Fallopian tubes & broad ligament

Fallopian tube tumor-like lesions

Tubo-ovarian abscess

Last author update: 1 March 2011
Last staff update: 30 December 2020

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PubMed Search: Fallopian tubes [title] salpingitis

Nicole D. Riddle, M.D.
Jamie Shutter, M.D.
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Cite this page: Riddle N, Shutter J. Tubo-ovarian abscess. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/fallopiantubessalpingitis.html. Accessed November 29th, 2023.
Definition / general
  • Inflammation of fallopian tube, most commonly sexually transmitted due to chlamydia and gonorrhea
  • Part of spectrum of pelvic inflammatory disease (PID)
  • > 1 million cases of acute salpingitis reported annually in US but actual number probably larger due to incomplete and untimely reporting
  • For women 16 - 25 years, salpingitis is most common serious infection; affects 11% of females of reproductive age, 12% of women before age 20
  • Salpingitis has higher incidence among lower socioeconomic classes, possibly due to earlier sex debut, multiple partners, poorer health care
  • Highest risk for people aged 15 - 24 years, possibly due to multiple partners, less awareness of symptoms, reduced willingness to use protective contraceptives
  • Infection also occurs via childbirth, abortion (therapeutic or elective), endometrial biopsy, IUD insertion, miscarriage
  • In 2005, World Health Organization (WHO) estimated 448 million new cases of curable STIs occur annually in individuals aged 15 - 49 years
  • Bacteria most associated with salpingitis are: actinomyces, Chlamydia trachomatis, enteric gram - negative rods (eg. E. coli), Gardnerella vaginalis, Haemophilus influenza, Mycoplasma, Neisseria gonorrhoeae, rarely other anaerobic and aerobic bacteria, Staphylococcus, Streptococcus, Trichomonos vaginalis, Ureaplasma urealyticum
  • Also Herpes and CMV, fungi, parasites
  • 30 - 40% are polymicrobial
  • In US, chlamydia is #1 most reported sexually transmitted disease associated with PID, N. gonorrhoeae is #2
  • 10 - 20% of untreated chlamydial or gonorrheal infections progress to PID
Clinical features
  • Symptoms usually appear after a menstrual period; most commonly abdominal pain, abnormal smell and color of vaginal discharge, bloating, fever, lower back pain, nausea, pain during ovulation, pain during periods, pain during sexual intercourse, vomiting
  • Tubo-ovarian abscess in 1/3 of women hospitalized for PID
  • Often asymptomatic, may be diagnosed clinically by pelvic examination, blood tests, vaginal or cervical swab
  • PID has 3 principal complications: chronic pelvic pain (~25%), infertility, ectopic pregnancy (15 - 50%)
  • Impaired fertility is major concern; infection and inflammation can lead to scarring and adhesions within tubal lumens
  • Of women with tubal factor infertility, 50% have no history of PID but have scarring of fallopian tubes and exhibit antibodies to C. trachomatis
  • May lead to tubule ovarian abscess, pelvic peritonitis, Fitz-Hugh-Curtis syndrome (perihepatitis)
  • Taiwanese studies of > 60,000 women diagnosed with PID found that PID was independent risk factor for myocardial infarction in women > age 55 (Int J Cardiol 2013;167:416), with increased risk of stroke for 3 years following PID (Stroke 2011;42:2074); also increased risk of ovarian cancer, particularly in women with 5+ episodes of PID (Lancet Oncol 2011;12:900)
Case reports
  • Antibiotics or antifungals
Gross description
  • Pyosalpinx (pus), hematosalpinx
  • Enlarged, erythematous, edematous
  • May have fibrinous exudate
  • Tubo-ovarian abscess common
Gross images

Images hosted on other servers:

Tubo-ovarian abscess from Neisseria gonorrheae

Microscopic (histologic) description
  • Marked neutrophilic infiltrate, congestion and edema
  • Mucosal ulceration
  • Reactive epithelial changes
  • Variable abscess formation, variable presence of microorganisms
Microscopic (histologic) images

Images hosted on other servers:

Neisseria gonorrheae


Differential diagnosis
  • Ectopic pregnancy
  • Hydrosalpinx: transudate, follows purulent salpingitis
  • Menstruation / pregnancy: neutrophils common but usually don't invade muscularis, no necrosis, no ulceration, no chronic inflammatory infiltrate
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