Salpingitis is an infectious inflammation of the fallopian (fallopian) tubes. Acute salpingitis occurs with severe abdominal pain, febrility, chills, intoxication. In the subacute and chronic form of salpingitis, the clinic is erased, but dyspaurenia and infertility are often noted. Diagnosis of salpingitis includes bimanual examination, bacterioscopic and bacteriological examination of smears, echography. Treatment is carried out with the help of antibacterial therapy, physiotherapy methods. In the formation of purulent tuboovarial tumors, laparoscopy is indicated.
Isolated salpingitis is rare; it occurs much more often with the involvement of the ovaries – salpingoophoritis (adnexitis). Disease can also be combined with endocervicitis and endometritis – inflammation of the uterus. This is due to the close anatomical and physiological connection of all parts of the reproductive system. Acute salpingitis and oophoritis are the pathology that gynecology diagnoses most often.
Causes and development
According to the etiology, salpingitis is divided into nonspecific and specific. Nonspecific salpingitis can be caused by Staphylococcus aureus or epidermal Staphylococcus, Streptococcus, Enterococcus, E. coli, bacteroids, peptococci, peptostreptococci, proteus, fungi of the genus Candida, as well as mixed flora. Microbial associations that cause salpingitis are usually resistant to commonly used antibiotics. Septic etiology is characterized by a unilateral lesion of the fallopian tube.
The development of nonspecific salpingitis is facilitated by a weakening of the somatic status, gynecological pathology (ovarian hypofunction, vaginal prolapse), birth trauma, complicated abortions, various intrauterine manipulations (metrosalpingography, diagnostic curettage of the uterus, hysteroscopy, insertion and removal of IUD). The gates for the penetration of pathogens in these cases are the damaged epithelial integuments of the uterus.
Specific forms are caused by gonococci, trichomonas, chlamydia, which enter the body sexually. Mycobacterium tuberculosis enters the fallopian tubes hematogenically, more often from foci of pulmonary infection, intra-thoracic or mesenteric lymph nodes. Specific salpigitis is usually bilateral.
Initially, inflammation captures the mucous membrane of the fallopian tube (endosalpinx), in which an inflammatory reaction develops – hyperemia, microcirculation disorders, exudation, edema, cellular infiltration. When the inflammatory edema spreads to the muscular layer of the fallopian tube, its thickening and deformation occurs.
The exudative contents with the microorganisms contained therein enter the abdominal cavity, causing damage to the serous cover of the tube and the surrounding peritoneum with the development of perisalpingitis and pelvioperitonitis. In the future, when the follicle ruptures, infection of the granulosa of the Graaf vesicle may occur – salpingoophoritis occurs.
With this disease, obliteration rapidly progresses in the mouth and ampullary part of the fallopian tube due to exudation and thickening of the fimbriae. Accumulation of secretions in the tube leads to the formation of hydrosalpinx and pyosalpinx. Between the inflamingly altered fallopian tubes, peritoneum, intestinal loops, appendix, an adhesive process develops – perisalpingitis. Chronic salpingitis is the main factor causing tubal infertility.
The onset of clinical manifestations is usually associated with the end of menstruation. Acute form manifests with a sharp deterioration in well-being, accompanied by fever, chills, the appearance of pain in the lower abdomen with irradiation into the sacrum and rectum. There are gastroenteric disorders (nausea, flatulence, vomiting), intoxication (weakness, myalgia, tachycardia), functional and emotional-neurotic disorders.
The pathognomonic symptom of salpingitis is serous-like white spots from the genital tract and urethra. Dysuric disorders are characterized by frequent urge to urinate, cuts, urine excretion in small portions. Intestinal disorders are manifested by the syndrome of “irritable bowel” – frequent loose stools. Often, with salpingitis, there is a sharp soreness during sexual intercourse.
With subacute salpingitis, well-being improves, pain decreases, body temperature becomes subfebrile. Chronic salpingitis can occur against the background of a satisfactory general condition, normal body temperature, but with persistent pain. Exacerbations of chronic salpingitis are provoked by overwork, hypothermia, stress, intercurrent infections. If salpingitis is complicated by pyosalpinx, hectic fever develops, chills, intoxication increases, pronounced symptoms of peritoneal irritation are determined. The rupture of the pyosalpinx and the outpouring of pus into the abdominal cavity can lead to spilled peritonitis.
Gonorrheal salpingitis does not differ much from the septic form of inflammation, however, with gonorrhea, in addition to the fallopian tubes, the urethra, cervical canal, paraurethral passages, bartholinium glands, rectum are affected. Chlamydial salpingitis proceeds more erased, with the phenomena of urethritis, cervicitis, endometritis, destructive damage to the fallopian tubes. After undergoing chlamydial salpingitis, ectopic pregnancy and infertility often develop. Salpingitis of tuberculous etiology has a chronic course; exacerbations are observed with the caseous form of the process.
Finding out the anamnesis allows the gynecologist to associate the disease with complicated childbirth, surgical termination of pregnancy, gynecological manipulations, change of sexual partner, etc. When diagnosing salpingitis, they rely on a set of data from physical, laboratory, and instrumental examinations.
In acute salpingitis, gynecological examination is sharply painful. Through the anterior abdominal wall, one- or two-sided infiltration is palpated in the appendage area, without clear boundaries due to swelling of the tissues. In the case of a chronic form, due to sclerosis and fibrosis, the appendages become sedentary. With pelvioperitonitis, symptoms of irritation of the peritoneum are revealed; accumulation of exudate in the douglas pocket – swelling and sharp soreness of the posterior vaginal arch.
The change in peripheral blood in salpingitis is characterized by leukocytosis with a shift of the leukoformula to the left, an increase in ESR. Microbiological analysis of the separated urethra, vagina and cervical canal makes it possible to identify pathogens and determine their susceptibility to antibiotics. The diagnosis of gonorrheal, tuberculous and chlamydial salpingitis can be confirmed by PCR and ELISA methods.
Ultrasound (transvaginal, transabdominal) visualizes the thickening of the fallopian tubes, the presence of adhesions and effusion in the pelvis; with hydro- or pyosalpinx, a tumor–like change in the tube. In case of accumulation of exudate in the Douglas space, a puncture of the posterior vaginal arch is performed. Diagnostic laparoscopy is advisable to exclude acute appendicitis, ectopic pregnancy, rupture of the pyosalpinx, ovarian apoplexy.
Acute salpingitis and severe exacerbation of the chronic form requires inpatient treatment. Important components of salpingitis therapy are bed rest, cold on the hypogastrium area, a sparing diet. The appointment of antimicrobial therapy is based on the results of bacteriological seeding and clarification of the etiology of salpingitis. Treatment can be carried out with semi-synthetic penicillins, cephalosporins, fluoroquinolones, aminoglycosides, macrolides, tetracyclines for 10-14 days. At the same time, nitrofuran derivatives, antifungal agents, NSAIDs, infusion therapy, autohemotherapy are prescribed. Stimulation of metabolic and microcirculatory processes is carried out by the introduction of vitamins, thiamine pyrophosphate, aloe extract, hyaluronidase.
Salpingitis caused by anaerobic flora and trichomonas is treated with metronidazole; therapy of tuberculous and gonorrheal salpingitis is carried out according to the principles of treatment of tuberculosis and gonorrhea. In chronic salpingitis and during the recovery period after an acute process, physiotherapy is widely used – UHF, magnetotherapy, electrophoresis, ultrasound, diadin therapy, hydrotherapy (radon, sulfide, sodium chloride baths, thalassotherapy), heat therapy (ozokeritotherapy, paraffin therapy). Acupuncture sessions for salpingitis help to relieve pain and regression of pathological changes.
When tuboovarial tumors are formed, diagnostic laparoscopy is performed; if necessary, tubectomy or adnexectomy is performed. Sometimes they resort to transvaginal aspiration-washing drainage and pelvic sanitation.
Prognosis and prevention
After undergoing salpingitis, menstrual, sexual and reproductive functions often suffer. Infertility, ectopic pregnancy, pelvic pain caused by the adhesive process are often observed in patients.
Preventive measures against salpingitis require sparing any gynecological interventions, promotion of barrier contraception and safe sex, timely elimination of foci of extragenital and genital infections, proper hygienic education of girls.