SALPINGITIS

Inflammation of the fallopian tubes often responds well to antibiotics, but a severe case can cause infertility. Any infection in a woman’s reproductive organs should therefore be treated immediately.

Salpingitis is a major gynecological problem. It means inflammation of the fallopian tubes (the oviducts), the tubes that the eggs normally pass through on their way to the womb and where fertilization of the egg occurs. It is thought that the inflammation is caused by bacteria, but doctors can usually only isolate bacteria from about half of the Fallopian tubes that they examine.

CHRONIC AND ACUTE CONDITIONS

Salpingitis is usually described as acute or chronic. During acute salpingitis the Fallopian tubes become congested with blood and so look deep red and swollen. Later they may return to normal or they may release a sticky secretion. This can either stick the walls of the tubes together and block them, or make the tubes stick to the other structures in the abdominal cavity such as the bowel.

The Fallopian tubes can also swell into a bag of pus which occasionally will burst, causing severe inflammation to spread throughout the abdominal cavity. Fortunately this is very rare. It is more common for the pus in the tube to be replaced by a clear, watery fluid so that the Fallopian tube becomes a thin-walled, misshapen structure distended with fluid, rather than the normal tubular structure down which an egg can pass.

Chronic salpingitis may follow acute salpingitis. In this case the inflammation decreases but never completely disappears. The chronic condition may also be a result of continuous mild inflammation which never becomes severe enough to damage the tubes seriously.

Because there is a rich supply of lymph channels between the Fallopian tubes, infection in one tube nearly always travels to the tube on the other side of the uterus.

CAUSES OF INFECTION

The Fallopian tubes may become infected by bacteria carried in the blood. This was commonly the case in the past when some women contracted tuberculosis in their tubes. Today it is more usual for the infection to spread directly from the vagina or the uterus. For example gonococci, the micro-organisms responsible into the vagina by a woman’s partner during sexual intercourse and then spread up the genital tract to the Fallopian tubes. Infection may also enter the Fallopian tubes after childbirth, an abortion or a miscarriage, causing inflammation in both the vagina and the tubes.

Finally, there may also be a spread of infection from a nearby abdominal organ, for example from an infected appendix.

It is probable that the increase in sexual freedom, together with the large number of abortions performed today have increased the risk of women contracting salpingitis. It is also known that women who are fitted with an intrauterine contraceptive (IUD) are at slightly greater risk of developing salpingitis. This may be because some of the threads attached to the earlier typs of IUD were capable of acting as a wick along which bacteria from the vagina could travel further. Today, intra uterine devices are fitted with monofilament nylon threads which do not act as a wick and therefore are much safer.

SYMPTOMS

Women with acute salpingitis often have an unpleasant vaginal discharge and a slightly raised temperature. They develop pain in the lower part of the abdomen which gradually increases in severity. They feel generally unwell and may notice that coughing or laughing makes the pain worse. If they attempt sexual intercourse during this time they usually find it greatly increases the pain and may actually be impossible.

In cases of chronic salpingitis, women may previously have experienced the above symptoms, but these may have settled to a dull ache in the lower part of the stomach. This occasionally gets slightly worse, especially if the woman is constipated. The dull ache may also get worse when the woman has her periods.

TREATMENT

If possible, it is important to find which bacteria are causing the inflammation so that the most effective antibiotic can be prescribed. In doing this it is assumed that the same bacteria are also present in the lower genital tract, and bacterial swabs are therefore taken from the urethra, vagina and cervix to try and culture them in the laboratory. In some hospitals, doctors also, look at the Fallopian tubes through an instrument called a laparoscope's and take bacterial swabs directly from the tubes. In cases of acute salpingitis a laparoscope is normally only done if there is genuine doubt about the exact diagnosis.

Women with acute salingitis always require pain killing tablets or injections as well as plenty of rest and a correctly prescribed course of the appropriate antibiotic drug.

Chronic salpingitis is usually treated with frequent courses of antibiotics. Deep heat treatment is also sometimes used in conjunction with the medication. This increases the blood supply to the area which helps the antibiotics to reach the infected tissue. Unfortunately, this condition can be very difficult to cure and women may suffer recurrent discomfort for years.

DANGERS OF SALPINGITIS

Many women who have salpingitis make complete recoveries but there are many possible consequences of the condition. A woman may become infertile because the tubes are so severely damaged that the eggs are no longer able to meet and he fertilized by sperm.

When damage is less severe the egg may be fertilized in the tube but will not travel on to implant in the womb; instead it implants in the damaged tube. This is called an entopic pregnancy and both the embryo and the tube must be surgically removed.

The sticky released from infected tube can make the bowel become attached to the tubes. This can give a patient discomfort, especially if she is constipated. The ovaries, which normally float in the pelvis, can also become stuck down behind the womb. These are always tender when touched; usually during sexual intercourse they move and so avoid pressure, but after salpingitis this may no longer be the case. As the ovaries may be exceptionally tender, sex becomes uncomfortable. Finally, the woman may be left with small areas of infected tissue that can occasionally spread and cause further pain.

OUTLOOK

The outlook for salpingitis depends on the severity of the attack and how promptly it is treated. Attempts have been made to treat some of the complications already mentioned but at present they are not always successful. For example, it is sometimes possible to operate the unblock Fallopian tubes. It is also possible to remobilize ovaries which are stuck behind the uterus and cause pain on intercourse.

The best chance of managing salpingitis in the future may be to prevent it, occurring by early treatment of vaginal infections and the careful screening of women for infection before they are given abortions.