Acute salpingitis: symptoms, treatment and risks to fertility

What is salpingitis?

Salpingitis is an infection and inflammation of one or both fallopian tubes. It often comes with an infection of the lining of the womb (endometritis). Doctors use the broader term upper genital tract infection, or pelvic inflammatory disease (PID), as opposed to infections of the vagina and cervix.

Bacteria travel up from the vagina and cervix to the womb, then to the tubes, and can reach the ovaries and the lining of the abdomen (peritoneum). In complicated cases an abscess can form, which sometimes needs drainage or keyhole surgery (laparoscopy) as part of gynaecological surgery.

What causes salpingitis?

• Sexually transmitted infections: Chlamydia trachomatis and gonorrhoea (Neisseria gonorrhoeae) are the classic causes. Mycoplasma genitalium is also involved. Read our article on chlamydia infection.
• Bacteria from the vaginal and gut flora: anaerobes, streptococci, Escherichia coli, especially when bacterial vaginosis is also present.
• After a procedure inside the womb: IUD fitting (especially in the following weeks), abortion, curettage, hysteroscopy, hysterosalpingogram. French guidelines advise STI screening before some of these procedures in women at risk.

Risk factors are young age, a new partner or several partners, unprotected sex and a previous STI or episode of salpingitis.

What are the symptoms of salpingitis?

The main sign is lower abdominal pain, on one or both sides, that comes on by itself. Other signs support the diagnosis:

• fever, although it may be absent;
• abnormal vaginal discharge, sometimes foul-smelling;
• bleeding between periods;
• pain during sex;
• burning when passing urine;
• pain under the right ribs, if the liver is involved (Fitz-Hugh-Curtis syndrome).

Conditions that can look like salpingitis

Other emergencies cause similar pain and must be ruled out: ectopic pregnancy, appendicitis, twisting or rupture of an ovarian cyst, kidney infection, endometriosis. This is why unusual lower abdominal pain always needs an examination, not self-medication.

Mild forms are common, especially with chlamydia. Simple pelvic discomfort can hide an infection that is damaging the tubes.

How is salpingitis diagnosed?

According to the guidelines of the French College of Gynaecologists and Obstetricians (CNGOF) and the French Society of Infectious Diseases (SPILF), diagnosis is first based on the clinical examination: in a woman with abdominal pain, tenderness when the womb is moved or when the tubes and ovaries are felt is enough to suspect salpingitis.

• Swabs from the cervix and vagina to test for chlamydia, gonorrhoea and Mycoplasma genitalium by PCR, and for other bacteria.
• Blood test: full blood count and CRP. Normal results do not rule out salpingitis.
• Pregnancy test, to rule out an ectopic pregnancy.
• Pelvic ultrasound: it cannot confirm simple salpingitis, but it looks for an abscess or another cause. It must not delay treatment.
• CT scan if appendicitis or another bowel or urinary cause is suspected.

Laparoscopy is no longer recommended just to confirm the diagnosis. It remains useful if doubt persists or if there is a complication.

Tests for HIV, syphilis and hepatitis B are offered, together with testing and treatment of your partner or partners.

How is salpingitis treated?

Treatment starts as soon as the diagnosis is suspected, without waiting for swab results.

Other regimens exist for allergies or if Mycoplasma genitalium is found. The choice of drugs and doses is made by the doctor.

• Abscess of the tube or ovary: drainage is recommended when the collection is larger than 3 cm, most often by ultrasound-guided needle drainage, or by laparoscopy.
• Painkillers to relieve pain.
• IUD: tell your doctor if you have one; whether it is removed or left in place depends on how severe the infection is and how it responds to treatment.
• Partner(s): testing and treatment, even without symptoms, and condoms until both of you are cured.

Unlike in the past, the pill is no longer routinely recommended after salpingitis to protect fertility. It can be prescribed as contraception if you wish.

Can salpingitis affect fertility?

Most cases of salpingitis heal well if treated early. But the inflammation can leave adhesions or block the tubes, especially after repeated infections or late treatment. French guidelines state that it comes back in 15 to 21% of women, often because of a new STI, and that each recurrence increases the risk of lasting damage.

• Tubal infertility: tests include a hysterosalpingogram.
• Ectopic pregnancy: the risk is higher in later pregnancies. An early ultrasound is useful at the start of any future pregnancy.
• Chronic pelvic pain.

What follow-up is needed after salpingitis?

• A check-up a few days after starting treatment, to make sure you are improving.
• A repeat swab 3 to 6 months after treatment, to look for reinfection with an STI.
• Condoms with any new partner, and regular testing.
• A swab before any future IUD fitting or hysterosalpingogram.
• If you are planning a pregnancy, tell your doctor about this history: they can offer tests of the tubes if pregnancy takes a while, and an early ultrasound to check that the pregnancy is inside the womb.

An STI diagnosis can be hard to cope with and to tell your partner about. In France, the free, anonymous abortion, sexuality and contraception helpline (0 800 08 11 11) answers questions.

When is salpingitis an emergency?

See a doctor the same day if you have unusual lower abdominal pain, especially with fever or abnormal discharge.

Call 15 (SAMU) or 112 in France, or your local emergency number, or go to A&E, if you have severe abdominal pain, a high fever with shivering, vomiting, feel faint, or could be pregnant.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.