Salphingitis

SALPHINGITIS
Sukmaning Ayu Melati H

1310211034
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
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).
CHRONIC
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
gonorrhea
C.
trachomatis
Causes roughly 50%

15% of GC cervicitis
More
of salpingitis.
progresses to PID.
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.,
N.
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
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
CBC
MANAGEMENT
Imaging Studies
ultrasound to r/o tubo-ovarian abscess, ectopic

pregnancy and ovarian torsion.
Procedures
Laparoscopy
if still unsure of diagnosis

Culdocentesis is now rarely required
Pelvic
TREATMENT
Outpatient therapy
Regimen
Ofloxacin/Levofloxacin + Metronidazole PO x 14 days
Regimen
A
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
Cefotetan or Cefoxitin IV until clinical improvement +

Doxycyline x 14 days
Regimen
A
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
10%
2 tubal scarring
risk after a single episode of PID

30% risk after 2 episodes
50% risk after 3 or more episodes
COMPLICATIONS
Chronic
Found
PID.
pelvic pain
in up to 18% of women after resolution of
Adhesions
Dyspareunia
COMPLICATIONS
Ectopic
Also
Pregnancy
2 to tubal scarring
7-10 fold increased risk after a single episode
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COMPLICATIONS
Ectopic Pregnancy
COMPLICATIONS
Pyosalpinx
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%.
is defined as pus in
the fallopian tube
Hydrosalpinx is a collection of
watery sterile fluid inside the
fallopian tube.
COMPLICATIONS
COMPLICATIONS
Tubo-ovarian
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.
Can
abscess
COMPLICATIONS
Fitz-Hugh-Curtis
Extrapelvic
Syndrome
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.
you
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Salphingitis

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SALPHINGITIS

Sukmaning Ayu Melati H

peradangan yang terjadi pada tuba fallopi

fallopian tubes become red and

Usually follows an acute

adalah bagian dari pelvic

Causes roughly 50%

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

Staph., E. coli, Bacteroides, Actinomyces,

In milder cases, salpingitis may have no symptoms.

vaginal discharge, such as unusual colour or

CLINICAL CRITERIA FOR

ANOTHER WAY TO DIAGNOSE

to look for leukocytosis

ultrasound to r/o tubo-ovarian abscess, ectopic

if still unsure of diagnosis

Ofloxacin/Levofloxacin + Metronidazole PO x 14 days

Ceftriaxone or Cefoxitin (+probenecid PO) IM x 1 dose +

to also provide treatment to the patients

Cefotetan or Cefoxitin IV until clinical improvement +

Clindamycin + Gentamycin IV until clinical improvement +

Medical therapy alone results in an 85% cure

risk after a single episode of PID

in up to 18% of women after resolution of

sequelae of PID causing

be diagnosed by ultrasound with 94% sensitivity.

manifestation of PID associated with RUQ

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