Salpingitis

Salpingitis is inflammation of one or both fallopian tubes, frequently occurring as part of pelvic inflammatory disease (PID). It usually results from ascending infection from the cervix or vagina and may involve surrounding pelvic organs. Causal organisms are commonly sexually transmitted bacteria, notably Neisseria gonorrhoeae and Chlamydia trachomatis, but mixed and nonsexually transmitted infections are possible, particularly after procedures or in postmenopausal women.

Risk factors include younger age, multiple sexual partners, prior PID, recent abortion or intrauterine device use, and inconsistent use of barrier protection. The clinical presentation ranges from mild lower abdominal or pelvic pain with pelvic tenderness to more severe illness with fever, cervical motion tenderness, adnexal tenderness, and vaginal discharge. Some cases are subclinical or present with nonspecific symptoms.

Diagnosis rests on clinical assessment supported by laboratory and imaging studies. A pelvic examination may reveal cervical motion or adnexal tenderness. Pregnancy testing is essential to exclude ectopic pregnancy. Inflammatory markers (e.g., elevated C-reactive protein, white blood cell count) may be present. Testing for gonorrhea and chlamydia by nucleic acid amplification is recommended. Transvaginal ultrasound can identify adnexal swelling, hydrosalpinx, or abscess, though imaging is not required for all cases. Laparoscopy is rarely needed but may be used when diagnosis is uncertain or to assess for tubo-ovarian abscess.

Treatment depends on severity. Mild to moderate PID with salpingitis is usually managed outpatient with broad-spectrum antibiotics effective against gonorrhea, chlamydia, and anaerobes, plus counseling and partner treatment. Severe disease or tubo-ovarian abscess requires inpatient intravenous antibiotics, with escalation as needed. Prompt treatment reduces the risk of infertility, ectopic pregnancy, and chronic pain. Prevention focuses on STI prevention, regular screening, and timely treatment of infections.