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PubMed2004

Tubal factor infertility, with special regard to chlamydial salpingitis.

PURPOSE OF REVIEW: This article will highlight recent research into tubal factor infertility as one of the main causes of involuntary childlessness in women. There will be a focus on chlamydial infections. RECENT FINDINGS: The most common cause of tubal factor infertility is occlusion of the fallopian tubes due to an infection by a sexually transmitted agent, by Chlamydia trachomatis or Neisseria gonorrhoeae. The prevalence of diagnosed cases of tubal factor infertility (TFI) can be correlated to the epidemiological situation regarding these agents that was prevailing several years ago. This is partly due to the trend seen in many Western countries that women often postpone to try to get pregnant. Therefore, there is often a time lag between the acute primary pelvic inflammatory disease (PID) and when women first consult because of fertility problems. Sub-clinical salpingitis is today regarded as even more common than symptomatic PID. Persistent tubal infections by C. trachomatis are also a common feature, even despite courses of antibiotic therapy. The current focus on TFI has been on the immunopathology of tubal chlamydial infections, for which differences in host factors, such as genetic polymorphism in cytokine response and human leukocyte antigen type, may play a role in the outcome of pelvic inflammatory disease. Hysterosonography is a more convenient mode for diagnosing tubal occlusion than hysterosalpingography. The use of new species-specific antibody tests for C. trachomatis has decreased previous specificity problems found when used to detect tubal occlusion in work-up of women consulting because of infertility. SUMMARY: Infection by C. trachomatis is a major cause of TFI. Many cases of chlamydial salpingitis have a more or less subclinical course. The tubal infection may become chronic in spite of antibiotic therapy. Immunological processes may continue after microbiological cure, which stresses the importance of screening for C. trachomatis in order to detect and treat carriers to hinder spread to still uninfected women.

Chlamydia Infections↗
PubMed2002

Pseudoxanthomatous and xanthogranulomatous salpingitis of the fallopian tube: a report of four cases and a literature review.

The clinical and pathological features of four cases of pseudoxanthomatous salpingitis (PXS) and xanthogranulomatous salpingitis (XGS) are described. The women with PXS underwent salpingectomy for primary sterility (Case 1) and endometriosis (Case 2). The two women with XGS presented with pelvic inflammatory disease (PID) and an adnexal mass and were initially treated with antibiotics. Shortly thereafter, a left salpingo-oophorectomy (Case 3) and total abdominal hysterectomy with bilateral salpingo-oophorectomy (Case 4) were performed. In Cases 1 and 2, histological examination revealed expansion of the tubal plicae with numerous pigmented histiocytes (PXS). In Cases 3 and 4, the tubal mucosa was infiltrated by foamy histiocytes admixed with other inflammatory cells (XGS). A review of the literature revealed that most patients with PXS have a clinical history of long-standing endometriosis, whereas XGS is an unusual manifestation of chronic PID. Although PXS can be confused on histological examination with XGS, the two processes should be distinguished because of their different clinical associations and pathogenesis.

Adult↗
PubMedDate not supplied

Thiamphenicol for treatment of salpingitis.

During a six-month period, 27 women with acute salpingitis diagnosed by laparoscopy were treated with thiamphenicol. Bacterial cultures and serologic tests for syphilis and Chlamydia trachomatis infection were systematically performed before treatment. Patients were assigned to one of two treatment groups. Treatment on the day of surgery was the same for both groups: 1.5 g of iv thiamphenicol immediately after laparoscopy and 0.75 g im 12 hr later. The first group received 0.75 g im twice daily thereafter for six days, while the second group received 0.5 g orally three times daily during the same period. Treatment with 0.5 g orally every 8 hr was initiated for an additional 14 days in the 13 patients in whom C. trachomatis was identified. Follow-up examination included clinical and laboratory tests and laparoscopy. Therapy was successful in 20 of the 27 patients, and there were no significant differences between the two treatment groups. Thiamphenicol is well tolerated at this dosage and appears to be an excellent treatment for acute salpingitis.

Administration, Oral↗
PubMedDate not supplied

Endometrial damage in acute salpingitis.

Histologic and bacteriologic analyses of endometrium were performed before and on day 15 after minocycline treatment of 20 patients with acute salpingitis. Endometritis was diagnosed in 15 patients before and in nine after treatment. Neisseria gonorrhoeae was recovered from the cervix and endometrium of seven patients but was not isolated after treatment. Chlamydia trachomatis was recovered from the cervix of eight, and from the endometrium of three patients, two of whom had negative cervical cultures. After treatment C. trachomatis was recovered from the cervix of three patients, although two of them had taken aluminum hydroxide for gastric symptomatology during minocycline treatment. Culture of an endometrial specimen revealed no growth of C. trachomatis. The histologic study revealed plasma cell infiltrates in specimens from patients who had cultures positive for C. trachomatis. The results showed that although endometritis is an important manifestation of acute salpingitis, there is no correlation between severity of endometritis and degree of tubal damage.

Acute Disease↗
PubMedDate not supplied

Does addition of anti-inflammatory agents to antimicrobial therapy reduce infertility after murine chlamydial salpingitis?

BACKGROUND AND OBJECTIVES: Infertility after murine chlamydial salpingitis can be prevented by tetracycline treatment given before or at the time of infection. This study evaluates the efficacy and timing of tetracycline treatment and anti-inflammatory agents in the prevention of inflammation and subsequent infertility. STUDY DESIGN: The left ovarian bursae and uterine horns were inoculated with the mouse pneumonitis strain of Chlamydia trachomatis. Mice were mated 54 days after inoculation. RESULTS: Infected mice treated with tetracycline beginning 2 days after infection showed mild inflammation and no significant reduction in fertility. However, when tetracycline treatment was delayed until 5 days after infection, a moderate degree of inflammation and a significant reduction in fertility (P < 0.01) was noted. Treatment with ibuprofen, prostaglandin E1 (PGE-1), or hydrocortisone beginning day 2 post-inoculation did not significantly alter the degree of inflammation or subsequent fertility. Mean anti-chlamydial IgG titers were significantly lower in mice treated with either PGE1 or hydrocortisone compared with infected, untreated mice. CONCLUSION: These results indicate that while early treatment of chlamydial salpingitis may prevent infertility, delay in treatment may result in significant inflammatory damage and infertility. There was no apparent benefit from the addition of anti-inflammatory agents.

Alprostadil↗
PubMed1989

Septic shock and acute respiratory distress syndrome after salpingitis caused by Streptococcus pyogenes group A.

A 32-year-old woman with acute salpingitis had signs and symptoms of sepsis, with hypotension, renal failure, acute respiratory distress syndrome, and disseminated intravascular coagulation. Streptococcus pyogenes group A was grown from blood cultures taken at the onset of illness, and salpingitis was confirmed at laparotomy. The patient recovered after appropriate antimicrobial and intensive supportive therapy.

Adult↗
PubMed2006

Acute peritonitis and salpingitis associated with streptococcal toxic shock syndrome caused by Lancefield group G alpha-haemolytic Streptococcus dysgalactiae subsp. equisimilis.

The authors treated a patient for what appears to be the first reported occurrence of acute peritonitis and salpingitis associated with streptococcal toxic shock syndrome (STSS). This was caused by Lancefield group G alpha-haemolytic Streptococcus dysgalactiae subsp. equisimilis TKCH2004-001. The isolate showed M protein type stc36 and carried the spegg gene. To the best of the authors' knowledge, the present report represents the first case of STSS complicating acute peritonitis and salpingitis caused by Lancefield group G alpha-haemolytic S. dysgalactiae subsp. equisimilis.

Acute Disease↗
PubMed2005

Management of bilateral fallopian tube carcinoma coexistent with tuberculous salpingitis.

Primary carcinoma of the fallopian tube is a rare gynecologic malignancy. Chronic tubal inflammation is associated with primary carcinoma of the fallopian tube. There are only a few reports on primary carcinoma of the fallopian tube coexisting with tuberculous salpingitis. We are reporting a patient with both the primary carcinoma of the fallopian tube and tuberculous salpingitis, which were detected in bilateral fallopian tubes. The histologic type was serous adenocarcinoma. The patient was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and bilateral pelvic lymphadenectomy followed by chemotherapy consisting of paclitaxel and cisplatin. She has been alive without evidence of disease for 18 months.

Combined Modality Therapy↗
PubMed1990

Tubal pregnancy: relationship of conservative and radical management and follicular salpingitis upon reproductive outcome.

Eight-four patients with tubal pregnancy presenting between January, 1981 and December, 1982 to National Women's Hospital, Auckland, New Zealand, were identified from medical records and pathology files; 64 had radical surgery, 20 had conservative surgery performed. The 2 groups were analysed for reproductive outcome over a 5-year follow-up period. Subsequent viable pregnancy rates of 53% for the group with radical surgery, and 50% for the group with conservative surgery, are similar to those quoted in the world literature, as is a recurrent tubal pregnancy rate of 14% for the radically treated group. However a recurrent tubal pregnancy rate of 45% for the conservatively treated group in our study is significantly higher than that reported elsewhere. The relationship between recurrent tubal pregnancy and histological evidence of follicular salpingitis was examined. An unexpected finding was that no correlation exists between salpingitis diagnosed at the time of the initial tubal pregnancy, and an increased risk of subsequent tubal pregnancy.

Adult↗
PubMed1982

Chlamydial serum IgG antibodies in patients with acute salpingitis measured by an enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) for the detection of serum IgG antibodies to Chlamydia trachomatis has been developed. The C. trachomatis subtype LGV-2 was used as antigen. The ELISA was reproducible and its sensitivity and specificity compared well with that of the single-antigen immunofluorescence test (r = 0.83). 29 (85%) of the 34 patients with acute salpingitis had chlamydial serum IgG antibodies measured by the ELISA technique. The detection level in single blood donor specimens was 30%. Among the 34 patients with acute salpingitis, 16 paired serum specimens showed a fourfold or greater rise/fall in antibody titres, and 12 of these belonged to the 19 who harboured C. trachomatis in the lower genital tract.

Acute Disease↗
PubMed1997

Endometritis, salpingitis and fertilisation rates after mating mares with a history of intrauterine lumenal fluid accumulation.

The occurrence of uterine and oviductal inflammation, and fertilisation rates, were measured on Day 3 post ovulation in inseminated mares that had either exhibited intrauterine lumenal fluid during a previous dioestrus (Experiment 1) or had acute endometritis induced by intrauterine infusion of 1% glycogen (Experiment 2). Endometritis was assessed by uterine cytology and histology whereas oviductal inflammation was measured histologically. Fertilisation rates were calculated from the percentage of cleaved ova recovered by retrograde flushing of the oviducts. Mares with or without pre-existing uterine fluid during dioestrus that were inseminated showed a higher incidence of endometritis than control mares without pre-existing uterine fluid that were not inseminated (n = 7 mares/group). However, inseminated mares with uterine fluid did not show a higher incidence of endometritis than inseminated mares without uterine fluid. Mares with or without pre-existing uterine fluid showed a higher incidence of endometritis than salpingitis and these 2 groups of mares showed equivalent rates of fertilisation and oviductal oocyte recovery. Mares inseminated with semen alone or semen following 1% glycogen treatment had a higher incidence of endometritis than control noninseminated mares (n = 17 mares/group) but mares that received semen plus 1% glycogen did not show a higher incidence of endometritis than mares that received semen alone. Both these groups of mares showed a higher incidence of endometritis than salpingitis and those that received semen plus 1% glycogen showed an equal recovery rate of recently ovulated ova but a lower fertilisation rate than the mares that received semen alone.

Administration, Intravaginal↗
PubMed1979

Experimental chlamydial salpingitis in immunosuppressed guinea pigs infected in the genital tract with the agent of guinea pig inclusion conjunctivitis.

At necropsy indication of spread of infection to fallopian tubes was found in 25 of 41 (60%) female guinea pigs infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis and immunosuppressed with cyclophosphamide. Eighteen were examined histologically, and the diagnosis of acute salpingitis was confirmed in 10, based on inflammatory reaction, detection of guinea pig inclusion conjunctivitis in tissue, and formation of cysts (pyosalpinx and hydrosalpinx). Infection of fallopian tube tissue was confirmed by indirect immunofluorescence and electron microscopy. Infection of endometrial tissue and peritoneum was also recognized. Data suggested that the immunosuppression mediated by cyclophosphamide resulted in a prolonged genital tract infection and concomitant ascending infection leading to salpingitis.

Animals↗
PubMed1976

Meningococcal salpingitis.

In a case of acute salpingitis a cervical smear showed Gram-negative diplococci but culture showed Neisseria meningitidis, which also cultured from the throat swab. It is suggested that N. meningitidis was the cause of the salpingitis in this case.

Adult↗
PubMed1979

Chlamydia trachomatis in acute salpingitis.

In a study to evaluate the possible role of Chlamydia trachomatis and Neisseria gonorrhoeae in acute salpingitis, 26% of 106 patients with severe symptoms had positive culture results for C. trachomatis; 43% of the 72 patients from whom paired sera were obtained had either positive culture results for or seroconversion in the single antigen immunofluorescence test to C. trachomatis. Twenty-six per cent of patients harboured N. gohorrhoeae and 14% had gonococcal complement-fixing antibody titres greater than or equal to 8. Intrauterine devices were used by 48% of patients, no difference being found in the frequency of use between patients harbouring C. trachomatis or N. gonorrhoeae. The possible role of C. trachomatis should be considered in the treatment of acute salpingitis.

Acute Disease↗
PubMed2005

Observations on salpingitis, peritonitis and salpingoperitonitis in a layer breeder flock.

A flock of 13,951 hens and 1379 cockerels was monitored from 26 to 58 weeks of age for the complex of salpingitis, peritonitis and salpingoperitonitis (sps). Two hundred and forty-three hens (78 per cent of the hens that died) were examined postmortem, and sps was recognised by gross examination for inflammatory exudate, in the body cavity or oviduct in 111 (46 per cent) of them. Salpingoperitonitis was the most common form, followed by salpingitis and then peritonitis. There were acute and chronic cases in all three conditions, but only in peritonitis were acute cases more common than chronic cases. Seventeen birds that had died of sps were cultured for aerobic bacteria within 12 hours of death. Escherichia coli was recovered from a variety of tissues from all of them, and other bacteria, including staphylococci, Mannheimia haemolytica and Streptococcus bovis, were isolated from a few carcases, either alone or together with E coli. Relatively few isolations of E coli were made from normal hens cultured 48, 72 and 96 hours after death.

Animals↗
PubMedDate not supplied

Type II collagen-induced autoimmune salpingitis in rats.

Autoimmune salpingitis was induced in 17 (85%) of 20 outbred Wistar rats by immunization with bovine type II collagen; three of those also developed eustachian tube chondritis. The lesions were characterized by infiltrations of a large number of mononuclear cells in the mucosa and submucosa, destruction of cartilaginous structure, and deposition of IgG and complement C3. The animals had high titers of anti-type II collagen antibody. Immunohistochemical examination using monoclonal antibody to type II collagen revealed the presence of type II collagen in the eustachian tube cartilage. These observations suggest a causal relationship between autoimmunity to type II collagen and salpingitis in the rat, and this animal model may be useful in defining the pathogenesis of eustachian tube diseases mediated by immunity to type II collagen.

Animals↗
PubMed1990

Correlation of infertility with altered tubal morphology and function in mice with salpingitis induced by a human genital-tract isolate of Chlamydia trachomatis.

Progesterone-treated C3H mice were inoculated into the uterus or ovarian bursa with a human genital tract isolate of C. trachomatis (serovar E), or with control medium alone. The mice were then observed at various times up to 260 days after inoculation. Before being killed the mice were given pituitary gonadotrophins to induce ovulation. Eggs were sought in the oviducts and ciliary activity in the fimbrial and ampullary sections of the oviducts was determined by light microscopy, before detailed examination by scanning electron microscopy. Eggs were visible in all control oviducts and both mucosal ultrastructure and ciliary activity appeared normal. By contrast, eggs were not recovered from the inoculated oviducts of mice infected intrabursally, nor was ciliary activity observed up to 28 days after inoculation. After this, ciliary activity reappeared but eggs were still not transported to the oviduct. Ultrastructural studies suggested that severe mucus congestion accompanied by tubal oedema and loss of ciliated epithelia play a major role in the aetiology of chlamydial-induced tubal damage. Infertility following chlamydial salpingitis could be associated with failure of egg transportation to the oviduct. Egg transport was still impaired even when luminal ciliary activity, ultrastructural integrity and patency had recovered. Our results suggest that chlamydial salpingitis in this mouse model closely resembles the human disease in its pathology and consequences for fertility, making the model particularly relevant for research on chlamydial vaccine development.

Animals↗
PubMed1992

Genetic susceptibility to chlamydial salpingitis and subsequent infertility in mice.

Groups of mice from genetically defined inbred strains were infected genitally with a pathogenic human strain of Chlamydia trachomatis and their subsequent fertility was compared. The CBA, C3H (H-2o) and C3H/He-mg (H-2k) mice were less fertile than control mice, at least up to 6 months after infection. In contrast, fertility was not impaired in BALB/c mice or in congenic BALB/K mice, which had the H-2k haplotype. Reduced fertility was paralleled by the extent of histological oviductal inflammation in mice of each strain. No salpingitis was seen 21 days after infection in the BALB strains, but lesions were apparent in CBA and C3H strains up to about 70 days after inoculation and these sometimes developed into hydrosalpinges. These results indicate that susceptibility to chlamydial salpingitis and subsequent infertility is under genetic control. This control was not simply associated with the major H-2 gene complex, as mouse strains of the same haplotype (H-2k) differed in susceptibility. The fertility of BALB/c (H-2d) and BALB/K (H-2k) strains was no different from that of controls, and congenic C3H mice of differing H-2 haplotypes (H-2k and H-2o) showed reduced fertility. Although all the infected F1 (BALB/K x C3H/He-mg) mice produced litters at the same rate as untreated controls, the litters were considerably smaller. This was due to the occurrence of unilateral pregnancies in the mice inoculated under the ovarian bursae and possibly also to early fetal death in mice inoculated directly in the uterus. These findings emphasize the importance of early diagnosis and treatment of infection of the lower genital tract of women.

Animals↗