Diagnosis and treatment of acute salpingitis

Abstract

Acute salpingitis is one of the most common acute gynecologic diseases and occurs in approximately 750,000 women each year in the United States. Use of laparoscopy to confirm the diagnosis of acute salpingitis has shown that the signs and symptoms classically ascribed to this disease are not specific to it. Fever, leukocytosis, elevated ESR and adnexal masses or swelling are not necessary to make a diagnosis of acute salpingitis. Lower abdominal pain and adnexal tenderness are the most consistent findings. Microbiologic data obtained by laparoscopy and culdocentesis have raised questions about the role of N. gonorrhoeae in salpingitis and have demonstrated that, as in pelvic infections generally, acute salpingitis is associated with mixed aerobic-anaerobic bacterial flora. Good results in the treatment of acute salpingitis depend upon: (1) early diagnosis, (2) hospitalization and bed rest, (3) the use of antibiotic therapy that takes into account the polymicrobial etiology of acute salpingitis, (4) prevention of recurrent episodes of salpingitis through efforts at patient education and identification and treatment of sexual partners. Most important, we must remember that what is at stake is often the future reproductive potential of a young woman. It must be weighed against both patient and physician convenience and cost. Further investigative efforts are essential to determine the role of IUDs in pelvic infections, discover the true microbiologic etiology of salpingitis and establish appropriate antimicrobial treatment as determined by prospective, microbiologically controlled investigations.

PIP: This paper discusses the problem of acute salpingitis, one of the most common gynecologic problems. The goal in management of this problem is to prevent sequelae such as infertility and chronic residual of inflammation. Thus, in management it is important that proper diagnostic methods and appropriate treatment based on microbiologic data be developed and utilized. Presently, culdocentesis is the only practical and reliable means of obtaining meaningful microbiologic data in cases of acute salpingitis. Microorganisms such as N. gonorrhea have been implicated in the etiology of salpingitis. It is clear that sexual transmission is involved in the pathogenesis of gonococcal salpingitis. It is unclear how the gonococci get to the endosalpinx from the endocervix; however, it is possible that menstruation plays a part in the breakdown of local host defense mechanisms which prevent the ascent of microorganisms from the endocervix. The pathogenesis of nongonococcal salpingitis is not yet clearly understood. While antibiotics have helped to alter the prognosis for infertility significantly, more must be done. Previous investigations indicate that the effectiveness of therapy is dependent upon the interval between onset of symptoms and the initiation of treatment. The treatment regimen must also take into account the polymicrobial etiology of acute salpingitis. Most cases are treated on an outpatient basis and the Center for Disease Control has promulgated a set of recommendations for the outpatient treatment of acute salpingitis. Treatment is briefly described. It has come to the attention of researchers recently that the presence of an IUD may ultimately lead to pelvic infection and increased risk of acute salpingitis. However, no particular type of IUD has been associated with an increased risk of pelvic infection in nonpregnant women. More research must be initiated to determine the role of IUDs in pelvic infection and to discover the true microbiologic etiology of salpingitis.