| Salpingitis | |
|---|---|
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| Micrograph of acute and chronic salpingitis. H&E stain. | |
| Specialty | Gynecology |
Salpingitis is an infection causing inflammation in the fallopian tubes (also called salpinges). It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, and peritonitis. [1] [2]
The symptoms usually appear after a menstrual period. The most common are: an abnormal smell and colour of vaginal discharge, fever, nausea, vomiting, bloating, and frequent urination. Pain may be felt during ovulation, during periods, during sexual intercourse, on both sides of the abdomen, and lower back. [3]
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. [3]
It's been theorized that retrograde menstrual flow and the cervix opening during menstruation allows the infection to reach the fallopian tubes.
Other risk factors include surgical procedures that break the cervical barrier, such as:
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 the vagina to the fallopian tube. Coital risk factors are:
The bacteria most associated with salpingitis are: [3]
However, salpingitis is usually polymicrobial, involving many kinds of pathogens such as Ureaplasma urealyticum , and anaerobic and aerobic bacteria.
Salpingitis may be diagnosed by pelvic examination, blood tests, and/or a vaginal or cervical swab.
Salpingitis can be acute, chronic, or subclinical. [4]
Approximately one in fourteen untreated Chlamydia infections will result in salpingitis. [5]
Over one million cases of acute salpingitis are reported every year in the US, 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 age 16–25, salpingitis is the most common serious infection. It affects approximately 11% of females of reproductive age. [2]
Salpingitis has a higher incidence among members of lower socioeconomic classes. However, this is thought of being an effect of earlier sexual 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 age 15–24 years. Decreased awareness of symptoms and less will to use contraceptives are also common in this group, raising the occurrence of salpingitis.
For those affected, 20% need hospitalization. For those aged 15–44 years, 0.29 per 100,000 die from salpingitis. [2]
One in six cases of salpingitis will lead to infertility. [4] Salpingitis can also lead to tubal factor infertility because the eggs released in ovulation cannot make contact with the sperm. Approximately 75,000-225,000 cases of infertility in the US 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. [2]
Damaged oviducts from salpingitis increase the risk of an ectopic pregnancy by 7-10 fold. Half of ectopic pregnancies are due to a salpingitis infection. [2]
Other complications are: [3]
Salpingitis is most commonly caused by bacteria and typically treated with antibiotics.
E. coli , Gallibacterium and other bacteria can cause salpingitis in chickens and other poultry. [7] [8] This can result in lower egg production. [8] Dairy cows can also have salpingitis. [9]
Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Most people who are infected have no symptoms. When symptoms do appear they may occur only several weeks after infection; the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks. Symptoms in women may include vaginal discharge or burning with urination. Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles. The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.
Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.
Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.
Neisseria gonorrhoeae, also known as gonococcus (singular), or gonococci (plural), is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.
Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.
Chlamydia trachomatis, commonly known as chlamydia, is a bacterium that causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory disease. C. trachomatis is the most common infectious cause of blindness and the most common sexually transmitted bacterium.
The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. In humans, the female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo which develops into the fetus. The uterus also produces secretions which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.
Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the formation of adhesions presenting with the clinical syndrome of right upper quadrant (RUQ) pain.
Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.
A hydrosalpinx is a condition that occurs when a fallopian tube is blocked and fills with serous or clear fluid near the ovary. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility. A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx.
Fallopian tube obstruction, also known as fallopian tube occlusion is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian tubes are also known as oviducts, uterine tubes, and salpinges.
Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.
A heterotopic pregnancy is a complication of pregnancy in which both extrauterine (ectopic) pregnancy and intrauterine pregnancy occur simultaneously. It may also be referred to as a combined ectopic pregnancy, multiple‑sited pregnancy, or coincident pregnancy.
Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.
The fallopian tubes, also known as uterine tubes, oviducts or salpinges, are paired tubes in the human female body that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In other mammals, they are only called oviducts.
Fertility testing is the process by which fertility is assessed, both generally and also to find the "fertile window" in the menstrual cycle. General health affects fertility, and STI testing is an important related field.
Hysterosalpingography (HSG), also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the Fallopian tubes. It is a special x-ray procedure using dye to look at the womb (uterus) and Fallopian tubes. In this procedure a radio-opaque material is injected into the cervical canal, and radiographs are taken. A normal result shows the filling of the uterine cavity and the bilateral filling of the Fallopian tube with the injection material. To demonstrate tubal rupture, spillage of the material into the peritoneal cavity needs to be observed. Hysterosalpingography has vital role in treatment of infertility, especially in the case of fallopian tube blockage.
Tubal factor infertility (TFI) is female infertility caused by diseases, obstructions, damage, scarring, congenital malformations or other factors which impede the descent of a fertilized or unfertilized ovum into the uterus through the Fallopian tubes and prevents a normal pregnancy and full term birth. Tubal factors cause 25-30% of infertility cases. Tubal factor is one complication of Chlamydia trachomatis infection in women.
A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary. These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. It is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs. A TOA can also develop as a complication of a hysterectomy.
Chromopertubation is a method for the study of fallopian tube patency for suspected infertility in women caused by fallopian tube obstruction. Occlusion or pathology of the fallopian tubes is the most common cause of suspected infertility. Chromopertubation is sometimes commonly referred to a "laparoscopy and dye" test. It is currently one of the standard procedures in this field. In most cases, chromopertubation is performed to assess and determine the cause of someone's difficulties in getting pregnant.