Salpingitis

SALPINGITIS
TIFANISA FEBRIAN
1310211137
SALPINGITIS
peradangan yang terjadi pada tuba fallopi
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Epidemiology
Salpigitis merupakan penyebab paling umum terjadinya
infertilitas pada wanita , karena kerusakan dari tuba
fallopi
Salpingitis paling umum disebabkan oleh infeksi menular
sexual yaitu yang paling sering akibat Neisseria
gonorhhoea dan chlamydia
1 million new cases occur in the United States every year,
most commonly in females aged 15-25 years, and about
1-2% of sexually active young women are affected
annually. (Medscape)
Type Of
Salpingitis
ACUTE
CHRONIC
fallopian tubes become red and

swollen
secrete extra fluid so that the
inner walls of the tubes often
stick together.
The tubes may also stick to
nearby structures such as the
intestines.
Sometimes, a fallopian tube
may fill and bloat with pus.
In rare cases, the tube ruptures
and causes a dangerous
infection of the abdominal
cavity (peritonitis).
Usually follows an acute

attack.
The infection is milder,
longer lasting and may not
produce many noticeable
symptoms
Etiology
Salpingitis adalah bagian dari pelvic
inflammatory disease (PID).
PID adalah polymicrobial infection pada
upper female genital tract (uterus,
fallopian tubes, ovaries) yang di
sebabkan oleh ascending infection dari
vagina atau cervix.
Etiology
N. gonorrhea
Causes roughly 50% of salpingitis.

15% of GC cervicitis progresses to PID.
C. trachomatis
More common than GC by up to 10:1, but only

accounts for 20-35% of PID.
Classically produces a more mild form of PID
with insidious onset.
Other bugs
Strep., Staph., E. coli, Bacteroides,

Actinomyces, Peptococcus, Clostridium,
Gardnerella, Haemophilus, CMV, etc.
Risk Factors
Young age (<25)
Prior history of STD
IUD or other non-barrier contraception
Multiple partners / Promiscuous partners
Iatrogenic factors
miscarriage
abortion
childbirth
appendicitis
Manifestasi
In milder cases, salpingitis may have no symptoms.
This means the fallopian tubes may become
damaged without the woman even realising she has
an infection.
abnormal vaginal discharge, such as unusual colour or
smell
spotting between periods
dysmenorrhoea (painful periods)
pain during ovulation
uncomfortable or painful sexual intercourse
fever
abdominal pain on both sides
Lower back pain
frequent urination
nausea and vomiting
the symptoms usually appear after the menstrual
period.
Clinical Criteria for

Diagnosis of PID
All 3 of the following:
Abdominal tenderness with or without rebound.
Adnexal tenderness
Cervical motion tenderness
Plus of the following:
Routine
Oral temperature greater than 38.3C
Abnormal cervical or vaginal discharge
Elevated ESR and/or C-reactive protein levels
Culture or nonculture evidence of cervical infection withN
gonorrhoeae orC trachomatis
Elaborate
Histopathologic evidence of endometritis on endometrial biopsy
Tubo-ovarian abscess (TOA) or thickened fluid-filled tubes with
or without free-fluid on ultrasonography or other imaging
techniques
Laparoscopic findings
Another way to
diagnose
general examination - to check for localised tenderness
and enlarged lymph glands
pelvic examination - to check for tenderness and

discharge
blood tests - to check the white blood cell count and
other factors that indicate infection
mucus swab - a smear is taken to be cultured and
examined in a laboratory so that the type of bacteria can
be identified
laparoscopy - in some cases, the fallopian tubes may
need to be viewed by a slender instrument inserted
through abdominal incisions
Differential Diagnosis
Acute appendicitis
Ectopic pregnancy
Ruptured ovarian cyst
Tubo-ovarian abscess
Endometriosis
Adnexal torsion
Acute UTI
Diverticulitis
Crohns/Ulcerative Colitis
Management
Lab studies
CBC to look for leukocytosis
-HCH to r/o ectopic pregnancy
Gonorrhea and Chlamydia cultures
ESR/CRP
UA to r/o cystitis or pyelonephritis
Fecal occult blood test
Wet mount
R/o other concurrent STDs with RPR/VDRL and HIV test
Management
Imaging Studies
Pelvic ultrasound to r/o tubo-ovarian abscess, ectopic
pregnancy and ovarian torsion.
Procedures
Laparoscopy if still unsure of diagnosis
Culdocentesis is now rarely required
Treatment
Outpatient therapy
Regimen A
Ofloxacin/Levofloxacin + Metronidazole PO x 14 days
Regimen B
Ceftriaxone or Cefoxitin (+probenecid PO) IM x 1 dose + Doxycycline +/Metronidazole PO x 14 days
Remember to also provide treatment to the patients partner if

the infection is due to an STD.
Treatment
Inpatient therapy
Regimen A
Cefotetan or Cefoxitin IV until clinical improvement + Doxycyline x 14 days
Regimen B
Clindamycin + Gentamycin IV until clinical improvement + Doxycycline or
Clindamycin PO x 14 days
Medical therapy alone results in an 85% cure rate with

the rest requiring surgical intervention.
Indications for
Hospitalization
Pregnancy
Immunodeficient
Nausea/Vomiting and high fever
Unpredictable compliance
Poor response to outpatient therapy
Complications
Infertility 2 tubal scarring
10% risk after a single episode of PID
30% risk after 2 episodes
50% risk after 3 or more episodes
Complications
Chronic pelvic pain
Found in up to 18% of women after resolution of
PID.
Adhesions
Dyspareunia
Complications
Ectopic Pregnancy
Also 2 to tubal scarring
7-10 fold increased risk after a single episode
Complications
Ectopic Pregnancy
Complications
Pyosalpinx is defined as pus in the

fallopian tube
Hydrosalpinx is a collection of watery
sterile fluid inside the fallopian tube.
Serious sequelae of PID causing 350,000

hospitalizations and 150,000 surgeries/yr.
Occurs in 15-30% of women requiring
hospitalization for PID treament.
Ruptured TOA has a mortality rate as high as 9%.
Complications
Complications
Can be diagnosed by ultrasound with 94% sensitivity.
Can attempt conservative management with antibiotics but
often require drainage or excision via laparoscopy.
86-93% infertility rate following TOA.
Complications
Fitz-Hugh-Curtis Syndrome
Extrapelvic manifestation of PID associated with

RUQ pain abdominal painaggravated by breathing,
coughing or laughing, which may be referred to the
right shoulder due to inflammation of the liver
capsule and diaphragm.
As with PID, it is mainly caused by N. gonorrhea
and C. trachomatis.
Probably spreads via direct seeding into the
peritoneal cavity, although hematogenous and
lymphatic spread cant be ruled out.
Occurs in 15-30% of women with PID worldwide
though this is probably less in developed countries.
Thank you

Salpingitis

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Salpingitis

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SALPINGITIS

fallopian tubes become red and

Usually follows an acute

Causes roughly 50% of salpingitis.

More common than GC by up to 10:1, but only

Strep., Staph., E. coli, Bacteroides,

Clinical Criteria for

pelvic examination - to check for tenderness and

Remember to also provide treatment to the patients partner if

Medical therapy alone results in an 85% cure rate with

Pyosalpinx is defined as pus in the

Serious sequelae of PID causing 350,000

Extrapelvic manifestation of PID associated with

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