fallopian tube can become blocked by scar tissue, making it impossible for an egg to be transported through the tube to the uterus. Because Chlamydia organisms can invade the fallopian tubes without causing any symptoms, many women with tubal infertility may never know they had the disease.

A woman who has salpingitis is ten times more likely to have a tubal (ectopic) pregnancy. Because it is blocked by scar tissue, the fertilized egg cannot pass down the tube into the uterus. The egg may then attach itself to the inside of the fallopian tube instead. Because the egg cannot grow normally inside the tube, the tube will rupture. This can be a life threatening medical emergency.

Alternatives

Conditions with similar symptoms include appendicitis, ectopic pregnancy, ruptured cyst, endometriosis, acute urinary tract infection, regional enteritis, and ulcerative colitis.

Appropriate specialists

Gynecologist, general surgeon, and infectious disease specialist.

Last updated 18 December 2011


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