Salpingitis
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This presentation consists of definition, epidemiology, types, causes, clinical features, diagnosis, treatment and complications of salpingitis
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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. www.freelivedoctor.com
- 18. Complications • Chronic pelvic pain – Found in up to 18% of women after resolution of PID. • Adhesions • Dyspareunia www.freelivedoctor.com
- 19. Complications • Ectopic Pregnancy – Also 2° to tubal scarring – 7-10 fold increased risk after a single episode www.freelivedoctor.com
- 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%. www.freelivedoctor.com
- 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:
- 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