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PubMed1982

Clinical staging of acute bacterial salpingitis and its therapeutic ramifications.

The use of single-drug therapy results in an overall 13% to 17% failure rate, and even this figure is misleading, because of the high prevalence of patients with uncomplicated disease. In patients with polymicrobial peritonitis, the failure rate varies between 30% and 60%, depending upon whether Neisseria gonorrhoeae can be concomitantly isolated from the cul-de-sac and the criteria used to define therapeutic cure. THe complexity of disease as we now understand it requires a corresponding degree of therapeutic individualization. In the Gainesville staging, acute salpingitis is subdivided into five stages. Stage I is acute endometritis-salpingitis without peritonitis. Stage II is salpingitis with peritonitis. Stage III is acute salpingitis with superimposed tubal occlusion or tuboovarian complex. Stage IV is where a tuboovarian abscess has ruptured. Stage V is a repository category for different etiologic agents which may emulate acute salpingitis, i.e., Mycobacterium tuberculosis. Each stage of disease differs by virtue of its therapeutic goal and the means by which this goal is achieved.

Abscess↗

PubMed1984

Fimbrial ciliated cells percentage and epithelial height during and after salpingitis.

Microbiopsies of 191 fimbriae were obtained from 146 patients undergoing laparotomy for acute salpingitis, or tubal surgery after salpingitis. The biopsies were classified in four groups according to the diagnosis at laparotomy: salpingitis, distal occlusion, peritubal adhesions or tuberculosis. The biopsies belonging to the group of distal occlusion were further classified in four sub-groups according to the extent of the lesions observed during the hysterosalpingography and laparoscopy. Since the crucial role of the ciliated epithelium in the ovum transport has been established, the percentage of ciliated cells and the epithelial height were determined in the groups and compared to those observed in fimbriae obtained from fertile women during an ovulatory cycle. Significant differences were noted in all groups when compared to fertile women. Acute salpingitis provoked a rapid and severe deciliation which recovered 3 months after triantibiotherapy. In the groups of distal occlusion, there was a significant correlation between the rate of deciliation and the extent of lesions. This suggests that deciliation of tubal epithelium is a sequela of salpingitis and that the extent of disease allows a prognosis of the percentage of ciliated cells.

Biopsy↗

PubMed1989

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis.

In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3-6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease). Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis). Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Acute Disease↗

PubMed1991

Salpingitis isthmica nodosa in female infertility and tubal diseases.

Salpingitis isthmica nodosa (SIN) is a condition of nodular thickening of the proximal Fallopian tube. The purpose of this study was to investigate the occurrence, distribution and frequency of SIN in Danish women salpingectomized because of tubal pregnancy or salpingitis and to correlate SIN with infertility, pregnancies, outcome of pregnancies, births, pelvic inflammatory disease and salpingitis. Sections from the isthmus were present in the specimens from 223 tubes from 193 patients and were analysed by the same pathologist. Originally, SIN was found in 12 patients but on re-examination, it was found in 24 patients. Ten women with SIN were bilaterally salpingectomized. Only one woman had SIN in both tubes. Women with SIN gave birth to as many children as women without SIN. After SIN had been diagnosed, no children were born, but this was not statistically different from the frequency of births in the non-SIN group after salpingectomy. Women with SIN had histological signs of salpingitis more often than women without SIN, but SIN complicated with salpingitis did not influence the number of children or tubal pregnancies. Women with SIN had a greater risk of two or more tubal pregnancies than women without SIN.

Adult↗

PubMedDate not supplied

Auxotypes and antibiotic susceptibilities of Neisseria gonorrhoeae from women with acute salpingitis. Comparison with gonococci causing uncomplicated genital tract infections in women.

An investigation of the MICs of various antibiotics and the nutritional requirements (auxotypes) of Neisseria gonorrhoeae recovered from the cervix, fallopian tubes, and peritoneal cavity of women with acute salpingitis was done. These MICs and auxotypes were compared to those of gonococci isolated from the cervix of women with uncomplicated or asymptomatic genital tract gonorrhea. The MICs of minocycline, penicillin G, ampicillin, cefoxitin, and cefaclor for gonococci isolated from women with acute salpingitis were significantly higher. Significant differences in auxotype patterns were identified between isolates from salpingitis cases and uncomplicated cases. The prototrophic form was the most common (75%) among salpingitis strains. No strains requiring arginine, hypoxanthine, and uracil were identified among the salpingitis isolates. In contrast, strains that required these nutrients were the most frequent auxotype among isolated from women with uncomplicated genital tract gonorrhea. Discriminant analysis revealed that the MIC of minocycline and the auxotype were the most powerful discriminators between groups of patients with different manifestations of gonorrhea.

Acute Disease↗

PubMed1979

Experimental acute salpingitis in grivet monkeys provoked by Chlamydia trachomatis.

Chlamydia trachomatis is a common cause of sexually transmitted diseases. Recently it has been shown that chlamydiae are also responsible for complications to such lower genital tract infections. In this study, isolates of C. trachomatis from the fallopian tubes of patients with acute salpingitis were inoculated direct into the fallopian tubes of two, and through the cervical canal into the uterine cavity of one grivet monkey. The experimental infections resulted in a self-limited acute salpingitis in the three animals. C. trachomatis was recovered from the monkeys 2 and 3 weeks post inoculation. As found at laparotomy, the infected tubes were swollen and reddened, and there was watery exudate in the abdominal ostia. Microscopically, cellular infiltrates--mainly lymphocytes--were seen in the mucosa, muscularis and subserosa of the tubes. Serologically, a primary antibody response with an IgM to IgG conversion was found. Salpingitis did not occur in a control monkey inoculated in the tubes with a medium lacking Chlamydia. The histological changes in the fallopian tubes of the infected monkeys were reminiscent of those described as being characteristic of "gonococcal" salpingitis in man. The fulfilment of Koch's postulates in the animal model used adds to the earlier evidence that C. trachomatis is capable of causing acute salpingitis in humans.

Acute Disease↗

PubMed1987

Importance of chlamydial antibodies in acute salpingitis in central Africa.

Of 35 women with acute salpingitis on laparoscopy, 86% had chlamydial antibodies at a titre of 1/16 or higher and 49% at a titre of 1/512 or higher. Geometric mean titres of chlamydial antibodies correlated significantly with a laparoscopic observation of chronic salpingitis (p less than 0.001), with a history of infertility (p less than 0.05), and with severe inflammation (p less than 0.10), but not with a history of salpingitis or a positive cervical culture for Chlamydia trachomatis. In the subgroup of infertile women, the geometric mean titre of antibodies to chlamydiae correlated significantly with the presence of chronic salpingitis (p less than 0.005). These data indicate that chlamydial infections play a major part in salpingitis and infertility in central Africa. In this area, which is known as the "infertility belt", programmes to control chlamydial infections should be implemented.

Acute Disease↗

PubMed2001

[Silent salpingitis. Does it exist?].

The diagnosis of salpingitis based solely on clinical criteria is inaccurate, with both low specificity and sensitivity. Laparoscopy has therefore become a valuable diagnostic tool in clinical practice and essential in clinical research on salpingitis. Different types of evidence indicate that atypical salpingitis without abdominal pain and discrete or absent symptoms is a common etiology of tubal factor infertility. A low threshold for suspecting salpingitis has been recommended to augment the sensitivity of clinical diagnosis. This leads to lower specificity and thereby a greater number of false positive diagnoses and unnecessary antibiotic treatment. Outpatient biopsy from the endometrium for histopathology and chlamydia testing might augment the specificity in cases with discrete symptoms, and should be investigated further. The sensitivity of laparoscopy is low for endosalpingitis without affection of the serosa, and might be augmented by using minibiopsies and chlamydia PCR from the tubal mucosa. The most significant measure toward reducing the sequelae of salpingitis is the combatting of chlamydia infection through screening programs and qualified partner management.

Abdominal Pain↗

PubMed1979

The intrauterine contraceptive device and acute salpingitis: a multifactor analysis.

From an indigent population hospitalized with acute salpingitis, 163 patients were compared with 222 control patients from the minor trauma section of the emergency room. Four factors were significantly different between cases and controls: race, type of contraception, number of sex partners, and previous history of salpingitis. A discriminate analysis based on a linear logistic equation demonstrated that each risk factor was independent rather than a reflection of another risk factor. Thus factors associated with race, IUD use, multiple sexual partners, and previous salpingitis increase the risk of salpingitis in the population studied.

Acute Disease↗

PubMed1994

Proliferative response to conserved epitopes of the Chlamydia trachomatis and human 60-kilodalton heat-shock proteins by lymphocytes from women with salpingitis.

OBJECTIVE: Our objective was to determine whether an upper genital tract Chlamydia trachomatis infection sensitizes lymphocytes to heat-shock protein epitopes expressed in both the human and chlamydial 60 kd heat-shock protein. STUDY DESIGN: Peripheral blood mononuclear cells were isolated from women with or without a prior documented salpingitis and tested for their ability to proliferate in response to the recombinant C. trachomatis heat-shock protein and to five synthetic peptides corresponding to conserved epitopes expressed in both the human and chlamydial heat-shock proteins. RESULTS: Among 22 healthy women with no history of chlamydial infections or salpingitis and 10 women seen for complaints other than a C. trachomatis infection, none had positive lymphocyte responses to any of the peptides and only one responded to the chlamydial heat-shock protein. Among nine women with a single episode of salpingitis none responded to the chlamydial heat-shock protein and one exhibited a positive lymphocyte response to a single peptide. This woman was also positive for C. trachomatis in the cervix. In contrast, among the 10 women with two or more episodes of salpingitis four (40%) had proliferation in response to the chlamydial heat-shock protein and five (50%) had positive lymphocyte responses to one of the peptides; two of these women also had C. trachomatis detected in their cervices. CONCLUSION: In women with a history of C. trachomatis upper genital tract infections, infection with C. trachomatis or other microorganisms can induce a lymphocyte proliferative response to the chlamydial 60 kd heat-shock protein and to epitopes present in the human heat-shock protein.

Adult↗

PubMed2000

Detection of Chlamydia trachomatis DNA in archival paraffinized specimens from chronic salpingitis cases using the polymerase chain reaction.

OBJECTIVE: To identify Chlamydia trachomatis by the polymerase chain reaction (PCR) in fallopian tube tissues with chronic salpingitis. DESIGN: Retrospective case-control study. SETTING: Academic tertiary institution. PATIENT(S): Women with a pathological diagnosis of chronic salpingitis or normal fallopian tube hospitalized between September 1992 and November 1994. Initial identification of 248 specimens with final analysis of 154. INTERVENTION(S): Paraffin-embedded fallopian tube tissues were analyzed with use of PCR to detect C. trachomatis. MAIN OUTCOME MEASURE(S): Identification of C. trachomatis DNA; demographics of age, ethnicity, parity, history of sexually transmitted disease, and surgical procedure. RESULT(S): C. trachomatis DNA was detected in 9 of 77 chronic salpingitis cases. Seventy-seven controls were negative for C. trachomatis. No statistically significant difference in age or ethnicity between cases and controls was identified. Nulliparity was more frequent in cases (26 of 74) than controls (14 of 76). Sexually transmitted disease history was more prevalent in cases (24 of 74) than controls (6 of 76). Chlamydia infection was not associated with a particular surgical indication. CONCLUSION(S): Chronic salpingitis is highly associated with the presence of C. trachomatis infection as detected by PCR.

Adolescent↗

PubMed1978

Salpingitis in ovarian endometriosis.

A histologic study of 87 cases of ovarian endometriosis with salpingectomy revealed 29 cases (33%) in which the removed fallopian tubes showed chronic salpingitis. Tubal obstruction could be demonstrated in only one of these patients. Tubo-ovarian adhesions were found in 15 patients (17%) and in only 7 of these in association with salpingitis. Although the patients in the present series did not consult their physicians because of infertility, but rather for other symptoms related to pelvic endometriosis, the finding of chronic salpingitis in 33% of the cases suggests that salpingitis may play a role in the infertility associated with endometriosis, possibly through altered tubal secretion.

Acute Disease↗

PubMed1994

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa.

STUDY OBJECTIVE: To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa. DESIGN: Prospective case study. SETTING: Obstetrics and Gynecology Department of a University Hospital. PATIENTS: Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied. INTERVENTIONS: Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa. MAIN OUTCOME MEASURES: Salpingoscopic findings were recorded and the patients were managed accordingly. RESULTS: Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction. CONCLUSIONS: One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.

Adult↗

PubMed1980

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.

Adolescent↗

PubMed1992

[Treatment of acute salpingitis with tetracycline/metronidazole with or without additional balneotherapy, Augmentin or ciprofloxacin/metronidazole: a second-look laparoscopy study].

110 patients suffering from laparoscopical verified salpingitis and desire for a baby, were treated with tetracycline (oxytetracycline or doxycycline; TC)/metronidazole (n = 67), augmentan (n = 22) or cipropfloxacin/metronidazole (n = 21). After an average period of 11.6 weeks, all patients underwent second-look laparoscopy with dye insufflation. In 34 patients treated with TC/metronidazole, the effects of additional physio-therapeutical measures were examined under conditions as they prevail in a Spa. 33 patients without balneotherapy served as controls. All the 4 groups were comparable (p greater than 0.05) in respect of mean age, percentage, share of nulliparous women, salpingitis gonorrhoica, contraceptive behaviour and also of the stage of salpingitis. All antibiotic regimens used resulted in a prompt decrease of inflammatory clinical signs after five days (temperature, blood sedimentation rate, leukocytes). Only 2 of 34 patients treated by additional cure at a Spa reported complaints, whereas complaints were reported by 14 of 33 control patients (p less than 0.01), 7 of 22 (p less than 0.01) treated with augmentan and to 7 of 21 (p less than 0.01) treated with ciprofloxacin/metronidazole. The tubal occlusion rates amounted to 33.3% (TC/metronidazole), 32.3% (TC/metronidazole and balneotherapy), 22.7% (augmentan) and 23.8% ciprofloxacin/metronidazole. The differences did not attain statistical significance (p greater than 0.05). With regard to adhesions, there were, likewise, no significant differences between findings at first laparoscopy and second look-laparoscopy, respectively. It is concluded, that additional physiotherapeutic measures, after antibiotic therapy of acute salpingitis, reduce the frequency of lower abdominal pain, but do not result in an improvement of tubal occlusion and reduction of adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1977

Chlamydia trachomatis infection in patients with acute salpingitis.

We examined the prevalence of Chlamydia trachomatis in the cervix and the fallopian tubes of patients with acute salpingitis. Cycloheximide-treated McCoy cells were used as the growth medium. For purposes of comparison, women with infections confined to the lower genital tract and women without signs of genital infections were also studied. C. trachomatis was isolated from the cervix in 19 of 53 patients with acute salpingitis, in one of 18 lower-genital-tract infections and in none of 12 without signs of genital infection. C. trachomatis was recovered from six of the 20 valid specimens from the fallopian tubes of the patients with acute salpingitis. Our results indicate that chlamydia is a common etiologic agent in acute salpingitis.

Acute Disease↗

PubMed2004

Detection of novel organisms associated with salpingitis, by use of 16S rDNA polymerase chain reaction.

Although Chlamydia trachomatis and Neisseria gonorrhoeae are established causes of salpingitis, the majority of cases have no known etiology. We used broad-range 16S rDNA polymerase chain reaction to identify novel, possibly uncultivable, bacteria associated with salpingitis and identified bacterial 16S sequences in Fallopian-tube specimens from 11 (24%) of 45 consecutive women with laparoscopically confirmed acute salpingitis (the case patients) and from 0 of 44 women seeking tubal ligations (the control subjects) at Kenyatta National Hospital, Nairobi, Kenya. Bacterial phylotypes most closely related to Leptotrichia spp. were detected as the sole phylotypes in 1, and mixed with other bacterial phylotypes in 2, specimens. Novel bacterial phylotypes and those associated with bacterial vaginosis, including Atopobium vaginae, were identified in 3 specimens. N. gonorrhoeae and Streptococcus pyogenes were identified in 2 and 1 specimens, respectively. The finding of novel phylotypes associated with salpingitis has important implications for the etiology, pathogenesis, and treatment of this important reproductive-tract disease syndrome.

Adult↗

PubMed1991

Acute chlamydial salpingitis with ascites and adnexal mass simulating a malignant neoplasm.

Chlamydia trachomatis is a well-known cause of acute and chronic salpingitis, accounting for approximately half of all cases of pelvic inflammatory disease. Typically, patients with acute chlamydial salpingitis present with acute lower abdominal pain, tenderness on bimanual pelvic examination, or vaginal discharge. We describe a case of acute chlamydial salpingitis with marked ascites and an adnexal mass that simulated a malignant neoplasm. Microscopically, a severe lymphofollicular salpingitis and a marked lymphofollicular hyperplasia of the omentum and retroperitoneal lymph nodes were found. Chlamydial inclusions in the fallopian tube epithelium were demonstrated by immunohistochemistry using a mouse monoclonal antibody to a genus-specific outer membrane lipoprotein. Chlamydial infection may cause marked ascites and a palpable adenexal mass and should be considered whenever marked chronic inflammation with a lymphofollicular hyperplasia involves the fallopian tube or other female genital tract sites.

Adnexa Uteri↗