Salpingitis

Salpingitis is really part of the larger family

of pelvic inflammatory disease (PID).
PID is a polymicrobial infection of the upper
female genital tract (uterus, fallopian tubes,
ovaries) caused by an ascending infection of
the vagina or cervix.
N. gonorrhea and C. trachomatis cause the
majority but endogenous bacteria can also
be present.

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.

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

Clinical Criteria for Diagnosis of

PID
All 3 of the following:
Abdominal tenderness with or without rebound.
Adnexal tenderness
Cervical motion tenderness

Plus 1 of the following:

Temp. of >101F
WBC >10,000 or elevated CRP or ESR
Gram stain with gram neg. intracellular
diplococci
Inflammatory mass
Purulent material from peritoneal cavity

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
Tubo-ovarian abscess

Complications

Infertility 2 tubal scarring

Chronic pelvic pain
Adhesions
Dyspareunia
Ectopic Pregnancy
Tubo-ovarian abscess
Fitz-Hugh-Curtis Syndrome