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Salpingitis is an infection of the Fallopian tubes, the pair of tubes that connect the ovaries to the uterus. They function as a passage for sperm cells to reach and fertilize the ovaries, and to transport the ovule, whether or not fertilized, to the uterus. Salpingitis is one of the main causes of preventable infertility. It is also known as pelvic inflammatory disease or PID, because the Fallopian tubes are rarely the only region infected. Salpingitis is usually caused by chlamydia or gonorrhea. The bacteria responsible for salpingitis can be transmitted via the exchange of bodily fluids during non-protected sexual relations. Without the treatment, the bacteria can reach the Fallopian tubes within two days to three weeks. Women at risk of contracting salpingitis are those who have more than one sexual partner, those whose sexual partner has multiple sexual partners, those who do not use condoms, those who have been previously diagnosed with a sexually transmitted infection, and those who are not regularly screened for sexually transmitted infections. Women under age 25 have the highest rate of chlamydial infection. We recommend that they be tested regularly for chlamydia, even in the absence of symptoms. During sexual intercourse, salpingitis sufferers can experience intense pain, which can last until the following day. Other symptoms include weak to severe abdominal pain, fever, abnormal vaginal discharge of a yellowish or greenish colour, light or significant blood loss through spotting, as well as problems urinating. In its most acute form, the symptoms are such that the woman has no choice but to see a doctor and have it treated right away. However, with some women, salpingitis may develop very discreetly without exhibiting symptoms for months or even years. This chronic form of salpingitis can cause serious and permanent damage to the reproductive system. Untreated salpingitis can increase the risk of extra-uterine pregnancy and sterility. In addition to the gynecological exam, we sometimes need to perform an ultrasound or a laparoscopy in order to identify salpingitis. We treat salpingitis with antibiotics injected into the muscles or the veins, usually combined with oral antibiotics for a period of ten to fourteen days. To alleviate the pain, we often prescribe anti-inflammatory drugs in conjunction with the antibiotic treatment. To avoid transmitting salpingitis bacteria, which can also affect men, you should refrain from sexual relations during the full course of treatment, or use a condom each time you have sexual relations. To avoid being re-infected and to break the chain of infection, you should inform all your sexual partners and recommend that they be screened and treated if required. This is called the "epidemiological treatment" of sexual contacts. Your doctor can assist you in this process. The best way to avoid salpingitis is to remain monogamous with a sexual partner who is free of the infection. Otherwise, you should always use a condom and be tested regularly for sexually transmitted infections.
Learning medicine is hard work! Osmosis makes it easy. It takes your lectures and notes to create a personalized study plan with exclusive videos, practice questions and flashcards, and so much more. Try it free today! Pelvic inflammatory disease, or PID, is an infection of the upper female reproductive system, including the uterus, fallopian tubes, and ovaries. It can cause a number of serious complications, including infertility. The female reproductive system includes all of internal and external organs that help with reproduction. The internal sex organs are the ovaries, which are the female gonads, the fallopian tubes, two muscular tubes that connect the ovaries to the uterus, and the uterus, which is the strong muscular sack that a fetus can develop in. The neck of the uterus is called the cervix, and it protrudes into the vagina. At the opening of the vagina are the external sex organs, and these are usually just called the genitals and they’re in the vulva region.They include the labia, the clitoris, and the mons pubis. The vagina, uterus, and fallopian tubes all have a mucosa, which is a layer of epithelial cells that lines the inside of these organs. PID usually develops from a bacterial infection in the vagina or cervix which causes inflammation of this mucosal layer. About 60 percent of the time, this changes the composition of the bacterial flora in the vagina, also called bacterial vaginosis. Because the reproductive tract is essentially one long tunnel that starts at the ovaries and ends at the external sex organs, the infection can travel up the tract pretty easily. Some mechanisms can make it even easier! For example, the cervical mucus, which normally acts as a barrier preventing bacteria from entering the uterus, may become less effective. The mucus can become thinner as a result of normal variations throughout the menstrual cycle, or alternatively, it can become less effective in the context of bacterial vaginosis, which is when the normal balance of the vaginal flora is altered, and anaerobic bacteria proliferate and degrade the cervical mucus. Other factors contributing to an infection may be retrograde menstruation, which is when menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of out of the body, and also sexual intercourse. Now, PID is most problematic when the infection reaches the fallopian tubes, in which case it’s called salpingitis. If it also affects the ovaries, it’s called salpingo-oophoritis. The infection triggers a response from the body, which sends in neutrophils, plasma cells, and lymphocytes into the fallopian tubes. That sounds like a good thing, right? But this actually damages the tubal epithelium and the tubes become filled with pus. When scar tissue forms to repair the damage, areas with damaged epithelium tend to stick to one another, creating closed-off pockets and little dead-end pouches in the fallopian tubes. This scarring in the fallopian tubes can lead to a number of complications related to PID. If pus builds up in the tube and ovary, it can turn into an tubo-ovarian abscess, which can be life-threatening if it ruptures. If a watery fluid builds up in a pocket created by scar tissue in the tubes, this is called hydrosalpinx and it can cause the affected area to become swollen. In general, because of the structural damage it causes in the fallopian tubes, individuals who have had PID tend to have more difficulty getting pregnant, and have a higher risk for ectopic pregnancy and chronic pelvic pain. One last complication is Fitz-Hugh-Curtis syndrome, which occurs when the inflammation from PID spreads to the peritoneum, and, from there, to Glisson's capsule, which surrounds the liver. This results in “violin string” adhesions, or thin strings of scar tissue that attach the liver to the peritoneum. There are many different bacteria that are associated with PID, but the most common are Neisseria gonorrhoeae and Chlamydia trachomatis, which are responsible for the sexually transmitted infections gonorrhea and chlamydia, respectively. Occasionally, PID can be caused by other forms of bacteria introduced in the reproductive tract by surgery, abortion, or even normal vaginal childbirth. Most of the time the infection is caused only by one type of bacteria but in about 30-40% of cases it becomes polymicrobial. Essentially, the original infection makes it easier for other bacteria to settle into the reproductive tract. Because of the relationship with chlamydia and gonorrhea infections, sexually active females, particularly those who have multiple sexual partners and do not use condoms, are most at risk of developing PID. Some women will have few or no symptoms of PID. When there are noticeable symptoms, they include pelvic pain, tenderness around the ovaries and fallopian tubes, fever, and abnormal vaginal discharge. Diagnosis of PID is usually based on clinical findings - particularly pelvic pain and cervical motion tenderness, which is when mobilizing the cervix during a vaginal exam causes pain or discomfort. Tenderness in the right upper quadrant of the abdomen is also common if Fitz-Hugh-Curtis syndrome has developed. There’s no specific test for PID, but there are some that can support the diagnosis, like testing vaginal discharge for signs of bacterial vaginosis, doing a nucleic acid amplification test to look for chlamydia and gonorrhea DNA in a sample taken from the inside of the vagina or cervix, or doing a laparoscopy of the fallopian tubes. An ultrasound can show if there is fluid in the fallopian tubes, and whether a tubo-ovarian abscess or hydrosalpinx is present. Treatment involves giving a mix of antibiotics, usually an injection of ceftriaxone or cefotetan followed by 14 days of oral doxycycline and metronidazole, to treat the bacterial infection responsible for PID. Acetaminophen can be given to manage the pain until the antibiotics have treated the infection. Occasionally, surgery will be done to remove adhesions that are causing pain or to treat complications of PID, such as tubo-ovarian abscesses and hydrosalpinx. All right, as a quick recap… Pelvic inflammatory disease is an infection of the upper female reproductive system. It caused inflammation of the mucous membrane of the inner reproductive tract, which damages the epithelium and results in scarring and adhesions, particularly in the fallopian tubes. It is usually caused by Neisseria gonorrhoeae and Chlamydia trachomatis, which are the bacteria responsible for chlamydia and gonorrhea. Complications include infertility, ectopic pregnancies, and tubo-ovarian abscesses.
An ectopic pregnancy is a pregnancy that occurs outside the uterus. Normally, fertilization takes place in the widest section of the fallopian tube. The fertilized egg then travels toward the uterus where it is to be implanted. Ectopic pregnancy happens when the egg gets stuck on its way and starts to develop inside the tube. This is known as tubal pregnancy. Implantation may also occur in the cervix, ovaries and abdominal cavity but tubal pregnancy is by far the most common. With extremely rare exceptions, the fetus cannot survive outside the uterus. Without treatment, the growing tissue may rupture, resulting in destruction of the surrounding maternal structures and a massive blood loss that could be life-threatening. An ectopic pregnancy may have no signs, or may feel like a normal pregnancy at first, with positive pregnancy test result for hCG. First clinical symptoms usually appear after 4 weeks from the last normal menstrual period and may include abdominal pain, v. bleeding, or both. There may also be shoulder pain. If the fallopian tube ruptures, heavy bleeding, fainting and shock can be expected. This is a medical emergency and requires immediate attention. Tubal pregnancy occurs because of problems in transportation of the fertilized egg through the tube. Fallopian tubes are lined with hair-like structures called cilia that help to move the egg through. It is believed that a reduction in number of cilia may slow down the transport and lead to tubal pregnancies. Cilia degeneration can happen as a result of tubal tissue scarring or as an effect of certain chemicals or drugs. Risks factors include: -Inflammation of fallopian tubes – salpingitis; or infection of pelvic organs - pelvic inflammatory disease. These infections are commonly caused by gonorrhea or chlamydia. -Use of an intrauterine device as a contraceptive method -Tubal or intrauterine surgeries such as tubal ligation, tubal reversal and dilation & curettage -Previous ectopic pregnancy -Abnormal fallopian tubes due to birth defects -Smoking -Exposure to certain fertility drugs -Daughters of mothers who have taken the synthetic estrogen diethylstilbestrol during pregnancy Diagnosis is often based on blood tests for hCG and a transvaginal ultrasound. If the ectopic pregnancy is detected early, methotrexate may be injected to dissolve the pregnancy tissue. In other cases, a keyhole surgery may be performed. If the fallopian tube has ruptured, an emergency open surgery is required. The ruptured tube is usually removed. After treatment the hCG levels are monitored to ensure that the entire ectopic tissue has been taken out. An hCG level that remains high would require further treatment.