Salpingitis in Non-Sexually Active Girls: Clinical Spectrum and Diagnostic Clues from a Pediatric Cohort

TL;DR

Salpingitis in non-sexually active girls often presents with vague abdominal symptoms and is caused by gastrointestinal or surgical factors, not sexually transmitted infections, requiring early imaging for timely diagnosis.

Contribution

This study characterizes the distinct clinical features and non-sexual causes of salpingitis in non-sexually active pediatric girls, emphasizing the need for early imaging and awareness.

Findings

Non-sexually active girls with salpingitis commonly present with non-specific abdominal symptoms and lack genitourinary signs.

Gastrointestinal, appendiceal, and postsurgical factors are more common causes than sexually transmitted infections.

Ultrasound is effective in detecting hydrosalpinx or pyosalpinx in most cases.

Abstract

What are the main findings?
Pediatric salpingitis in non-sexually active girls shows distinct clinical features compared with sexually active adolescents and adults, presenting predominantly with non-specific abdominal symptoms and often lacking genitourinary signs or identifiable sexually transmitted pathogens, which contribute to diagnostic delay.Gastrointestinal, appendiceal, and postsurgical factors, rather than sexually transmitted infections, represent the main predisposing pathways, with enteric and anaerobic organisms being the most frequently identified pathogens.

Pediatric salpingitis in non-sexually active girls shows distinct clinical features compared with sexually active adolescents and adults, presenting predominantly with non-specific abdominal symptoms and often lacking genitourinary signs or identifiable sexually transmitted pathogens, which contribute to diagnostic delay.

Gastrointestinal, appendiceal, and postsurgical factors, rather than sexually transmitted infections, represent the main predisposing pathways, with enteric and anaerobic organisms being the most frequently identified pathogens.

What are the implications of the main findings?
Increased clinical awareness and early imaging, particularly ultrasound, are crucial to identify salpingitis in children presenting with unexplained abdominal pain and to avoid missed or delayed diagnosis.Improved recognition of non-sexually transmitted pediatric salpingitis may reduce unnecessary surgical interventions, optimize antimicrobial management, and potentially limit long-term reproductive sequelae.

Increased clinical awareness and early imaging, particularly ultrasound, are crucial to identify salpingitis in children presenting with unexplained abdominal pain and to avoid missed or delayed diagnosis.

Improved recognition of non-sexually transmitted pediatric salpingitis may reduce unnecessary surgical interventions, optimize antimicrobial management, and potentially limit long-term reproductive sequelae.

Background: Pediatric salpingitis is rare and often underrecognized, especially in non-sexually active girls in whom symptoms are non-specific and sexually transmitted infections are absent. Delayed diagnosis may increase the risk of complications. We aimed to characterize the clinical presentation, diagnostic features, management, and outcomes of pediatric salpingitis and to identify predisposing factors in non-sexually active pediatric patients. Methods: We retrospectively reviewed pediatric cases of radiologically or surgically confirmed salpingitis at a tertiary children’s hospital (2000–2025) and conducted a narrative review of published pediatric cases. Results: Ten non-sexually active girls were included (median age 12.8 years). Abdominal pain was the most common symptom (80%), followed by fever and gastrointestinal complaints (50% and 30%, respectively); two patients (20%) were asymptomatic. Hydrosalpinx or pyosalpinx was detected on ultrasound in 80%. A causative organism was identified in 30%, predominantly enteric or anaerobic flora. All patients received broad-spectrum intravenous antibiotics; half required procedural or surgical intervention. Clinical outcomes were favorable in all cases. The literature review identified 56 additional non-sexually active girls, most of whom were postmenarchal. Abdominal pain was the predominant presentation, and gastrointestinal or anatomical predisposing factors were common. Conclusions: Non-sexually transmitted salpingitis is an uncommon but clinically relevant condition in children. Its atypical and often subtle presentation in non-sexually active girls warrants heightened clinical awareness. Early imaging and attention to gastrointestinal or postsurgical antecedents can facilitate timely diagnosis. Further multicenter studies are needed to establish diagnostic criteria and clarify long-term reproductive outcomes.