2. Salpingitis and Related Diseases
• Etiology
• Risk Factors
• Diagnosis and DDx
• Management
• Treatment
• Complications
• References
3. Etiology
• Salpingitis is really part of the larger family of pelvic
inflammatory disease (PID).
• PID is a polymicrobial infection of the upper female
genital tract (uterus, fallopian tubes, ovaries) caused
by an ascending infection of the vagina or cervix.
• N. gonorrhea and C. trachomatis cause the majority
but endogenous bacteria can also be present.
4. Etiology
• N. gonorrhea
– Causes roughly 50% of salpingitis.
– 15% of GC cervicitis progresses to PID.
• C. trachomatis
– More common than GC by up to 10:1, but only
accounts for 20-35% of PID.
– Classically produces a more mild form of PID with
insidious onset.
• Other bugs
– Strep., Staph., E. coli, Bacteroides, Actinomyces,
Peptococcus, Clostridium, Gardnerella, Haemophilus,
CMV, etc.
5. Risk Factors
• Young age (<25)
• Prior history of STD
• IUD or other non-barrier contraception
• Multiple partners
• Promiscuous partners
• Iatrogenic factors
6. Clinical Criteria for Diagnosis of PID
• All 3 of the following:
– Abdominal tenderness with or without rebound.
– Adnexal tenderness
– Cervical motion tenderness
• Plus 1 of the following:
– Temp. of >101°F
– WBC >10,000 or elevated CRP or ESR
– Gram stain with gram neg. intracellular diplococci
– Inflammatory mass
– Purulent material from peritoneal cavity
8. Management
• Lab studies
– CBC to look for leukocytosis
– β-HCH to r/o ectopic pregnancy
– Gonorrhea and Chlamydia cultures
– ESR/CRP
– UA to r/o cystitis or pyelonephritis
– Fecal occult blood test
– Wet mount
– R/o other concurrent STDs with RPR/VDRL and
HIV test
9. Management
• Imaging Studies
– Pelvic ultrasound to r/o tubo-ovarian abscess,
ectopic pregnancy and ovarian torsion.
• Procedures
– Laparoscopy if still unsure of diagnosis
– Culdocentesis is now rarely required
10. Treatment
• 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.
11. Treatment
• 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.
12. Indications for Hospitalization
• Pregnancy
• Immunodeficient
• Nausea/Vomiting and high fever
• Unpredictable compliance
• Poor response to outpatient therapy
• Tubo-ovarian abscess
13. Complications
• Infertility 2° tubal scarring
– 10% risk after a single episode of PID
– 30% risk after 2 episodes
– 50% risk after 3 or more episodes
17. 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%.
19. Complications
• 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.
20. Complications
• 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.
21. Complications
• 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.
