This presentation consists of definition, epidemiology, types, causes, clinical features, diagnosis, treatment and complications of salpingitis

2. • The fallopian tubes extend from the uterus, one on
each side, and both open near an ovary.
• During ovulation, the released egg (ovum) enters a
fallopian tube and is swept along by tiny hairs
towards the uterus.

3. • It is inflammation of the fallopian tubes.
• Almost all cases are caused by bacterial infection, including
sexually transmitted diseases such as gonorrhoea and chlamydia.
• The inflammation prompts extra fluid secretion or even pus to
collect inside the fallopian tube.
• Infection of one tube normally leads to infection of the other,
since the bacteria migrates via the nearby lymph vessels.
• Salpingitis is one of the most common causes of female infertility.
• Without prompt treatment, the infection may permanently
damage the fallopian tube so that the eggs released each
menstrual cycle can't meet up with sperm.

4. Contd…
• Scarring and blockage of the fallopian tubes is the
most frequent long-term complication of pelvic
inflammatory disease (PID) and so this condition can
sometimes be referred to as PID.
• However, the umbrella term of PID includes other
infections of the female reproductive system, such as
the uterus and ovaries.

5. 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.

6. Types of salpingitis
1. Acute salpingitis:
o 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.
o The tubes may also stick to nearby structures such as the
intestines.
o Sometimes, a fallopian tube may fill and bloat with pus.
o In rare cases, the tube ruptures and causes a dangerous
infection of the abdominal cavity (peritonitis).
2. Chronic salpingitis:
o Chronic salpingitis usually follows an acute attack.
o The infection is milder, longer lasting and may not produce
many noticeable symptoms.

7. Causes of salpingitis
In 9 out of 10 cases of salpingitis, bacteria are the cause.
Some of the most common bacteria responsible for
salpingitis include:
 Chlamydia
 Gonococcus
 Mycoplasma
 Staphylococcus
 Streptococcus.

8. Contd:
The bacteria must gain access to the woman's reproductive
system for infection to take place. The bacteria can be
introduced in a number of ways, including:
• sexual intercourse
• insertion of an IUD (intra-uterine device)
• miscarriage
• abortion
• childbirth
• appendicitis.

9. Risk Factors:
• Young age (<25)
• Prior history of STD
• IUD or other non-barrier contraception
• Multiple partners
• Promiscuous partners
• Iatrogenic factors

10. Symptoms of salpingitis
In milder cases, salpingitis may have no symptoms. This means the fallopian
tubes may become damaged without the woman even realising she has an
infection. The symptoms of salpingitis may include:
• Abnormal vaginal discharge, such as unusual colour or smell
• Spotting between periods
• Dysmenorrhoea (painful periods)
• Pain during ovulation
• Uncomfortable or painful sexual intercourse
• Fever
• Abdominal pain on both sides
• Lower back pain
• Frequent urination
• Nausea and vomiting
• Bloating
• The symptoms usually appear after the menstrual period.

11. Diagnosis of salpingitis
Diagnosing salpingitis involves a number of tests, including:
• general examination - to check for localised tenderness and
enlarged lymph glands
• pelvic examination - to check for tenderness and discharge
• blood tests - to check the white blood cell count and other
factors that indicate infection
• mucus swab - a smear is taken to be cultured and examined in
a laboratory so that the type of bacteria can be identified
• laparoscopy - in some cases, the fallopian tubes may need to
be viewed by a slender instrument inserted through
abdominal incisions.

12. Treatment for salpingitis
Treatment depends on the severity of the condition, but
may include:
• antibiotics - to kill the infection, which is successful in
around 85 per cent of cases
• hospitalisation - including intravenous administration
of antibiotics
• surgery - if the condition resists drug treatment

13. Contd…
• Outpatient therapy
– Regimen A
• Ofloxacin/Levofloxacin + Metronidazole PO x 14 days
– Regimen B
• Ceftriaxone or Cefoxitin (+probenecid PO) IM x 1 dose
+ Doxycycline +/- Metronidazole PO x 14 days
– Remember to also provide treatment to the
patient’s partner if the infection is due to an STD.

14. Contd…
• Inpatient therapy
– Regimen A
• Cefotetan or Cefoxitin IV until clinical improvement +
Doxycyline x 14 days
– Regimen B
• Clindamycin + Gentamycin IV until clinical improvement
+ Doxycycline or Clindamycin PO x 14 days
• Medical therapy alone results in an 85% cure rate
with the rest requiring surgical intervention.

15. Indications for Hospitalization
• Pregnancy
• Immunodeficient
• Nausea/Vomiting and high fever
• Unpredictable compliance
• Poor response to outpatient therapy
• Tubo-ovarian abscess

16. Complications of salpingitis
Without treatment, salpingitis can cause a range of
complications, including:
• Further infection - the infection may spread to
nearby structures, such as the ovaries or uterus.
• Infection of sex partners - the woman's partner or
partners may contract the bacteria and become
infected too.
• Tubo-ovarian abscess - about 15 per cent of women
with salpingitis develop an abscess, which requires
hospitalisation.

17. Complications
• Infertility
– Infertility - the fallopian tube may become deformed or
scarred to such an extent that the egg and sperm are unable
to meet. After one bout of salpingitis or other PID, a woman's
risk of infertility is about 15 per cent. This rises to 50 per cent
after three bouts.
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18. Complications
• Chronic pelvic pain
– Found in up to 18% of women after resolution of PID.
• Adhesions
• Dyspareunia
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19. Complications
• Ectopic Pregnancy
– Also 2° to tubal scarring
– 7-10 fold increased risk after a single episode
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20. Complications
• Ectopic Pregnancy
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21. Complications
• Tubo-ovarian abscess
– Serious sequelae of PID causing 350,000 hospitalizations and
150,000 surgeries/yr.
– Occurs in 15-30% of women requiring hospitalization for PID
treament.
– Ruptured TOA has a mortality rate as high as 9%.
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22. Complications
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23. • Tubo-ovarian abscess
– Can be diagnosed by ultrasound with 94%
sensitivity.
– Can attempt conservative management with
antibiotics but often require drainage or excision
via laparoscopy.
– 86-93% infertility rate following TOA.

24. • Fitz-Hugh-Curtis Syndrome
– Extrapelvic manifestation of PID associated with RUQ pain
due to inflammation of the liver capsule and diaphragm.
– As with PID, it is mainly caused by N. gonorrhea and C.
trachomatis.
– Probably spreads via direct seeding into the peritoneal
cavity, although hematogenous and lymphatic spread can’t
be ruled out.
– Occurs in 15-30% of women with PID worldwide though
this is probably less in developed countries.
Complication:

25. Fitz-Hugh-Curtis Syndrome

26. Complication:
• Fitz-Hugh-Curtis Syndrome
– Vague symptoms often make it a diagnosis of
exclusion.
• Amylase/Lipase to r/o gallbladder disease
• LFTs to r/o hepatitis
• UA to r/o pyelonephritis or kidney stones
• Hemoccult to r/o perforated ulcer
• Ultrasound and CT to r/o other diseases
– Gold standard for diagnosis is laparoscopy and
visualization of adhesions or inflammation.

27. Reference:
1. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticl
es.nsf/pages/Salpingitis
2. https://en.wikipedia.org/wiki/Salpingitis
3. http://www.fairview.org/healthlibrary/Article/4049
2
4. http://www.slideshare.net/rajud521/salpingitis-
and-related-diseases?qid=64736c1f-f5df-45fe-b4ed-
2979efbb9f59&v=default&b=&from_search=1
5. https://en.wikipedia.org/wiki/Salpingitis