Infection can reach the pelvic organs in two ways: hematogenously (with the bloodstream, from organs where there are foci of inflammation) and from the external genital organs, through the uterine cavity.
According to statistics, the pathology occurs in every fourth woman of reproductive age. Of particular danger are complications of salpingoophoritis - disruption of the ovaries, irregular menstrual cycle, adhesions, obstruction of the fallopian tubes, ectopic pregnancy, infertility, the treatment of which takes a longer time. You can be examined and undergo therapy at the AltraVita clinic.
Salpingitis
Oophoritis
Causes
The main causes of salpingoophoritis are pathogenic microflora. This can be either a banal coccal flora (streptococci, staphylococci) or sexually transmitted infections - ureaplasma, mycoplasma, chlamydia, gonococci, trichomonas.
- Acute salpingoophoritis usually develops against the background of systemic pathology, due to a decrease in the immune function of the body. Provoking factors in this case may be severe stress, hypothermia, failure to comply with the rules of intimate hygiene, unprotected sexual intercourse and a number of other, at first glance, insignificant points.
- Chronic salpingoophoritis is, as a rule, a consequence of incomplete or improper treatment of the acute form of the disease or relapses if the above provoking factors are constantly repeated. This form of the disease is especially dangerous due to the sluggish nature of the course and the tendency to develop complications. From the perineum and vagina, pathogenic microorganisms enter the uterine cavity and fallopian tubes. By intensively multiplying, bacteria and their metabolic products damage the mucous membrane, provoking an inflammatory process. Toxins released into the blood cause intoxication syndrome (read more here).
If salpingoophoritis develops as a secondary process, the infection enters the appendages with blood. The further mechanism of development does not differ from that during the ascending process.
Factors of occurrence
The content of the article
The most common cause of the disease is hypothermia. For example, if your lower back is very cold. Wet feet in the autumn or winter season often become a factor leading to salpingo-oophoritis.
Causes:
- “Ordinary” bacteria are sources of disease.
- Pathogens acquired through sexual intercourse are chlamydia and gonococci. When such bacteria enter the genital tract due to infection, they try to penetrate the uterine tubes. The reason for this lies in the acidity of the mucous membrane. It is most suitable in pipes; in addition, columnar epithelium is located there - the best place for chlamydia to live.
Chlamydia is a pathogenic bactericidal pathogen that has all the necessary means to resist the body's immune system.
Signs and symptoms
Symptoms of acute and chronic salpingoophoritis are somewhat different, but the general clinical picture of the disease is quite typical and does not cause difficulties in diagnosis.
In the acute form of the disease, the following clinical signs are observed:
- general malaise and weakness;
- cycle failure;
- increased body temperature;
- vaginal discharge;
- itching and burning in the external genitalia;
- severe pain in the lower back and lower third of the abdomen.
The severity of clinical manifestations varies greatly, depending on the form of the disease and the severity of its course.
In severe cases, the body temperature reaches febrile levels, the malaise is very severe, there is no appetite, sweating is bothersome. The pain is localized in the lower abdomen and lower back, with a unilateral process - more on the right or left, constant, acute. In the purulent form, signs of inflammation of the peritoneum are added.
The regularity of menstruation depends on the function of the ovaries. If it is slightly disturbed, the patient maintains a regular cycle, the amount of discharge does not exceed the norm. With a pronounced hormonal imbalance, delays in menstruation, intermenstrual bleeding, an increase in the amount of spotting, and increased pain are possible. The nature and amount of vaginal discharge are determined by the etiological factor. In most cases, a large amount of mucous or mucopurulent discharge is observed. The gonococcal flora gives the discharge a green tint; with trichomoniasis, it is foamy in nature.
Itching and burning in the external genitalia are observed only with the ascending type of the disease. These signs indicate an infectious lesion of the lower genital tract and the spread of infection upward, into the uterine cavity, fallopian tubes and ovaries. In the subacute process, clinical manifestations are not so pronounced. Body temperature is low-grade, abdominal pain and general malaise are moderate. Often in such cases, women do not consult a doctor, and after a few days their condition improves. In fact, the disease becomes chronic.
Symptoms of chronic salpingoophoritis:
- irregular pain in the lower third of the abdomen, which intensifies during sexual intercourse or during hypothermia;
- menstrual irregularities;
- development of tubal infertility (due to the appearance of adhesions in the Eustachian tubes).
A characteristic feature of chronic salpingoophoritis is alternating periods of exacerbation and remission.
During the remission phase there are no complaints, the patient feels almost healthy. Sometimes there is an irregular menstrual cycle. Periods of exacerbation are characterized by an increase in the severity of symptoms; the patient is forced to consult a doctor to undergo treatment. The latent form of pathology is especially dangerous. A sluggish inflammatory process can proceed for several years without manifesting itself. They learn about the disease only after the development of complications of salpingoophoritis, in particular, infertility or ectopic pregnancy.
Symptoms of salpingoophoritis
Diet
During the acute and subacute stages of adnexitis, patients should follow a hypoallergenic diet. It is advisable to exclude from the diet:
- mushrooms;
- chicken egg whites;
- chocolate;
- baked goods, sweets;
- citrus fruits, etc.
Limit the amount of table salt. Food must be processed by boiling or stewing.
If salpingoophoritis does not have pronounced symptoms, it is not necessary to adhere to a diet. But nutrition should always be complete, with sufficient vitamins and proteins.
Diagnostics
Diagnosis of salpingoophoritis at the AltraVita clinic begins with a consultation with a gynecologist. At the appointment, the doctor first interviews the patient. The doctor asks whether the woman has chronic diseases, what pathologies of the genitourinary system the patient has had in the past, and so on. This is followed by an examination in a gynecological chair.
After completing the examination, the following procedures are performed to confirm the diagnosis:
- Ultrasound of the pelvic organs;
- taking gynecological smears for flora, the presence of infections;
- general blood analysis;
- biochemical screening.
Methods for diagnosing salpingoophoritis
Ultrasound examination allows you to examine the internal genital organs, identify signs of acute or chronic inflammatory process, and assess the condition of the fallopian tubes and ovaries. At the AltraVita clinic, ultrasound is performed transabdominal and transvaginally. In the first case, the examination is carried out through the lower part of the anterior abdominal wall. To ensure that the internal genital organs are clearly visible on the screen, a woman should drink several glasses of water an hour before the procedure. A filled bladder will serve as a kind of acoustic window, conducting ultrasonic waves deep into the pelvis. During a transvaginal examination, a sensor is inserted into the vagina. This technique is more informative and does not require preparation. To prevent the spread of infection, a condom is placed over the sensor.
Microscopic and bacteriological examination of discharge allows us to identify the true causes of salpingoophoritis, determine the sensitivity of bacteria to antibacterial agents and select treatment with the most effective drugs.
A general and biochemical blood test allows you to assess the general condition of the patient’s body who has been diagnosed with this disease, identify concomitant diseases, abnormalities in the functioning of internal organs and systems.
According to the patient’s indications, the level of hormones in the blood is determined, CT and MRI, and hysteroscopy are performed. A comprehensive diagnosis of salpingoophoritis allows you to accurately determine the form and nature of the disease, significantly increasing the chances of a good clinical outcome.
Complications of adnexitis
It is important not to delay treatment of adnexitis. At the first signs of inflammation of the ovaries and appendages, make an appointment with your doctor for help. Otherwise, you may encounter various complications, including:
- disruptions of the menstrual cycle;
- peritonitis;
- adhesions blocking the tubal cavity. This often provokes infertility;
- increased risk of ectopic pregnancy. The probability may increase by 15-50%;
- purulent lesions of the ovary. Cavities are formed in the thickness of the organ, which are filled with exudate;
- pelvioperitonitis;
- damage to the fallopian tubes. With prolonged inflammation, hydrosalpinx or pyosalpinx is formed;
Incorrect therapy can lead to chronic inflammation. This is fraught with problems with reproductive function.
Therapy
Treatment of acute salpingoophoritis or during exacerbations is carried out in a specialized hospital. Therapy includes the prescription of antibacterial drugs, which is carried out taking into account the sensitivity of the flora to them and the type of causative agent of the disease. Simultaneously with antibacterial therapy, detoxification therapy is prescribed, during which special anti-inflammatory suppositories are used, which reduce temperature, relieve inflammation and have an analgesic effect on the affected pelvic organs.
After the inflammatory process is relieved, the patient is prescribed absorbable medications and physiotherapeutic procedures. They will prevent the appearance of adhesions in the fallopian tubes, reducing the risk of infertility and ectopic pregnancy in the future.
If conservative treatment does not produce results, then surgery is indicated, usually laparoscopy. The scope of the operation is determined individually. If an abscess forms, the fallopian tube is removed as a source of infection. To restore the patency of the appendages, adhesions are cut and rough scars are removed.
Chronic salpingoophoritis during periods of exacerbation is treated similarly to acute. During the remission phase, the use of physiotherapy is indicated. The appropriateness of prescribing a particular technique is determined by the attending physician, depending on the severity of menstrual irregularities, the presence of adhesions, and the symptoms of the disease. Treatment includes techniques such as ultrasound, magnetic fields, pulsed currents, reflexology, mineral waters, mud in the form of applications, irrigations, baths. These procedures have a beneficial effect on general and local immunity, improve blood supply to the pelvic organs, enhance regenerative processes, and restore hormonal balance.
Patients with inflammation of the appendages are not recommended to visit hot countries with a humid climate; it is better to give preference to balneological hospitals and local sanatoriums. If the pathology causes infertility, an IVF procedure is indicated. This technique allows you to give birth to a child even for those women who have a history of hormonal or tubal infertility. Pregnancy after IVF usually proceeds normally. Hormonal support is rarely necessary to prevent spontaneous miscarriage.
Options for surgical treatment of salpingoophoritis
Treatment of salpingoophoritis
Acute salpingoophoritis must be treated in a hospital. The patient is prescribed an easily digestible diet, and excretory function is monitored. Of the medications, gynecologists resort to help:
- broad-spectrum antibiotics;
- anti-inflammatory;
- painkillers;
- desensitizing.
Antibacterial drugs are selected taking into account the pathogen. Their dose should ensure the maximum concentration of the active substance at the site of inflammation. The most commonly used:
- tetracyclines (“Tetracycline”, “Doxacycline”);
- penicillins (“Ampicillin”, “Ampioks”, “Oxacillin”);
- macrolides (“Erythromycin”, “Azithromycin”, “Roxithromycin”);
- fluoroquinolones (“Ofloxacin”);
- lincosamides (“Clindamycin”);
- nitroimidazoles (“Metranidazole”);
- aminoglycosides (“Gentamicin”, “Kanamycin”).
Preference is given to agents with a long half-life and elimination. In case of severe adnexitis, a high risk of septic complications, anaerobic or mixed flora, it is possible to simultaneously prescribe antibiotics from different groups. Thus, Levomycetin can be combined with Gentamicin, Lincomycin with Clindamycin, Chloramcenicol with Clindamycin, aminoglycosides with penicillins.
Infusion therapy helps eliminate the symptoms of intoxication during salpingoophoritis. Solutions of glucose, polyglucin, rheopolyglucin, hemodez and protein preparations are administered to the patient intravenously.
Purulent forms of acute adnexitis require surgical treatment. It can be:
- laparoscopy, during which pus is removed and the inflamed tissues are irrigated with an antiseptic;
- evacuation of the contents of the saccular tumor by puncture of the vaginal vaults (afterwards antibiotics are administered locally).
When purulent melting of the appendages develops, they are completely removed.
Treatment of chronic salpingoophoritis is carried out according to the same scheme as acute - hospitalization, antibacterial and infusion therapy, desensitizing drugs. When the symptoms of exacerbation subside, the woman is prescribed:
- aloe injections;
- autohemotherapy (the patient is injected intramuscularly or subcutaneously with her own blood taken from a vein).
Physiotherapeutic procedures for salpingoophoritis
Physiotherapy procedures that are effective for salpingoophoritis include:
- UHF therapy;
- ultrasound;
- electrophoresis with various medications (potassium, magnesium, iodine, zinc, Lidaza);
- vibration massage;
- biostimulants;
- paraffin treatment;
- medicinal baths.
Physiotherapy for acute and chronic salpingoophoritis can reduce tissue exudation, relieve pain, reduce swelling, and prevent the formation of adhesions.
Prevention
Prevention of salpingoophoritis does not differ from that for other inflammatory diseases of the pelvic organs. In order to prevent the development of inflammation of the appendages, it is necessary to abandon casual relationships, use protection during sex, avoid abortions, and prevent the development of postpartum infections.
Women who are sexually active should avoid frequently changing sexual partners. Regular medical examinations are recommended at least every six months. This will allow you to timely diagnose diseases of the genital organs, regardless of their nature, origin, and undergo treatment.
To minimize episodes of exacerbation of the chronic form, you need to avoid physical overexertion, overwork, hypothermia, in general, everything that can weaken the body and reduce its immune defense. Here, secondary prevention of salpingoophoritis comes to the fore—prevention of complications. The patient should follow all the doctor’s recommendations very carefully. It is strongly recommended not to make changes to the therapeutic regimen on your own, to stop taking prescribed medications prematurely, or to reduce or increase the dose or frequency of administration.
If you find signs of any inflammatory gynecological disease, consult a doctor immediately. Treatment can be done at the AltraVita clinic. At the clinic, you can undergo all examinations in the shortest possible time, without wasting time on travel and long queues, because it is equipped with all the necessary diagnostic equipment. Timely treatment will allow you to achieve the fastest possible recovery, as well as avoid complications, including those from the reproductive system.
