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PubMed1983

Follow-up of patients with tubo-ovarian abscess(es) in association with salpingitis.

The medical records of 143 patients hospitalized with a diagnosis of salpingitis over a five-year period were reviewed. Ninety-three patients had salpingitis without clinical evidence of a tubo-ovarian abscess. Seven (7.5%) of these women had surgical treatment; five of the seven were found to have tubo-ovarian abscesses which had not been detected clinically. Eighty-six of 93 (92.5%) patients with a clinical diagnosis of salpingitis and no abscess responded to medical management alone. Fifty patients had salpingitis and clinical evidence of a tubo-ovarian abscess(es); five of these patients had medical management only, 27 had medical treatment followed by surgery, and 18 had surgery initially before receiving antibiotics. There was a significant difference in age but not in parity between patients with evidence of a tubo-ovarian abscess that was managed medically and those who had surgery. There was no significant difference in surgical procedure performed, chronic symptoms, subsequent gynecologic surgery, or subsequent pregnancy among the groups with an abscess. There was a trend toward more surgical complications among women who had delayed surgical intervention for an abscess. Among women with a unilateral tubo-ovarian abscess, those who had a unilateral salpingo-oophorectomy had a higher pregnancy rate than those who received antibiotics alone. In this study, women with a tubo-ovarian abscess in association with salpingitis did not respond well to antibiotic treatment alone. This may be the most reliable way of distinguishing these patients from women with salpingitis alone or salpingitis in association with a tubo-ovarian inflammatory complex, who, as a group, did respond well to medical management alone.

Abscess↗
PubMed1995

Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization.

OBJECTIVE: To investigate the role of transcervical tubal catheterization in diagnosis and treatment of proximal tubal obstruction associated with salpingitis isthmica nodosa. DESIGN: Retrospective case study. SETTING: University hospital and outpatient radiology practice. PATIENTS: Fifty-two women with proximal tubal obstruction associated with salpingitis isthmica nodosa. INTERVENTION: Selective salpingography and catheter recanalization using fluoroscopic guidance. MAIN OUTCOME MEASURES: The number of tubes visualized to the fimbria as a percentage of the tubes with proximal tubal obstruction on the initial hysterosalpingogram was determined as a measure of diagnostic efficacy. To evaluate the treatment potential of catheter recanalization, the patients were grouped according to tubal status at the conclusion of the procedure and subsequent pregnancies were evaluated. RESULTS: Forty-seven of 65 tubes (72%) with proximal tubal obstruction were recanalized successfully. Among the 19 women who were able to conceive only via a recanalized salpingitis isthmica nodosa tube, there were 6 live births (32%) and two tubal pregnancies (10%). CONCLUSION: Selective salpingography allows complete tubal diagnosis in almost three fourths of patients with proximal tubal obstruction and salpingitis isthmica nodosa. The radiographic diagnosis of salpingitis isthmica nodosa may be pressure dependent. Intrauterine pregnancies occur via recanalized salpingitis isthmica nodosa tubes, therefore catheter recanalization may be attempted before tubal microsurgery or IVF in patients with proximal tubal obstruction and associated salpingitis isthmica nodosa.

Adult↗
PubMed1984

Salpingitis and cervicitis in uro-arthritis.

To compare anamnestic cervicitis and salpingitis as a relative risk for uro-arthritis the medical history of 60 consecutive females with uro-arthritis was compared with that of 311 interviewed controls. Salpingitis was revealed to be a relative risk factor of 3.2 as compared to cervicitis 1.4 in connection with uro-arthritis. HLA-B27 was tested in the 60 patients and in an additional 7 females with uro-arthritis, all of whom had a history of salpingitis. HLA-B27 was positive in 42% (28/67). There were no significant differences between those with or without cervicitis or salpingitis or both. Salpingitis could thus as justifiably be accepted as a diagnostic criterion for RS as cervicitis. These findings and clinical observations, including comprehensive histories of the patients concerned, serve as a basis for our hypothesis of rheumatic salpingitis. Further prospective and co-operative investigations will be needed to confirm or disprove this hypothesis.

Adolescent↗
PubMed1989

Serovars of Chlamydia trachomatis causing postabortion salpingitis.

In a previously reported investigation, 69 women with genital chlamydial infection following legal abortion were studied prospectively. Ten cases of postabortion salpingitis and 16 cases of endometritis were identified. To ascertain whether some serovars of Chlamydia trachomatis are particularly likely to initiate an infection in the fallopian tubes and cause salpingitis, the chlamydial isolates from the patients with salpingitis and those isolates from cases free of infectious complications were serotyped using a panel of monoclonal antibodies. Six of the seven different serovars demonstrated in the symptom-free group were identified in salpingitis cases. The strains associated with salpingitis seemed to reflect the overall distribution of chlamydial serovars in the entire study group. The predominant serovars were E, F and H. A protective effect associated with chlamydial serum antibodies had previously been observed in salpingitis cases. Therefore, the antibody titres subdivided according to serovar were compared. No difference in the antibody response induced by the different serovars could be verified statistically, but the B-complex strains were associated with a higher antibody titre than the C-complex strains or the intermediate strains F and G.

Abortion, Legal↗
PubMed1993

Detection of Chlamydia trachomatis by the polymerase chain reaction in the cervices of women with acute salpingitis.

OBJECTIVE: Our objective was to determine whether an increased prevalence of Chlamydia trachomatis could be detected by the polymerase chain reaction as opposed to culture in the cervices of women with acute salpingitis. STUDY DESIGN: Endocervical samples from 15 women with laparoscopy-verified acute salpingitis and 20 women seeking medical help for conditions other than pelvic pain were tested for Chlamydia trachomatis with the polymerase chain reaction. The oligonucleotide primer pairs used were specific for a 144 bp region of the major outer membrane protein that contained a single EcoRI endonuclease cleavage site. The detection of a 144 bp band that was cleaved by EcoRI to a 103 bp band denoted a Chlamydia trachomatis-positive sample. Cervical samples were cultured for Chlamydia trachomatis with the use of McCoy cells. The lymphocyte proliferative response to Chlamydia trachomatis elementary bodies was also determined. RESULTS: Nine of the 15 women (60%) with salpingitis had positive results when tested with the polymerase chain reaction for cervical Chlamydia trachomatis. Only two of these women (13%), both of whom had positive results when tested with the polymerase chain reaction, had cultures that were positive for Chlamydia trachomatis (p < 0.02). Among the 20 other women, only two patients with cervicitis had positive cultures for Chlamydia. Those women plus two women with unexplained recurrent abortions had positive polymerase chain reaction test results for Chlamydia trachomatis. A lymphocyte proliferative response to Chlamydia trachomatis was detected in five of eight women with salpingitis, as well as three of the other four patients, all of whom had positive polymerase chain reaction test results; lymphocytes from the remaining women were unresponsive. Follow-up cervical samples were obtained 4 to 6 months after treatment from six of the patients with salpingitis who had positive polymerase chain reaction test results; at that time five had negative polymerase chain reaction test results for Chlamydia trachomatis. CONCLUSION: The polymerase chain reaction appeared to be more sensitive and more rapid than culture in detecting Chlamydia trachomatis in the cervices of women with acute salpingitis. This assay may be of value for the early diagnosis of chlamydial infections.

Acute Disease↗
PubMed1994

[Is there a correlation between tubal occlusions in chronic salpingitis and urogenital chlamydia infections?].

A prospective study was performed to analyse the relationship between urogenital infections caused by Chlamydia trachomatis and occlusions of the fallopian tubes with histologically confirmed chronic salpingitis and salpingitis isthmica nodosa. 110 infertile patients were tested for C. trachomatis infection. 23 patients with tubal occlusions and histologically confirmed chronic salpingitis (group 1) and eight patients with salpingitis isthmica nodosa (group 2) were compared to 13 patients with tubal occlusions after tuboligation (group 3), and to 66 patients with patent fallopian tubes as demonstrated by laparoscopy or hysterosalpingography (group 4). The prevalence of infections of the endocervix or urethra and the presence of Chlamydia in urine was low in all four groups. However, in groups 1 and 2, the median Chlamydia IgG and IgA serum antibody titres were significantly higher (p < or = 0.0002) than in groups 3 and 4. This result illustrates the association between urogenital infections with Chlamydia and tubal occlusions with histologically documented chronic salpingitis and salpingitis isthmica nodosa.

Adult↗
PubMed1987

Postabortal Chlamydia trachomatis salpingitis: correlating risk with antigen-specific serological responses and with neutralization.

Serum antibodies to Chlamydia trachomatis were studied by microimmunofluorescence (micro-IF) testing and by immunoblotting among 52 women with C. trachomatis cervical infection. All women underwent therapeutic abortion, and 10 (19.2%) subsequently developed laparoscopically confirmed salpingitis. Women who developed salpingitis had lower geometric mean titers of micro-IF antibody before abortion (14.9 x/divided by 2.3) than did women who did not develop salpingitis (41.6 x/divided by 4.9, P less than .01). Women who developed salpingitis significantly less often had serum IgA antibodies to a 60-kilodalton (kDa) chlamydial antigen (P = .02) and IgG antibodies to antigens of 75-kDa (P = .008), 60-kDa (P = .03), and 57-kDa (P = .0003). Serum antibodies to 100-kDa, 32-kDa, and 29-kDa antigens occurred only in women who did not develop salpingitis. Differences in antibody prevalence to specific chlamydial antigens were not due to differences in serum antibody titers between the two groups. No correlation between neutralizing sera and the risk of postabortal salpingitis was detected.

Abortion, Therapeutic↗
PubMed1996

Humoral immune response to the chlamydial heat shock proteins hsp60 and hsp70 in Chlamydia-associated chronic salpingitis with tubal occlusion.

The aim of this study was to evaluate the prevalence of serum immunoglobulin (Ig)G and IgA antibodies to recombinant chlamydial 60 kDa heat shock protein (C-hsp60) and to assess the prevalence of serum IgG antibodies to recombinant chlamydial 70 kDa heat shock protein (C-hsp70) in Chlamydia-associated chronic salpingitis and/or salpingitis isthmica nodosa with tubal occlusion. Infertile patients (n =34) with Chlamydia-associated, histologically documented chronic salpingitis and/or salpingitis isthmica nodosa and bilateral tubal occlusions (group I) were compared with infertile patients (n = 19) without tubal occlusions (group II). The prevalence of chlamydial antigen in endocervical, urethral and urine samples was low in both groups. The median chlamydial serum IgG and IgA antibody titres were significantly higher in group I than in group II (P < 0.0001 and P = 0.0002 respectively). Serum IgG antibodies to C-hsp60 and C-hsp70 were detected in 24 out of 34 patients (71%) in group I compared with 10 out of 19 (53%) and nine out of 19 (47%) patients in group II (not significantly different). There was a significant difference (P = 0.035) between the prevalences of serum IgA antibodies to C-hsp60 in groups I (seven out of 34 patients; 21%) and II (none of the 19 patients). The association between the presence of serum IgA antibodies to C-hsp60 and Chlamydia-associated chronic salpingitis and/or salpingitis isthmica nodosa with tubal occlusion underlies the significance of chlamydial 60 kDa heat shock protein in the pathogenesis of tubal infertility.

Adult↗
PubMed2002

Salpingitis, salpingoliths, and serous tumors of the ovaries: is there a connection?

We have observed luminal and mucosal calcifications frequently surrounded by a mantle of bland epithelium in the fallopian tubes ("salpingoliths") of women with serous tumors of the ovaries. These lesions resemble noninvasive peritoneal "implants" in women with advanced stage atypical proliferative serous tumors (APSTs) and micropapillary serous carcinomas (MPSCs). The presence of salpingitis and salpingoliths was prospectively evaluated in 358 women with a variety of nonneoplastic and neoplastic ovarian conditions and compared with 87 previously reported women with APSTs/MPSCs in an effort to determine whether these lesions were specifically associated with serous tumors. The frequency of chronic salpingitis among women without ovarian pathology was 27%, and the frequency of salpingoliths was 4%. Serous epithelial tumors (cystadenomas, APST/MPSC, and carcinomas) were significantly more often associated with chronic salpingitis (53%) and salpingoliths (32%) than all other cases with or without ovarian neoplasms (p<0.01). APSTs/MPSCs were associated with salpingoliths significantly more frequently than all other groups (p<0.001). For patients with APSTs/MPSCs, salpingoliths were found significantly more often in advanced stage (FIGO II and III) patients (51%) than stage I patients (24%) (p<0.01), but salpingitis, present in 60% of these patients, was not stage-dependent (p>0.05). Chronic salpingitis was identified in 66% of women with endometriosis, which was significantly more frequent than those with normal ovaries (27%) (p<0.001). In conclusion, fallopian tube abnormalities may be related to both the high frequency of infertility and the noninvasive peritoneal implants in women with APSTs/MPSCs. Whether the fallopian tubes with salpingoliths are the source of the peritoneal "implants," the recipient of implants, or are independent is unknown. In addition, the high frequency of salpingitis in women with endometriosis may be related to the mechanism of endometriosis-associated infertility.

Calcinosis↗
PubMed1986

Acute salpingitis subsequent to tubal ligation.

Acute salpingitis subsequent to tubal ligation is an uncommon event. Multiple studies have given credence to the assumption that salpingitis after tubal ligation does not occur. Four cases of salpingitis after tubal ligation are reported during the period of January 1980 to May 1985. This relates to an incidence of one in approximately 450 cases of acute salpingitis. A case of acute stump salpingitis with sequela from tubal rupture is reported and represents (to the authors' knowledge) the third reported case in the literature. Salpingitis can occur in the proximal stumps of tubes that have been ligated.

Acute Disease↗
PubMed2006

Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis.

OBJECTIVE: To examine the effect of human immunodeficiency virus (HIV)-1 infection on treatment outcome of laparoscopically verified acute salpingitis. METHODS: Women aged 18-40 years with laparoscopically verified acute salpingitis received antibiotic therapy that included cefotetan 2 g intravenously and doxycycline 100 mg orally every 12 hours and laparoscopically guided drainage of tuboovarian abscesses of 4 cm or more. Clinical investigators blinded to HIV-1 serostatus used predetermined clinical criteria, including calculation of a clinical severity score and a standard treatment protocol to assess response to therapy. RESULTS: Of the 140 women with laparoscopically confirmed acute salpingitis, 61 (44%) women had mild, 38 (27%) had moderate, and 41 (29%) had severe disease (ie, pyosalpinx, tuboovarian abscesses, or both). Fifty-three (38%) were HIV-1-infected. Severe disease was more common in HIV-1-infected in comparison with HIV-1-uninfected women (20 [38%] compared with 21 [24%], P = .02). Defined as time of hospital discharge or 75% or more reduction in baseline clinical severity score, HIV-1-infected women with severe (6 days [4-16] compared with 5 days [3-9], P = .09) but not those with either mild (4 days [2-6] compared with 4 days [2-6] P = .4) or moderate salpingitis (4 days [3-7] compared with 4 days [3-6] P = .32) tended to take longer to meet criteria for clinical improvement. The need for intravenous clindamycin or additional surgery was not different in HIV-1-infected and uninfected cases (15 [28%] compared with 18 [21%], P = .3). CONCLUSION: Although HIV-1 infection may prolong hospitalization in women with severe salpingitis, all women hospitalized with acute salpingitis responded promptly to antibiotic therapy and surgical drainage regardless of HIV-1 infection status. LEVEL OF EVIDENCE: II-2.

Acute Disease↗
PubMed1978

Changes in the incidence of acute gonococcal and nongonococcal salpingitis. A five-year study from an urban area of central Sweden.

The incidence of acute gonococcal and nongonococcal salpingitis for a five-year-period (1970--74) was studied retrospectively in an urban area of central Sweden. The investigation was undertaken to see if the reported decrease of gonorrhoea in Sweden had been followed by a change in the incidence of gonococcal salpingitis--the most common complication of gonorrhoea. The study showed that the relative incidence of acute gonococcal salpingitis had decreased even more than urogenital gonorrhoea and these findings thus indicate a real decrease of gonorrhoea. At the same time there were more patients with nongonococcal salpingitis. During the period of the study the gonococcal complement-fixation test (GCFT) gave positive results in 40% to 80% of the patients with gonococcal salpingitis. The yield with this test was only 4% in patients with nongonococcal salpingitis during 1970 but it increased successively and was 23% in 1974. This increase was statistically highly significant (P less than 0.001).

Acute Disease↗
PubMed1981

Glandular inclusions in lymph nodes. The problem of extensive involvement and relationship to salpingitis.

Para-aortic and pelvic lymph nodes surgically removed from 50 female patients were examined for glandular inclusions. The findings were correlated with fallopian tube changes in patients whose lymph nodes were found to contain inclusions. Seven of the 50 patients had lymph node glandular inclusions; in six, the inclusions were located primarily in the cortical or capsular regions and were few in number. Of these six patients, four had acute or chronic salpingitis. The seventh patient had exuberant lymph node glandular inclusions initially interpreted as metastatic adenocarcinoma and salpingitis isthmica nodosa. This patient is discussed in detail. The association of lymph node glandular inclusions with salpingitis has been reported twice previously; one of these two patients had salpingitis isthmica nodosa. These findings suggest a definite relationship between tubal disease lymph node glandular inclusions. The rare exuberant form of glandular inclusions is benign and should not be confused with adenocarcinoma. It appears definitely associated with salpingitis isthmica nodosa. We suggest two different mechanisms for the pathogenesis of these inclusions. The first is "benign metastasis" from the proliferating tubal epithelium to the draining lymph nodes. The second is a proliferative stimulus responsible for salpingitis isthmica nodosa which also acts on preexisting glandular inclusions to produce the extensive nodal lesion.

Adenocarcinoma, Papillary↗
PubMed1981

Etiology of acute salpingitis: influence of episode number and duration of symptoms.

The role of Neisseria gonorrhoeae in the etiology and pathogenesis of acute salpingitis and its relationship to nongonococcal salpingitis were investigated. To accomplish this goal, isolated microorganisms obtained from the fallopian tubes and cul-de-sac via laparoscopy were evaluated in relation to the number of episodes of salpingitis, duration of symptoms, and phase of menstrual cycle at infection onset. The incidence of isolation of N gonorrhoeae was inversely proportional to the number of episodes of salpingitis. No isolation of the gonococcus occurred from patients with 3 or more previous episodes of salpingitis. N gonorrhoeae was the most frequent organism recovered within the initial 24 hours of symptoms. Beyond 48 hours, the most frequent isolates were anaerobic bacteria, especially anaerobic cocci. Anaerobic bacteria were also recovered from the fallopian tubes in patients having their initial episode of salpingitis and within 24 hours of onset of symptoms. All fallopian tube isolates of gonococci were recovered within 7 days of the onset of menses.

Acute Disease↗
PubMed1982

Treatment of acute salpingitis--with special reference to Chlamydia trachomatis.

Conservative treatment of acute salpingitis should be the rule, surgery the exception. Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, are common etiological agents in pelvic inflammatory disease, particularly in women below the age of 25 years. In women above that age as well as in those with two or more episodes of acute salpingitis, there is a higher proportion of tubal infections caused by aerobic and facultatively anaerobic bacteria. Apart from some resistant strains, tetracycline generally has an effect on all three of the above-mentioned agents of sexually transmitted diseases (STD). We recommend that this drug be chosen if the results of etiological studies are not known when therapy is started. If there is reason to believe that anaerobic bacteria may be involved, tetracycline may be combined with nitroimidazole. The short-term effects of various antibiotic drugs in acute salpingitis suggest that women with gonococcal salpingitis will respond sooner than will women with non-gonococcal salpingitis, regardless of which antibiotic regimen is given. The long-term effect of several different antibiotics on the post-salpingitic fertility does not differ. Glucocorticosteroids do not seem to positively influence the prognosis for fertility. To help prevent salpingitis, it is important to advise patients on appropriate contraceptive usage and to examine and treat both patients and consorts for STD.

Acute Disease↗
PubMed1981

Salpingitis in poultry. II. Prevalence, bacteriology, and possible pathogenesis in egg-laying chickens.

Among 116,886 egg-laying chickens slaughtered 438 (0.37%) were condemned because of salpingitis (Table I). Profuse growth of a single bacterial species was demonstrated in 96 out of 150 randomly selected cases of salpingitis (Table II). E. coli was isolated from 64 cases (43%). P. haemolytica, Pr. mirabilis and P. gallinarum occurred next most frequently, and made up 26 cases. Staph. aureus, Str. faecalis and Moraxella sp. finally accounted for six cases. A mixed flora was demonstrated in 16 cases (11%) while unspecific growth or no growth was recorded in 38 cases (25%). The bacteriological findings in cases of salpingitis in egg-laying chickens routinely received for post mortem examination were in accordance with the findings above in carcasses condemned because of salpingitis, except in a single case in which Bact. fragilis was obtained in pure culture. Salmonella spp. could not be demonstrated. No correlation could be demonstrated between the nature of the pathological changes and the bacteriological findings. Nineteen different O-groups of E. coli were found, O2 being the one occurring most frequently (Table III). Changing the environment from a floor type with bedding to cages or sloping wire floor without bedding does not seem to have resulted in a change of bacterial species associated with salpingitis in egg-laying chickens. The food-hygienic implications of salpingitis seem to be the same for laying hens as for broilers.

Animal Husbandry↗
PubMed1998

Laparoscopic and microbiological features of acute salpingitis in developing countries.

One hundred and twenty-four out of 198 consecutive women who underwent diagnostic lasparoscopy for clinical symptoms and signs of acute salpingitis at the University College Hospital, Ibadan, Nigeria had acute salpingitis. These were slightly younger than those without acute salpingitis, otherwise there were no differences in the sociodemographic characteristics of the two groups. Urinary and gastrointestinal symptoms, abnormal vaginal discharge, fever (> 38 degrees C) and sexually transmitted organisms were significantly more in women with acute salpingitis. Ninety-five per cent of the Neisseria gonorrhoea cultured were of the PPNG strain. Pelvic adhesions were present in 69.4% of the women with acute salpingitis. Forty-one per cent of the women had tubal occlusion. It was concluded that laparoscopy rather than clinical findings alone would determine the severity of acute salpingitis. This should be performed along with culture of genital discharges and peritoneal fluid for optimum management. The use of a single dose broad spectrum antibiotics active against both PPNG and non-PPNG strains, and chlamydial infections is advocated for treatment in developing countries.

Journal Article↗
PubMed1998

Clinical utility of CA125 levels in predicting laparoscopically confirmed salpingitis in patients with clinically diagnosed pelvic inflammatory disease.

OBJECTIVE: The purpose of this study was to determine the utility of serum CA125 determinations in diagnosing acute salpingitis. METHODS: CA125 levels were determined for 34 women with the clinical diagnosis of pelvic inflammatory disease (PID). Acute salpingitis was confirmed laparoscopically in 28 women (82.3%). RESULTS: Twenty patients (71.4%) with laparoscopically confirmed acute salpingitis had CA125 levels greater than 7.5 units, compared with no patients (0/6) with laparoscopically normal tubes (P = 0.002). The degree of elevation of CA125 levels correlated with the severity of tubal inflammation noted at laparoscopy. All patients with levels above 16 units had laparoscopically severe salpingitis. CONCLUSIONS: We conclude that while CA125 levels above 7.5 units may modestly improve the ability of the clinical diagnosis of PID to accurately reflect visually confirmed acute salpingitis, limitations of the test make its clinical utility questionable.

Adult↗