Clinical overview
Tubal infection — salpingitis — is the pathological lesion that underlies most of the clinical phenomena of pelvic inflammatory disease. The pathology explains the clinical findings: why cervical motion tenderness occurs, why some women develop tubo-ovarian abscesses while others recover completely, why infertility and ectopic pregnancy follow some episodes, and why "burnt-out" PID can leave chronic pain. Tubal infection evolves over time, from acute mucosal inflammation through chronic damage, and each stage maps to a recognisable clinical picture.
Core knowledge
Microbiology recap
See Acute pelvic infection for full epidemiology. Briefly: Chlamydia trachomatis (silent ascent, gradual damage), Neisseria gonorrhoeae (more acute), Mycoplasma genitalium, anaerobes (particularly in TOA), and in South Africa, Mycobacterium tuberculosis (genital TB) — an important cause of chronic salpingitis and tubal infertility, especially in HIV-positive women.
Stages of tubal pathology
Acute salpingitis can close fimbriae, fill the tube with pus, and fuse tube and ovary into a TOA.
Acute salpingitis (early stage):
- Mucosal hyperaemia and oedema.
- Polymorphonuclear (neutrophil) infiltrate in lamina propria.
- Loss of ciliary action on columnar epithelium (early functional damage even when histology looks modest).
- Tubal lumen contains serous-to-purulent exudate.
- Clinical correlate: bilateral lower abdominal pain, deep dyspareunia, cervical motion tenderness (from inflamed broad ligament tugged by cervix), fever, raised WCC and CRP. Mucopurulent cervical discharge.
Acute salpingitis (advanced):
- Tubal wall thickened, congested.
- Pus in lumen → pyosalpinx.
- Fimbriae become oedematous, agglutinated → closure.
- Peritubal inflammation extends to involve ovary, broad ligament, pouch of Douglas.
- Clinical correlate: severe pain, more systemic features, palpable adnexal mass, peritoneal signs if inflammation reaches parietal peritoneum.
Tubo-ovarian abscess (TOA):
- Tube and ovary fused into a single inflammatory mass with central liquefactive necrosis.
- Polymicrobial — anaerobes dominate.
- Capsule of granulation tissue contains abscess; if it ruptures, generalised peritonitis follows.
- Clinical correlate: severe constant pain, high fever, marked systemic illness, complex adnexal mass on TVS, often unilateral.