Salpingitis: Causes, Symptoms & Treatment of Fallopian Tube Infection

What Is Salpingitis?

Salpingitis is an infection and inflammation of the fallopian tubes, the two thin tubes that connect the ovaries to the uterus. It is a component of pelvic inflammatory disease (PID) and is most commonly caused by sexually transmitted bacteria, particularly Chlamydia trachomatis and Neisseria gonorrhoeae.

The fallopian tubes play a crucial role in reproduction, serving as the pathway for eggs to travel from the ovaries to the uterus. When these delicate tubes become infected, the resulting inflammation can cause significant pain and, if left untreated, lead to permanent damage that affects fertility. Salpingitis can affect one tube (unilateral) or both tubes (bilateral), with bilateral infection being more common.

The infection typically begins in the lower reproductive tract (vagina or cervix) and ascends through the uterus to reach the fallopian tubes. This ascending pattern is why sexually transmitted infections are the primary cause, as bacteria introduced during sexual contact can travel upward through the reproductive system. The body's inflammatory response to the infection causes the characteristic swelling, redness, and pain associated with salpingitis.

Understanding salpingitis requires recognizing its relationship to the broader condition known as pelvic inflammatory disease (PID). While PID refers to infection of the upper female reproductive tract including the uterus, fallopian tubes, and ovaries, salpingitis specifically describes involvement of the fallopian tubes. In clinical practice, these terms are often used somewhat interchangeably because infections rarely affect just one structure in isolation.

Salpingitis affects approximately 1-2% of sexually active women each year, with the highest rates occurring in young women between ages 15 and 25. This age group faces elevated risk due to biological factors such as cervical ectopy (when cells from inside the cervix are present on the outside), which provides a more vulnerable surface for bacterial infection. Additionally, behavioral factors including multiple sexual partners and inconsistent condom use contribute to higher infection rates in this demographic.

Types of Salpingitis

Salpingitis can be classified into two main types based on the duration and severity of the infection. Acute salpingitis develops rapidly over days and presents with pronounced symptoms including severe pelvic pain, fever, and abnormal discharge. This form requires immediate medical treatment to prevent complications. Chronic salpingitis develops when an acute infection is not properly treated or goes undetected. The ongoing low-grade infection causes gradual scarring and damage to the fallopian tubes, often with milder or intermittent symptoms that may be mistaken for other conditions.

Additionally, there is a condition called hydrosalpinx, which occurs when the fallopian tube becomes blocked due to infection and fills with clear fluid. Pyosalpinx describes a more serious situation where the blocked tube fills with pus, requiring more aggressive treatment including potential surgical intervention.

What Are the Symptoms of Salpingitis?

The main symptoms of salpingitis include lower abdominal or pelvic pain, abnormal vaginal discharge (often yellow or green with an unpleasant odor), fever, painful urination, pain during sexual intercourse, and irregular menstrual bleeding. Symptoms can range from mild and vague to severe and debilitating.

Salpingitis symptoms can vary considerably between individuals, which sometimes makes diagnosis challenging. Some women experience intense, unmistakable symptoms that prompt immediate medical attention, while others have subtle symptoms that develop gradually and may be initially attributed to other causes such as urinary tract infections or menstrual cramps. This variability is one reason why pelvic inflammatory disease, including salpingitis, is sometimes called a "silent epidemic" - many cases go undiagnosed until complications develop.

The most characteristic symptom is pain in the lower abdomen, typically described as a constant, dull ache that may be more intense on one side or felt equally on both sides. The pain often worsens with movement, physical activity, or sexual intercourse. Many women also experience a sensation of heaviness or pressure in the pelvis that is distinct from typical menstrual discomfort.

Changes in vaginal discharge are another hallmark of salpingitis. Normal vaginal discharge varies throughout the menstrual cycle, but infected discharge typically becomes more abundant and may change color to yellow, green, or grayish. An unpleasant or foul odor is often present, particularly with bacterial infections. These changes reflect the body's immune response attempting to fight the infection and expel bacteria and inflammatory cells.

Common Symptoms

• Lower abdominal pain: Persistent aching or cramping, often bilateral
• Abnormal vaginal discharge: Increased volume, unusual color (yellow, green), or foul odor
• Fever and chills: Temperature above 38°C (100.4°F) indicates active infection
• Painful urination (dysuria): Burning or stinging sensation when urinating
• Frequent urination: Feeling the need to urinate more often than usual
• Pain during intercourse (dyspareunia): Deep pelvic pain during or after sexual activity
• Irregular bleeding: Spotting between periods or after intercourse
• Lower back pain: Dull ache that may accompany pelvic symptoms
• Fatigue and malaise: General feeling of being unwell

Mild or Atypical Symptoms

It's important to recognize that salpingitis doesn't always present with dramatic symptoms. Many women experience only mild, intermittent discomfort that they attribute to other causes. These atypical presentations might include occasional dull aching in the lower abdomen, subtle changes in discharge that seem normal, or mild lower back pain that comes and goes. This "subclinical" form of salpingitis is particularly concerning because the lack of obvious symptoms means many women don't seek treatment until significant damage has already occurred to the fallopian tubes.

Research suggests that up to 60% of women with tubal infertility caused by previous infection have no history of being diagnosed with PID, indicating they had unrecognized or untreated infections. This underscores the importance of regular STI screening, particularly for sexually active young women, even in the absence of symptoms.

What Causes Salpingitis?

Salpingitis is most commonly caused by sexually transmitted infections (STIs), with Chlamydia trachomatis and Neisseria gonorrhoeae responsible for the majority of cases. Less commonly, it can result from bacterial infections following gynecological procedures, childbirth, miscarriage, or IUD insertion.

Understanding the causes of salpingitis is essential for both prevention and treatment. The fallopian tubes are normally sterile, protected from bacterial invasion by several defense mechanisms including the cervical mucus barrier and the body's immune responses. When these defenses are compromised or overwhelmed by particularly virulent bacteria, infection can ascend from the lower genital tract to the fallopian tubes.

Chlamydia trachomatis is the most common cause of salpingitis worldwide, responsible for approximately 60-70% of cases. This bacterium is particularly dangerous because it often causes minimal symptoms in its initial stages, allowing the infection to spread undetected. Chlamydia damages the fallopian tubes by triggering an inflammatory immune response that, while attempting to fight the infection, also harms the delicate tissue lining the tubes.

Neisseria gonorrhoeae (the bacterium causing gonorrhea) is the second most common cause, accounting for about 15-20% of salpingitis cases. Gonorrhea typically causes more acute, noticeable symptoms than chlamydia, but can still go undetected, particularly in women. Both chlamydia and gonorrhea can be present simultaneously (co-infection), creating a more severe infection.

Other Bacterial Causes

While STIs are the primary cause, other bacteria can also cause salpingitis. These include:

• Mycoplasma genitalium: An increasingly recognized cause of PID, often resistant to standard antibiotics
• Anaerobic bacteria: Bacteria that thrive without oxygen, often part of mixed infections
• Escherichia coli (E. coli): Normally found in the intestines, can sometimes cause pelvic infections
• Streptococcus and Staphylococcus species: Various bacteria that can cause opportunistic infections

Non-Sexual Routes of Infection

While less common, salpingitis can occur through non-sexual routes. Medical procedures that involve instrumentation of the cervix or uterus can potentially introduce bacteria into the upper reproductive tract. These include:

• IUD insertion: The risk of infection is highest in the first three weeks after insertion, particularly if pre-existing STIs are present
• Endometrial biopsy: Tissue sampling from the uterine lining
• Hysteroscopy: Examination of the uterine cavity
• Dilation and curettage (D&C): Often performed after miscarriage or for diagnostic purposes
• Childbirth: Particularly following cesarean section or prolonged labor

It's important to note that these procedures rarely cause infection when proper sterile technique is used, and the benefits of necessary medical care far outweigh the small risk of infection. Healthcare providers take precautions to minimize this risk, including screening for STIs before certain procedures.

How Is Salpingitis Diagnosed?

Salpingitis is diagnosed through a combination of clinical examination (pelvic exam), laboratory tests (STI testing, blood tests), and sometimes imaging studies (ultrasound). The diagnosis is often clinical, based on the presence of lower abdominal tenderness, cervical motion tenderness, and adnexal tenderness during examination.

Diagnosing salpingitis can be challenging because its symptoms overlap with many other conditions, including appendicitis, ovarian cysts, ectopic pregnancy, and urinary tract infections. Healthcare providers use a combination of patient history, physical examination, and diagnostic tests to make an accurate diagnosis. Because early treatment is crucial for preventing complications, doctors may begin treatment based on clinical suspicion even before all test results are available.

Clinical Examination

The cornerstone of salpingitis diagnosis is a thorough pelvic examination. During this exam, the healthcare provider will assess for several key findings:

• Lower abdominal tenderness: Pain when pressing on the lower abdomen
• Cervical motion tenderness (CMT): Pain when the cervix is moved during the exam, sometimes called the "chandelier sign" because of its severity
• Adnexal tenderness: Pain in the area of the ovaries and fallopian tubes
• Abnormal discharge: Visual assessment of vaginal or cervical discharge
• Cervical inflammation: Redness or swelling of the cervix

Laboratory Tests

Several laboratory tests help confirm the diagnosis and identify the causative organism:

• STI testing: Nucleic acid amplification tests (NAATs) for chlamydia and gonorrhea are highly accurate and can be performed on urine samples or swabs
• Vaginal wet mount: Microscopic examination of vaginal discharge to look for white blood cells and bacterial vaginosis
• Blood tests: Complete blood count (CBC) may show elevated white blood cells; C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) indicate inflammation
• Pregnancy test: Essential to rule out ectopic pregnancy, which can have similar symptoms
• HIV and syphilis testing: Often recommended when other STIs are detected

Imaging Studies

Transvaginal ultrasound is the primary imaging modality for suspected salpingitis. While it cannot definitively diagnose uncomplicated salpingitis, it can reveal:

• Thickened, fluid-filled fallopian tubes (hydrosalpinx or pyosalpinx)
• Tubo-ovarian abscess (collection of pus involving the tube and ovary)
• Free fluid in the pelvis
• Other conditions that may be causing symptoms (ovarian cysts, ectopic pregnancy)

In some cases, laparoscopy (minimally invasive surgery with a camera) may be performed. This is considered the gold standard for diagnosis because it allows direct visualization of the fallopian tubes. However, it is not routinely performed due to its invasive nature and is typically reserved for unclear cases, severe infections, or when an abscess needs to be drained.

How Is Salpingitis Treated?

Salpingitis is treated with antibiotics, typically a combination that covers both chlamydia and gonorrhea as well as other potential bacteria. Treatment usually lasts 14 days and must be completed fully even if symptoms improve. Sexual partners must also be tested and treated to prevent reinfection.

Prompt antibiotic treatment is the foundation of salpingitis management. Because delays in treatment significantly increase the risk of long-term complications like infertility, healthcare providers often start antibiotics based on clinical suspicion, even before laboratory confirmation of the specific bacteria involved. The choice of antibiotics follows established guidelines (such as those from the CDC and WHO) and typically covers a broad spectrum of potential pathogens.

Most cases of mild to moderate salpingitis can be treated on an outpatient basis with oral antibiotics. The standard treatment course is 14 days, and completing the full course is absolutely essential - stopping early because symptoms have improved allows bacteria to survive and potentially develop antibiotic resistance. Rest, adequate hydration, and over-the-counter pain relievers can help manage symptoms during recovery.

Antibiotic Treatment Regimens

Common outpatient antibiotic regimens include combinations of:

• Ceftriaxone: A single injection that covers gonorrhea
• Doxycycline: Taken orally twice daily for 14 days, covers chlamydia and other bacteria
• Metronidazole: Often added to cover anaerobic bacteria

Your healthcare provider will select the most appropriate regimen based on local antibiotic resistance patterns, your medical history, and any allergies. If you are allergic to certain antibiotics, alternative regimens are available.

Hospital Treatment

Some patients require hospitalization and intravenous (IV) antibiotics. Hospital admission is typically recommended for:

• Severe illness with high fever, nausea, and vomiting
• Pregnancy (salpingitis in pregnancy requires close monitoring)
• Failure to respond to oral antibiotics after 72 hours
• Inability to take oral medications or follow outpatient treatment
• Tubo-ovarian abscess (requires IV antibiotics and possibly drainage)
• Uncertain diagnosis where surgical emergency cannot be ruled out

Surgical Treatment

Surgery is rarely needed for salpingitis but may be required in certain situations:

• Tubo-ovarian abscess: Large abscesses may need to be drained, either through a needle guided by ultrasound or through laparoscopic surgery
• Failed medical treatment: If antibiotics do not resolve the infection
• Ruptured abscess: A medical emergency requiring immediate surgical intervention

What Are the Complications of Salpingitis?

Untreated or inadequately treated salpingitis can lead to serious complications including tubal infertility (15-20% risk per episode), ectopic pregnancy (6-10 times higher risk), chronic pelvic pain, and tubo-ovarian abscess. The risk of complications increases with delayed treatment and recurrent infections.

The consequences of salpingitis extend far beyond the immediate symptoms. The inflammation caused by infection can permanently damage the delicate internal lining of the fallopian tubes, creating scar tissue (adhesions) that interferes with their normal function. Understanding these potential complications emphasizes why early diagnosis and treatment are so critical.

Infertility

Tubal factor infertility is one of the most devastating consequences of salpingitis. The fallopian tubes have a complex internal structure lined with tiny hair-like projections called cilia that help transport eggs toward the uterus and sperm toward the egg. Infection damages these cilia and creates scar tissue that can partially or completely block the tubes.

Research indicates that:

• One episode of PID increases infertility risk by approximately 15-20%
• Two episodes increase the risk to about 35%
• Three or more episodes can raise the infertility risk to over 75%

The severity of the infection also matters - mild infections treated promptly cause less damage than severe or prolonged infections. Notably, even subclinical infections (those without obvious symptoms) can cause tubal damage, which is why many women with tubal infertility have no history of diagnosed PID.

Ectopic Pregnancy

Women who have had salpingitis have a 6-10 times higher risk of ectopic pregnancy compared to women without a history of pelvic infection. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a damaged fallopian tube. This happens because scar tissue and impaired cilia can slow the egg's progress through the tube, allowing implantation to occur before the egg reaches the uterus.

Ectopic pregnancy is a medical emergency because it can lead to life-threatening internal bleeding if the tube ruptures. Any woman who has had salpingitis and becomes pregnant should seek early prenatal care to confirm the pregnancy's location through ultrasound.

Chronic Pelvic Pain

Approximately 30-40% of women who have had PID experience chronic pelvic pain lasting months or years after the acute infection resolves. This pain results from adhesions (bands of scar tissue) that form between pelvic organs, causing them to stick together abnormally. Movement and activities that shift these organs can cause ongoing discomfort.

Tubo-Ovarian Abscess

A tubo-ovarian abscess (TOA) is a serious complication where infection creates a collection of pus involving the fallopian tube and ovary. TOA occurs in approximately 15% of women hospitalized for PID. Without treatment, an abscess can rupture, spilling infected material into the abdominal cavity and causing life-threatening peritonitis and sepsis.

How Can I Prevent Salpingitis?

Salpingitis can be prevented by practicing safer sex (consistent condom use), limiting sexual partners, getting regular STI screenings, ensuring prompt treatment of any STIs, and avoiding douching. Partners should also be tested and treated if an STI is diagnosed.

While you cannot prevent salpingitis itself, you can significantly reduce your risk by preventing the infections that cause it. Since sexually transmitted infections are the primary cause, prevention strategies focus on safe sexual practices and early detection and treatment of STIs.

Safer Sex Practices

• Use condoms consistently: Latex or polyurethane condoms, when used correctly every time, significantly reduce the risk of STI transmission. Condoms protect against both chlamydia and gonorrhea.
• Use dental dams for oral sex: These thin latex barriers reduce STI transmission during oral-vaginal or oral-anal contact
• Limit sexual partners: Having fewer partners reduces your exposure to potential infections
• Know your partner's STI status: Open communication about sexual health and recent testing helps both partners make informed decisions
• Mutual monogamy: Being in a mutually monogamous relationship with a partner who has tested negative for STIs eliminates the main risk factor

Regular STI Screening

Regular testing is crucial because many STIs, particularly chlamydia, often cause no symptoms. Current recommendations include:

• Annual chlamydia screening for all sexually active women under 25
• Annual screening for women 25 and older with risk factors (new partner, multiple partners, partner with an STI)
• Screening at every pregnancy
• Testing whenever symptoms develop or exposure is suspected

Prompt Treatment

If you are diagnosed with an STI, prompt treatment prevents the infection from ascending to the fallopian tubes. Complete all prescribed antibiotics and ensure your sexual partner(s) are also tested and treated. Avoid sexual contact until treatment is complete for both you and your partner(s) to prevent reinfection.

Salpingitis and Pregnancy

Salpingitis significantly impacts fertility and pregnancy outcomes. It increases the risk of infertility due to tubal damage and raises the risk of ectopic pregnancy 6-10 fold. Women who have had salpingitis and become pregnant should seek early prenatal care to confirm proper implantation of the pregnancy.

The relationship between salpingitis and pregnancy is complex and concerning. The fallopian tubes are essential for natural conception - they capture the egg released from the ovary and provide the environment where fertilization typically occurs. Damage from infection can disrupt every step of this process.

Women who have had salpingitis may face challenges conceiving naturally. The scar tissue formed during infection can partially or completely block the tubes, preventing sperm from reaching the egg or preventing a fertilized egg from reaching the uterus. Even if the tubes are not fully blocked, damaged cilia may not be able to move the egg efficiently.

For women with tubal damage who wish to conceive, options include:

• In vitro fertilization (IVF): This bypasses the fallopian tubes entirely by fertilizing eggs outside the body and transferring embryos directly to the uterus
• Tubal surgery: In some cases, surgery can repair blocked or damaged tubes, though success rates vary
• Natural conception: Some women with tubal damage can still conceive naturally, particularly if damage is mild or affects only one tube

Women with a history of salpingitis who become pregnant face an increased risk of ectopic pregnancy. Warning signs include one-sided pelvic pain, vaginal bleeding, shoulder pain (from internal bleeding irritating the diaphragm), and dizziness. Any pregnant woman with a history of PID should report unusual symptoms immediately.

Frequently Asked Questions