Chronic salpingitis is a long-term condition characterized by inflammation of the fallopian tubes, the structures connecting the ovaries to the uterus. These tubes transport the egg for potential fertilization and passage to the womb. When salpingitis becomes chronic, the inflammatory process has persisted, leading to cumulative damage over time. This ongoing inflammation is a specific form of Pelvic Inflammatory Disease (PID) that directly impacts the reproductive tract.
Defining Chronic Salpingitis
Chronic salpingitis is defined by the enduring presence of inflammation and subsequent structural changes within the fallopian tubes. This persistent inflammation causes the tubal walls to thicken and the delicate internal folds (plicae) to adhere to one another. The body’s long-term response involves the formation of scar tissue (fibrosis), which permanently alters the tubes’ architecture. This chronic state differs from acute salpingitis, which presents with sudden, severe symptoms and rapid inflammation.
Chronic inflammation often results in the occlusion of the tubes, particularly near the ovary. When the fimbrial end closes, fluid accumulates inside the tube, creating a distended, fluid-filled sac known as a hydrosalpinx. This structural damage is characteristic of the chronic form, where the initial infection may have subsided, but residual tissue damage remains. Chronic salpingitis may also occur when an acute infection is not completely cleared, leaving behind a low-grade inflammatory process.
Causes and Primary Risk Factors
The majority of chronic salpingitis cases originate from an untreated or inadequately treated episode of Pelvic Inflammatory Disease (PID). Bacteria ascend from the lower genital tract, through the cervix and uterus, finally reaching the fallopian tubes. The most frequently implicated bacteria are those responsible for sexually transmitted infections (STIs), specifically Chlamydia trachomatis and Neisseria gonorrhoeae. These organisms can cause significant tubal damage, even when the initial infection is mild or asymptomatic.
Other bacteria, such as Mycoplasma and Streptococcus species, can also contribute to salpingitis. Less common causes include infections following certain pelvic procedures or appendicitis. The risk of developing chronic salpingitis increases with a history of PID, as each subsequent infection compounds the existing damage. Lifestyle factors, including having multiple sexual partners or engaging in sexual activity without barrier protection, increase the likelihood of acquiring the causative infections.
Recognizing Symptoms and Potential Complications
The symptoms of chronic salpingitis are less intense but more persistent than those of the acute form, often making the condition difficult to recognize initially. Women commonly report a dull, persistent ache in the lower abdomen or pelvis that may wax and wane. Painful sexual intercourse (dyspareunia) is a frequently reported symptom, along with abnormal vaginal discharge or irregular menstrual bleeding. These lingering symptoms result from ongoing inflammation and scar tissue formation in the pelvic structures.
The chronic scarring and blockage within the fallopian tubes lead directly to severe, long-term complications affecting reproductive health. Tubal factor infertility occurs because the scar tissue prevents the egg from traveling down the tube and meeting the sperm. After just one episode of salpingitis, the risk of infertility is estimated to be around 15%, increasing substantially with subsequent episodes.
Another serious complication is an increased risk of ectopic pregnancy, where a fertilized egg implants outside the uterus, most often in the damaged fallopian tube. The tube’s compromised structure allows fertilization but prevents the egg from completing its journey to the uterus. Ectopic pregnancy is a life-threatening condition that occurs seven to ten times more frequently in women with a history of salpingitis. The presence of a hydrosalpinx can also negatively affect the success rates of in vitro fertilization (IVF) by potentially leaking fluid into the uterine cavity.
Diagnostic Procedures and Treatment Options
Diagnosing chronic salpingitis often begins with a thorough physical and pelvic examination to check for tenderness or masses. Lab work may be ordered, including blood tests to measure general markers of inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Cultures of vaginal or cervical discharge can help identify the specific bacteria responsible for the initial or current infection.
Imaging techniques are crucial for assessing structural damage to the fallopian tubes. A transvaginal ultrasound can reveal a hydrosalpinx, appearing as a sausage-shaped, fluid-filled structure next to the uterus. A hysterosalpingography (HSG), an X-ray procedure using contrast dye, can demonstrate tubal blockage and the extent of internal damage. Laparoscopy, a minimally invasive surgical procedure, remains the most definitive diagnostic tool, allowing direct visualization of the fallopian tubes and surrounding tissues for scarring and inflammation.
Treatment is aimed at clearing any residual infection, managing chronic pain, and addressing reproductive complications. If an active, low-grade infection is suspected, a prolonged course of antibiotics may be necessary. Chronic pelvic pain is managed with various pain medications or, in some cases, nerve blocks. Surgical intervention is often necessary to treat the structural consequences of chronic salpingitis. Procedures range from salpingostomy (opening a blocked tube) to salpingectomy (removing a severely damaged, non-functioning tube), especially if a large hydrosalpinx is present.