Salpingitis is the inflammation of one or both fallopian tubes, the ducts that transport the egg from the ovary to the uterus. This condition is almost always caused by a bacterial infection, leading to swelling and fluid accumulation within the tubes. Salpingitis is a common presentation of Pelvic Inflammatory Disease (PID), a broader term for infection affecting the female reproductive organs, including the uterus and ovaries. Inflammation can quickly damage the fallopian tubes, making prompt medical attention necessary to preserve reproductive function.
How the Infection Begins
The infection that results in salpingitis typically follows an ascending pathway, where bacteria travel upward through the reproductive tract. Microorganisms gain access to the vagina and cervix, moving into the uterus, and finally reaching the fallopian tubes. Once inside, the bacteria cause an inflammatory reaction leading to mucosal swelling and the production of pus.
The most frequent infectious agents are the sexually transmitted bacteria Chlamydia trachomatis and Neisseria gonorrhoeae. Routine screening is important for sexually active individuals due to these common causes. Salpingitis can also be caused by bacteria normally part of the vaginal flora, such as Mycoplasma, Streptococcus, or Staphylococcus species.
The upward spread of non-STI-related bacteria can be triggered by events that disrupt the cervical barrier. Procedures like the insertion of an intrauterine device (IUD) or an endometrial biopsy, or events like childbirth or miscarriage, can introduce bacteria higher into the reproductive system.
Recognizing the Warning Signs
The presentation of salpingitis can vary widely. Acute salpingitis typically manifests with intense lower abdominal or pelvic pain, often felt on both sides of the body. This pain may be accompanied by systemic signs of infection, such as fever, chills, nausea, and vomiting.
An unusual vaginal discharge, which may be yellow, green, or foul-smelling due to pus and bacteria, is common. Patients may also experience discomfort or pain during sexual intercourse (dyspareunia). Painful or frequent urination can occur if the inflammation affects nearby urinary structures.
In contrast, chronic salpingitis often presents with mild, persistent symptoms lasting for a longer duration. A person might experience only a dull pelvic discomfort or mild pain during menstruation or ovulation. A significant number of cases are entirely asymptomatic, meaning the fallopian tubes can suffer damage without the individual realizing they have an infection. This silent damage is often discovered later during investigation for chronic pelvic pain or difficulty conceiving.
Medical Confirmation and Treatment Protocols
Diagnosing salpingitis requires a clinical assessment, as symptoms can overlap with other conditions like appendicitis or ectopic pregnancy. A healthcare provider performs a physical examination, including a pelvic exam to check for tenderness in the uterus, ovaries, and fallopian tubes. Tenderness upon movement of the cervix is a highly suggestive finding.
Laboratory tests look for evidence of infection and inflammation. Blood tests may reveal an elevated white blood cell count or increased levels of inflammatory markers, such as C-reactive protein. Swabs and cultures of the cervical or vaginal discharge identify specific causative organisms, particularly Neisseria gonorrhoeae and Chlamydia trachomatis.
Imaging techniques, particularly a pelvic ultrasound, help visualize the fallopian tubes and surrounding structures. Imaging may show thickened, fluid-filled tubes, or in severe cases, a collection of pus known as a tubo-ovarian abscess. In rare instances, laparoscopy, a surgical procedure, may be used to directly view the pelvic organs and confirm the diagnosis.
The treatment for salpingitis relies on antibiotics to eliminate the bacterial infection. Since the infection is often polymicrobial, broad-spectrum antibiotics are typically initiated before the specific organism is identified. A common outpatient regimen involves a combination of intramuscular injections and a course of oral antibiotics, such as doxycycline.
In more severe cases, such as those involving high fever, signs of sepsis, or an abscess, hospitalization is necessary for intravenous administration of antibiotics. The patient is monitored until clinical improvement, then treatment transitions to an oral regimen completed at home. The full course of medication must be finished, even if symptoms resolve quickly. Furthermore, sexual partners must also be tested and treated simultaneously to prevent reinfection.
Impact on Reproductive Health
The long-term consequence of salpingitis is the damage inflammation causes to the fallopian tubes. The healing process involves scar tissue and adhesions forming on the inner lining of the tubes. This scarring alters the structure of the tubes, which are responsible for sweeping the egg from the ovary toward the uterus.
Inflammation and subsequent scarring can lead to partial or complete tubal blockage, a direct cause of female factor infertility. If the egg and sperm cannot meet, natural conception becomes difficult or impossible. Even a partial blockage can impede the egg’s transit.
An ectopic pregnancy occurs when a fertilized egg implants outside the main cavity of the uterus. This is a medical emergency because the tube cannot accommodate the growing embryo and is prone to rupture. Individuals who have had salpingitis, particularly if left untreated, face an elevated risk of this life-threatening complication.