Salpingitis: symptoms, causes and treatment

Salpingitis is inflammation of the fallopian tubes, usually caused by a chlamydia or gonorrhoea that has travelled upward. In a Swedish cohort of 1,844 women with confirmed disease, 16.0 percent failed to conceive. Among the control women that figure was 2.7 percent (Weström, 1992).

Here is what strikes me about this topic: the tube is where the damage sticks.

Pelvic inflammatory disease can involve several organs at once. But it's the scar in the fallopian tube that decides later how easily you conceive. That is what this article is about, and why timing counts for more here than with almost any other STI.

What is salpingitis?

Salpingitis is inflammation of one or both fallopian tubes, the roughly ten centimetre channels that connect an ovary to the uterus. Adnexitis is the word you meet alongside it, and it means something slightly broader: inflammation of the tube and the ovary together. Both sit under the umbrella of pelvic inflammatory disease.

A fallopian tube isn't a simple pipe. Its inner surface carries tiny hairs that move the egg toward the uterus, and at its narrowest the channel is about one millimetre across.

That is what makes it vulnerable.

Inflammation leaves scar tissue behind, and in a channel that narrow there is little room for it. Doctors group inflammation of the tubes, the uterus and the surrounding tissue under one heading, because more than one organ is often involved. The wider picture sits in pelvic inflammatory disease.

If the inflammation sits mainly in the uterine lining, the term is endometritis. That is covered in endometritis.

How do you recognise salpingitis?

Usually by pain low in the abdomen that does not pass, on one side or on both. Fever can come with it, along with discharge that smells or looks different, bleeding between periods, or pain during sex. No single symptom proves it, and there is no simple test that confirms or rules it out (Hillier, 2021).

So watch for change instead.

Pain that is new, feels different from your usual period pain and lasts more than a few days is the kind of change a GP can work with. Severe pain with fever or nausea needs same-day assessment. Waiting on a test result is the wrong order in that situation.

This table exists to make that choice easier.

A table does not make a diagnosis. What it does is stop you waiting on a result when what you actually need is a doctor.

How do you get salpingitis?

Almost always because bacteria travel up from the vagina. Chlamydia and gonorrhoea are the two found most often. Both can evade the immune defence around the cervix, which lets them reach the upper genital tract (Darville, 2021). From that point the infection sits in tissue that copes badly with it.

The cervix is not equally closed at all times. During a period, after childbirth, after a miscarriage and around the fitting of an IUD, that threshold sits lower.

Age plays a part too.

The Dutch national institute RIVM reports the same picture year after year. Chlamydia is the most frequently found STI in the Netherlands, with the highest numbers among people under twenty-five. That is the same group in which an upward infection is seen most often.

Non-sexual routes are rarer, such as inflammation after a procedure inside the uterus. They exist, but they explain a small share of cases.

Can salpingitis run without symptoms?

Yes, and that is the worst thing about it. Some women with damaged tubes never noticed any clear inflammation. It often surfaces during a fertility work-up, after a year of trying. Antibodies against chlamydia turn up in the blood, although no diagnosis was ever made (den Hartog, 2006).

This is the strongest argument I know for testing after a risk moment.

Not because something is probably wrong. Because a test is the only way to find an infection that causes no symptoms. How symptom-free STIs behave is covered in STIs without symptoms.

You can get checked with us through a test for chlamydia, gonorrhoea and trichomonas, without an appointment and without anything reaching your GP records.

What does salpingitis mean for your fertility?

Treated, usually little. Untreated, scar tissue can form inside the tube, and that tissue doesn't go away again. In the same Swedish cohort, tubal damage caused infertility in 10.8 percent of the women with confirmed disease. Among the control women it caused none (Weström, 1992).

Hospital pages often say roughly one in ten women is less fertile after pelvic inflammatory disease. That ratio matches the figure above reasonably well. What they almost never add is where it came from.

It came from here.

There is a second number in that same study. Of first pregnancies after the laparoscopy, 9.1 percent were ectopic among patients, against 1.4 percent among controls. A damaged tube passes a fertilised egg less easily, and the egg can then implant on the way.

Read those figures carefully. They describe women in whom inflammation was actually confirmed, not everyone with abdominal pain.

And now the point most pages leave out: antibiotics clear the bacteria, but they don't un-scar a tube.

Treating six months later still removes the infection. Adhesions already sitting there stay put. That is the honest reason time matters here, and it is not a reason to panic.

Picture this: you are 29 and you have been trying to conceive for fourteen months. You never had fever or severe abdominal pain. Something quiet years ago could still have left a mark. What chlamydia can do over the long run is covered in chlamydia complications and infertility.

How is salpingitis treated?

With antibiotics prescribed by a doctor, usually a combination, because more than one bacterium is often involved. With high fever or severe pain that sometimes happens in hospital through a drip. The Dutch GP standard on the STI consultation describes how GPs here approach this picture.

Two things get forgotten a lot.

Treating your partner as well is part of it, otherwise you are reinfected the moment you have sex again. And finishing the course counts even if the pain is gone after three days.

Waiting for it to pass on its own is the one step that gains you nothing.

Thuisarts.nl explains in plain language what to expect from a GP visit for lower abdominal pain. If symptoms persist or get worse, have them reassessed rather than repeating the same step.

Have you had unprotected sex in recent months, with something nagging low in your abdomen since? Then set two things going today: a test for chlamydia and gonorrhoea, and a call to your GP about the pain.

Further reading

For what can happen to your tubes once scar tissue has formed: blocked fallopian tubes.

For testing before you start trying: STIs and trying to conceive.

References

• Weström L, et al. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sexually Transmitted Diseases, 1992;19(4):185-92. PMID 1411832.
• den Hartog JE, et al. Chlamydia trachomatis-associated tubal factor subfertility: Immunogenetic aspects and serological screening. Human Reproduction Update, 2006. PMID 16832042.
• Hillier SL, et al. A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. The Journal of Infectious Diseases, 2021. PMID 34396398.
• Darville T. Pelvic Inflammatory Disease Due to Neisseria gonorrhoeae and Chlamydia trachomatis: Immune Evasion Mechanisms and Pathogenic Disease Pathways. The Journal of Infectious Diseases, 2021. PMID 34396413.
• RIVM, Sexually transmitted infections in the Netherlands, annual report. Accessed July 2026.
• NHG-Standaard Het soa-consult, Dutch College of General Practitioners. Accessed July 2026.
• Thuisarts.nl, I have pain in my lower abdomen. Accessed July 2026.

Every test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.