Salpingitis

What is salpingitis?

The uterine or Fallopian tubes are two channels (right and left) that extend from the uterus cavity towards its corresponding ovary (on the same side). The association of Fallopian tube and ovary is what is termed the adnexae. The role of these structures in the transport and delivery of spermatozoa from the uterine cavity to the outer third of the Fallopian tube where the free ovum (ovule or egg) is waiting to be fertilized. These structures are then critical in the transport of the fertilized (or unfertilized egg) towards the uterine cavity where the fetus is eventually implanted. The bottom line is that these tubes play a critical role in the reproduction system. The average Fallopian tube measures on average 10 to 12 cm.

Salpingitis is an infection of the Fallopian tubes. This infection, that can at times, pass unnoticed and avoid diagnosis and treatment is one of the principle causes of preventable infertility or sterility.

An infection of the tubes is usually caused by a sexually transmitted infection (STI): chlamydia and gonorrhea are the microbes most frequently implicated in the occurrence of salpingitis. The majority of these infections are transmitted via unprotected sexual relations. It is estimated that 70 to 80 % of clinical cases of infertility are of tubular origin and attributable to chlamydia.

Is Salpingitis frequent?

Please refer to the chapter on chlamydia and gonorrhea.

How is salpingitis transmitted?

The microbes responsible for salpingitis can be transmitted by sexual relations that include the exchange of bodily fluids and/or contact of these liquids with the mucous membranes of the genitals (penis, vagina, etc.), oral region (mouth) and anal region. This translates into the fact that chlamydia is primarily transmitted via unprotected vaginal or anal penetration and/or via unprotected oral sex (fellatio). This infection (chlamydia) can also be transmitted vertically (that means from mother to child during delivery and childbirth). This infection is rarely transmitted via cunnilingus.

These microbes, which are transmitted during unprotected sexual relations, then multiply in the genital tracts. Untreated, these germs are able to climb their way towards the uterus (through the cervical canal) and gradually make their way to the Fallopian tubes where they may wreak havoc (inflammation and infection). This is a salpingitis. On average it takes these untreated microbes 2 to 3 weeks to make there way to level of the tubes.

What are the symptoms of salpingitis?

At times salpingitis is manifest by extreme or violent pelvic (lower abdominal) pain, fever and associated abnormal vaginal discharge. This is a situation that requires immediate consultation and treatment. Unfortunately, in some infected women, salpingitis may evolve with very subtle symptoms and signs. The diagnosis may not be obvious for weeks or months, at times for periods as long as several years. This chronic form of salpingitis is a troublesome infection, as the damage that it can leave behind in the reproductive system is significant.

Symptom review

• Recent unilateral or bilateral abdominal pain (one or both sides), at times intense in nature, that irradiates towards the lower back, the thighs or the external genital organs,
• An infectious syndrome including the constellation of symptoms: fever (often very high), with or without chills (rigors). In the most common clinical scenario, there are NOT generalized symptoms,
• Abundant leukorrhea (vaginal discharge) that is often yellowish or purulent in nature (pus),
• At times there may be metrorrhagia (excessive bleeding),
• There may by signs of a functional urinary tract infection ( or similar to a urinary tract infection): cloudy urine (pus in the urine), dysuria (burning when you pee),
• Signs of discrete peritoneal (lower abdomen or belly) irritation : nausea, bloating, cramping, constipation, etc.

How is salpingitis diagnosed?

In the ideal world, we would be able to successfully detect the infection when it is still hovering at the level of the uterine cervix, prior to its ascent towards the Fallopian tubes. Ideally this would be achieved during the routine gynecological examination. Unfortunately, the infection is only discovered when it has already been present for some time and has managed to attack one or two of the uterine tubes.

In order to diagnose salpingitis, a classical gynecological examination may suffice. In the case of more subtle or « silent » infections further tests or investigations may be required

• An abdominal/pelvic ultrasound,
• An abdominal/pelvic x-ray or
• occasionally, a laparoscopy (visualization of the pelvic cavity via surgery) under general anesthesia may be required in order to visually confirm the pathology at the level of the tubes or ovaries.

Is there a treatment for salpingitis?

The treatment of salpingitis rests on the administration of antibiotics (often for periods of several weeks). The antibiotics selected are targeted to attack the most likely organism, and often provide broad coverage to include may different possible microbes. The sexual partner should obviously be evaluated, screened and treated appropriately, ensuring compliance with all medication and abstinence from sexual relations during the treatment period so as to prevent re-infection. Your physician will follow you closely so as to ensure a timely cure and thereby attempt to decrease the risks of permanent scarring of the tubes. Anti-inflammatories are often prescribed in association with antibiotics in an attempt to minimize inflammation and eventual scarring. A woman previously afflicted with salpingitis is never immunized against salpingitis. This infection can be contracted several times during a woman’s lifetime. Prevention is key.

At times, in the case of a severe or acute infection, hospitalization may be required. This permits the administration of intravenous antibiotics and is important in quickly treating serious form so salpingitis. The routine treatment of non-acute salpingitis entails antibiotics by mouth as mentioned previously.

What complications may arise if I do not treat my salpingitis? Is it dangerous?

Fallopian tubes that have been damaged or altered secondary to a salpingitis may no longer be able to function normally in their essential role in reproduction. As stated earlier, it is in the tubes that a spermatozoon fertilizes the released ovum or egg. Furthermore, it is in these same tubes that the fertilized ovum undergoes its initial divisions prior to its implantation in the uterus where the fetus then develops. The infection known as salpingitis may have as a complication the ultimate blockage of the tube(s), or an alteration in the passage through the tubes. Blockages or narrowing in the tubes increase the risk for spontaneous abortion (miscarriage) or extra-uterine pregnancies (which are dangerous and/or potentially life threatening). A woman who has been afflicted by a previous salpingitis has a greater than 6 fold risk of developing an extra-uterine pregnancy. Among all complications of salpingitis, the most disquieting is that of infertility. Too often, a diagnosis of antecedent salpingitis is made during the process of a medical work-up for infertility. This scenario confirms the fact that salpingitis often is subtle in its symptomatology and presentation.

The more often a woman is afflicted with salpingitis, the greater the risk for sterility. After one episode of salpingitis, the risk is approximately 15 %. After two episodes of salpingitis, the risk doubles to approximately 30 %. 60 % of women with three or more episodes of salpingitis will have difficulties related to infertility.

Who is at risk of developing salpingitis ?

• Individuals with more than one sexual partner;
• Individuals whose sexual partner has more than one sexual partner;
• Individuals who do not use prophylactics (condoms); or chlamydia (primarily past the in illness transmitted sexually a with diagnosed been have who
• Victims of sexual abuse;
• Women under the age of 25 have the highest rates of chlamydial infection. This group at risk should consider routine testing for chlamydia, and this, even in the absence of symptoms;
• Women who contract an infection such as chlamydia, and who have an IUD (intra-uterine device for contraception purposes) are at a greater risk of developing salpingitis or pelvic inflammatory disease, given that the microbe has an easier access route to the upper genital tract (the IUD cord hangs out of the uterine cervix). This is the main reason why the IUD is recommended mainly to women in a stable monogamous relationship.

It is important to note that frequent changes in sexual partners increases the risk of exposing oneself to the risks and complications associated with chlamydia and gonorrhea, the main bugs responsible for salpingitis. The use of a latex or polyurethane condom with new sexual partners offers an excellent means of decreasing the risks for chlamydia and gonorrhea, and other sexually transmitted illnesses. Once you have deemed your new sexual relationship to be stable, and prior to passing from protected to unprotected sexual relations, consider STI testing together. This done, your risks of contracting an STI and its associated complications will be greatly decreased. If there are symptoms suggestive of an STI or salpingitis, consult!

The IUD and salpingitis : When a woman employs an IUD for contraception purposes, the risk for salpingitis is present in two specifif situations :

• When the IUD is inserted into the uterine cavity by your physician and in the weeks subsequent to its insertion. The risk is not associated with the act of insertion, but the possibility that there is an asymptomatic infection already present at this time. An STI screening test is habitually performed during the month prior to the IUD’s insertion. This will significantly decrease the risk of salpingitis.
• When you or your sexual partner have a new sexual partner whose STI status is unknown. New partners should be tested prior to unprotected sexual relations so as to decrease the risks associated with the presence of your IUD.

How can a woman with salpingitis prevent its transmission ?

• Inform one’s sexual partners of your infection ( your physician or the department of public health can assist you in contact tracing and treatment…if you wish).
• Please remember to refrain/abstain from all sexual relations until your treatment has been completed (re-infection is a risk).
• Ensure that all of your sexual partners have been tested and treated so as to break the chain of transmission and once again, to protect against the risks of re-contamination.
• Use a latex or polyurethane condom. It offers a good protection against the microbes responsible for salpingitis…when it is used properly and consistently.
• Consider routine STI testing, particularly if you have multiple sexual partners.

How can I prevent salpingitis ?

The basic principles of prevention for all sexually transmitted illnesses: use a prophylactic…a latex or polyurethane based condom. Ideally, it would help to have a stable, monogamous sexual partner that you trust and who has undergone STI screening tests (and results are normal). A condom does not offer 100 % protection against all STIs, however, it is extremely effective in the prevention of most infections and their associated complications. No glove…No love!

• Use a condom (male, female or dental dam for oral-genital sexual relations) at all times with all sexual partners
• Undergo routine STI testing at a frequency to be discussed with your physician
• Sexual abstinence or a stable monogamous sexual relationship who is negative for STIs (based on screening tests) is an effective means of preventing chlamydia, gonorrhea and other infections that may be responsible for salpingitis and/or other STIs.

The best time to undergo STI screening testing is once you have been in a stable monogamous relationship for at least 3 months (at this time testing is reliable) and you may decide to remove the condom with a greater sense of security. STI testing should be considered when you have symptoms suggestive of a sexually transmitted illness. In this event, don’t hesitate…call and book an appointment for STI testing.