Fallopian Tube Infections - An Overview

Introduction:

Fallopian tube infection occurs as a pelvic inflammatory disease (PID), which includes the womb and ovaries. It is mainly caused by a bacterial infection that spreads from the lower genital tract to the upper genital tract. The majority of infection occurs as sexually transmitted infection. It causes pelvic or abdominal pain and genital tract tenderness. The primary pathogens causing the infection are Neisseria gonorrhea and Chlamydia trachomatis. Early diagnosis and treatment prevent potential complications.

What Is a Fallopian Tube Infection?

Fallopian tube infection is salpingitis which means inflammation of the fallopian tubes, which results in a trumpet-like structure that extends from the ovary to the uterus. A type of pelvic inflammatory disease that affects the female reproductive system and is caused by sexually transmitted bacterial infections. It can affect one or both tubes and result in complications if left untreated.

What Are the Causes of Fallopian Tube Infections?

The causes of fallopian tube infections are:

• Bacterial infections are caused by sexually transmitted, such as Chlamydia trachomatis or Neisseria Gonorrhea.

• Pelvic inflammatory disease is a term used for diseases in the female reproductive system caused by bacteria.

• Endometriosis can cause fallopian tube infection, as it is a condition in which the lining tissue of the uterus grows outside it, leading to inflammation and infection.

• Any kind of surgery of the reproductive organs, such as pregnancy termination (abortion) or hysterectomy, increases the risk of infection.

• Other causes include pelvic abscess, ectopic pregnancy, and tubal-ovarian abscess.

How Does the Fallopian Tube Infections Occur?

Generally, the infection is caused by sexually transmitted bacteria, an ascending infection from the cervix leading to PID. The bacteriology includes:

• Neisseria Gonorrhea.

• Chlamydia trachomatis.

• Mycoplasma genitalium.

• Peptostreptococcus species.

• Bacteroides species.

• Haemophilus influenza

• Streptococcus pneumonia.

• Staphylococcus aureus.

• Escherichia coli.

• Bacteriodes fragilis.

These bacteria can cause mild to severe infections along with long-term consequences.

Infection in the genital tract leads to inflammatory damage that results in adhesions, scarring, partial or complete obstructions of the fallopian tube lining, impaired ovum transport, and ectopic pregnancy. Additionally, the adhesions lead to chronic pelvic pain.

Risk factors for infection are a history of PID, intrauterine device implantation, intercourse with multiple partners, age, and tubal ligation.

What Are the Symptoms of Fallopian Tube Infections?

The symptoms include:

• Lower abdominal or pelvic pain.

• Vaginal discharge.

• Dyspareunia - pain during sexual intercourse.

• Abnormal vaginal bleeding.

• Pain during urination.

• Infertility or difficulties in conceiving.

• General symptoms like fever, nausea, and chills associated with infection.

• Irregular menstrual bleeding.

• Abdominal bloating.

How to Diagnose Fallopian Tube Infections?

The diagnosis of fallopian tube infection can be based on the history and symptoms presented by the patient. The diagnosis includes:

• Physical Examination: The healthcare provider will ask for the symptoms and do a pelvic examination to check for inflammation, pain, or tenderness.

• Laboratory Tests: These include a pregnancy test to exclude the possibility of ectopic pregnancy. Blood tests and urine tests are also advised to determine an infection.

• Swab Test: Swab tests for vaginal or cervical discharge and nucleic acid amplification tests (NAAT) for culture to determine the bacteria involved.

• Other Tests: Tests for sexually transmitted diseases like syphilis and HIV (human immunodeficiency virus).

• Imaging Tests: Ultrasound imaging or computed tomography (CT) scan of the pelvis is done for tubo-ovarian abscess.

• X-Ray: A type of X-ray, known as a hysterosalpingogram, is done to look for any fallopian tube infection.

• Laparoscopy: A minimally invasive surgical procedure is recommended to get a complete image of the fallopian tube and other reproductive organs.

What Is the Treatment for Fallopian Tube Infections?

Most of its diagnosis procedure is clinical, and laboratory tests confirm the infection or disease. Then, the treatment is started, depending on the clinical diagnosis. Hospitalization may require in case of pregnancy, severe clinical illness, PID with abscess, need for surgery, or failed outpatient treatment.

In case of abscess formation, surgical drainage is required.

The empiric treatment after hospitalization or inpatient admission includes:

• Cefotetan 2 gm I.V. every 12 hours and Doxycycline 100 mg orally.

• Clindamycin 900 mg I.V. every 8 hours and Gentamicin 3 to 5 mg/kg I.V. once a day.

• Cefoxitin 2 g I.V. every 6 hours and Doxycycline 100 mg orally.

The outpatient therapy includes:

• Doxycycline 100 mg orally, twice daily for 14 days, with Ceftriaxone 500 mg I.M., one dose.

• Cefoxitin 2 g I.M. with Probenecid 1 g orally once a day, or,

• Third-generation Cephalosporin.

• Metronidazole 500 mg twice daily for 14 days orally is added in case of trichomonas or recent vaginal instrumentation.

What Are the Associated Complications?

Long-term and worse outcomes are associated with delayed pelvic inflammatory disease (PID) treatment. It includes chronic pain, ectopic pregnancy, and infertility.

• Chronic Pain: It is seen in one-third of females with PID and is related to inflammation, adhesions, and scarring due to infection. Chronic pain is the predictor of recurrent PID development.

• Infertility: PID can lead to infertility in symptomatic or asymptomatic patients. The infection causes severe damage to the fallopian tubes, resulting in a complete loss of ciliary epithelial cells and occlusion of the tube. Infertility is associated with a history of PID. PID due to chlamydia infection and recurrent and severe PID.

• Ectopic Pregnancy: A known risk of pelvic inflammatory disease due to damage to fallopian tubes.

What Is the Differential Diagnosis?

The differential diagnosis includes:

• Ovarian cyst rupture.

• Ectopic pregnancy.

• Endometriosis.

• Cystitis.

• Appendicitis.

• Traumatic injury.

• Ovarian torsion.

• Pyelonephritis.

• Diverticulitis.

Conclusion:

The fallopian tube infection is called salpingitis, an infection that affects the fallopian tubes that help transport the egg from the ovary to the uterus and is related to the fertilization process. A sexually transmitted infection causes the infection wherein the bacteria enters the body and moves from the cervix to the uterus and fallopian tube. Fallopian tube infection is a type of pelvic inflammatory disease (PID) that causes symptoms like lower abdominal pain, vaginal discharge, irregular periods, etc. The diagnosis usually depends on the clinical presentation of symptoms and history and may require imaging and laboratory tests for confirmation. Antibiotic therapy is the treatment of choice and surgical drainage in case of abscess formation. Delayed treatment leads to complications such as infertility, chronic pain, and ectopic pregnancy.