Salpingitis
Encyclopedia
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.
opens during menstruation allows the infection to reach the fallopian tubes.
Other risk factors include:
Surgical procedures, breaking the cervical barrier:
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:
Finally, sexual intercourse may facilitate the spread of disease from vagina to fallopian tube. Coital risk factors are:
However, salpingitis usually is polymicrobal, involving many kinds of organisms. Other examples of organisms involved are:
Salpingitis has a higher incidence among members of lower socioeconomic classes. However, this is thought of being an effect of earlier sex debut, multiple partners and decreased ability to receive proper health care rather than any independent risk factor for salpingitis.
As an effect of an increased risk due to multiple partners, the prevalence of salpingitis is highest for people aged 15–24 years. Decreased awareness of symptoms and less will to use contraceptives are also common in this group, raising the occurrence of salpingitis.
Regarding patients aged 15–44 years, 0.29 per 100,000 dies from salpingitis.
However, salpingitis can also lead to infertility, because the eggs released in ovulation can't get contact with the sperm. Approximately 75,000-225,000 cases of infertility in the U.S. are caused by salpingitis. The more times one has the infection, the greater the risk of infertility. With one episode of salpingitis, the risk of infertility is 8-17%. With 3 episodes of salpingitis, the risk is 40-60%, although the exact risk depends on the severity of each episode.
In addition, damaged oviducts increase the risk of ectopic pregnancy
. Thus, if one has had salpingitis, the risk of a pregnancy to become ectopic is 7 to 10-fold as large. Half of ectopic pregnancies are due to a salpingitis infection.
Other complications are:
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.
, blood tests and mucus swab a doctor can diagnose salpingitis.
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
and inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
in the fallopian tubes. It is often used synonymously with Pelvic inflammatory disease (PID
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
), although PID lacks an accurate definition and can refer to several diseases of the female upper genital tract, such as endometritis
Endometritis
Endometritis refers to inflammation of the endometrium, the inner lining of the uterus. Pathologists have traditionally classified endometritis as either acute or chronic: acute endometritis is characterized by the presence of microabscesses or neutrophils within the endometrial glands, while...
, oophoritis
Oophoritis
Oophoritis is an inflammation of the ovaries.It is often seen in combination with salpingitis .-See also:* Pelvic inflammatory disease...
, myometritis, parametritis
Parametritis
Parametritis is an inflammation of the parametrium .It is considered a form of pelvic inflammatory disease.-References:...
and infection in the pelvic peritoneum
. In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes.
Acute and chronic salpingitis
There are two types of salpingitis: Acute salpingitis and chronic salpingitis.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
- FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
- 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 that the cervixCervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
opens during menstruation allows the infection to reach the fallopian tubes.
Other risk factors include:
Surgical procedures, breaking the cervical barrier:
- endometrial biopsy
- curettageCurettageCurettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....
- hysteroscopyHysteroscopyHysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
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 diseaseSexually transmitted diseaseSexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
(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 trachomatisChlamydia trachomatisChlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies...
- MycoplasmaMycoplasmaMycoplasma refers to a genus of bacteria that lack a cell wall. Without a cell wall, they are unaffected by many common antibiotics such as penicillin or other beta-lactam antibiotics that target cell wall synthesis. They can be parasitic or saprotrophic. Several species are pathogenic in humans,...
- StaphylococcusStaphylococcusStaphylococcus is a genus of Gram-positive bacteria. Under the microscope they appear round , and form in grape-like clusters....
- StreptococcusStreptococcusStreptococcus is a genus of spherical Gram-positive bacteria belonging to the phylum Firmicutes and the lactic acid bacteria group. Cellular division occurs along a single axis in these bacteria, and thus they grow in chains or pairs, hence the name — from Greek στρεπτος streptos, meaning...
However, salpingitis usually is polymicrobal, involving many kinds of organisms. Other examples of organisms involved are:
- Ureaplasma urealyticumUreaplasma urealyticumUreaplasma urealyticum is a bacterium belonging to the family Mycoplasmataceae. Its type strain is T960.-Clinical significance:U. urealyticum is part of the normal genital flora of both men and women...
- anaerobicAnaerobic organismAn anaerobic organism or anaerobe is any organism that does not require oxygen for growth. It could possibly react negatively and may even die if oxygen is present...
and aerobicAerobic organismAn aerobic organism or aerobe is an organism that can survive and grow in an oxygenated environment.Faculitative anaerobes grow and survive in an oxygenated environment and so do aerotolerant anaerobes.-Glucose:...
bacteria.
Epidemiology
Over one million cases of acute salpingitis are reported every year in the U.S., but the number of incidents is probably larger, due to incomplete and untimely reporting methods and that many cases are reported first when the illness has gone so far that it has developed chronic complications. For women aged 16–25, salpingitis is the most common serious infection. It affects approximately 11% of the female of reproductive age.Salpingitis has a higher incidence among members of lower socioeconomic classes. However, this is thought of being an effect of earlier sex debut, multiple partners and decreased ability to receive proper health care rather than any independent risk factor for salpingitis.
As an effect of an increased risk due to multiple partners, the prevalence of salpingitis is highest for people aged 15–24 years. Decreased awareness of symptoms and less will to use contraceptives are also common in this group, raising the occurrence of salpingitis.
Complications
For the affected, 20% need hospitalization.Regarding patients aged 15–44 years, 0.29 per 100,000 dies from salpingitis.
However, salpingitis can also lead to infertility, because the eggs released in ovulation can't get contact with the sperm. Approximately 75,000-225,000 cases of infertility in the U.S. are caused by salpingitis. The more times one has the infection, the greater the risk of infertility. With one episode of salpingitis, the risk of infertility is 8-17%. With 3 episodes of salpingitis, the risk is 40-60%, although the exact risk depends on the severity of each episode.
In addition, damaged oviducts increase the risk of ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
. Thus, if one has had salpingitis, the risk of a pregnancy to become ectopic is 7 to 10-fold as large. Half of ectopic pregnancies are due to a salpingitis infection.
Other complications are:
- Infection of ovaries and uterus
- Infection of sex partners
- An abscess on the ovary
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
Cefoxitin
Cefoxitin is a cephamycin antibiotic developed by Merck & Co., Inc., often grouped with the second−generation cephalosporins. It is sold under the brand name Mefoxin.- Microbiology :...
2gr/6hrls slow IV with Doxycyclin 100 mg/12h PO) initially then Doxycyclin 100 mg /12 h PO with Metronidazole
Metronidazole
Metronidazole is a nitroimidazole antibiotic medication used particularly for anaerobic bacteria and protozoa. Metronidazole is an antibiotic, amebicide, and antiprotozoal....
400 mg 12h PO until 14 days can cover gonorrhea and chlamydia infection.
if less unwell Ofloxacin
Ofloxacin
Ofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class considered to be a second-generation fluoroquinolone. The original brand, Floxin, has been discontinued by the manufacturer in the United States on 18 June 2009, though generic equivalents continue to be...
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.
Diagnosis
By Pelvic examinationPelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.Broadly, it can be divided into the external examination and internal examination.It is also called "Bimanual Exam" & "Manual Uterine Palpation"....
, blood tests and mucus swab a doctor can diagnose salpingitis.