Disease code 70.1. Clinical protocol for the diagnosis and treatment of inflammatory diseases of the pelvic organs (salpingitis, oophoritis, salpingoophoritis). How do surgeries proceed?
![Disease code 70.1. Clinical protocol for the diagnosis and treatment of inflammatory diseases of the pelvic organs (salpingitis, oophoritis, salpingoophoritis). How do surgeries proceed?](https://i0.wp.com/women-medcenter.ru/userimages/laennek_lechenie_pridatkov.jpg)
Oophoritis, the medical term for inflammation of the ovaries in women in gynecology, is a widespread gynecological disease. According to statistics, its highest frequency occurs in the age group of 20-29 years; It ranks second after pathological discharge among the reasons for visiting a gynecologist.
ICD-10 code:
N70 Salpingitis and oophoritis;
N70.0 Acute salpingitis and oophoritis;
N70.1 Chronic salpingitis and oophoritis;
N70.9 Salpingitis and oophoritis, unspecified.
WHAT IS OOPHORITIS
6. Ovarian pain during menstruation - causes and what to do?
Most women consider it normal if pain in the ovaries appears a few days before the start of menstruation and becomes stronger during it. The nature of the pain is twisting, stabbing, aching. There are cases when health worsens significantly before the arrival and in the first days of menstruation. Significant physical activity, overwork, and constant stress lead to aggravation of what is happening. What to do in this case? If this has not been observed before or the course of the “critical days” has become different, you should visit a gynecologist. What can a gynecologist do in this situation and how will he recommend reducing pain in the ovary during menstruation? In the absence of pathological causes, any treatment for painful periods is not required. A woman just needs to take her favorite painkiller or apply a warm heating pad to her lower abdomen. Herbal infusions and decoctions, which can be purchased at the pharmacy, are good for relieving pain in the ovaries during menstruation. In the presence of gynecological pathology, inflammation of the ovary, it can be treated with the help of drugs and traditional medicine, which will be described in detail on the page below.
7. Appendicitis or ovarian inflammation?
Right-sided oophoritis is inflammation of the right ovary, which led to its pathological changes. Right-sided inflammation is often confused with appendicitis, since these two diseases have similar manifestations. Women complain of sharp girdling pain in the lower abdomen, which radiates to the lower back, side, and rectum. Without timely medical care from a gynecologist, inflammation of the ovary can spread to neighboring organs, and in the presence of acute appendicitis, a late visit to a surgeon can lead to peritonitis and death.
ACUTE OOPHORITIS
SYMPTOMS OF ACUTE OOPHORITIS:
- High temperature, general weakness, chills;
- Disruption of the gastrointestinal tract;
- Severe pain in the ovarian area, on the right, left or both sides;
- Muscle pain, headaches, migraine;
- Painful, frequent urination.
- The appearance of purulent vaginal discharge;
- Uterine bleeding due to dysfunction;
- Acyclic, intermenstrual bleeding;
- The stomach feels tight, the ovaries on the side of the inflammation hurt;
- Sharp pain in the vagina, side, lower abdomen during sexual intercourse.
Diagnosis of this pathology in gynecology is usually not difficult. The practitioner will be helped by the woman’s characteristic complaints, the clinical picture typical of acute ovarian inflammation and the high informativeness of the basic diagnostic techniques.
Acute oophoritis can be detected during a gynecological examination. The ovaries are significantly enlarged due to the inflammatory process and swelling, and are painful on palpation. The development of signs of an acute form requires immediate hospitalization with treatment in a hospital. With timely diagnosis and proper treatment, acute oophoritis can be completely cured.
CHRONIC OOPHORITIS
Chronic ovarian inflammation is a long-term inflammatory process that occurs in the ovary(s) against the background of a weakened immune system. Chronic oophoritis can also be the outcome of an acute or subacute course of the disease - in case of untimely contact with a specialist, self-medication or inadequate therapy. This is a serious disease, debilitating, lasting for years, periodically exacerbating or passing into a subacute stage and having many serious consequences. Develops approximately six months after acute inflammation of the ovaries. For a long time, the disease may not make itself felt, that is, it may proceed without an acute stage, or the clinical picture may be so erased that the disease may not manifest itself at all for the time being.
If there are signs, then you can ignore them. These are vague nagging pains in the ovary on the left, right or both sides, or some discomfort in the lower abdomen, absence or insignificant amount of discharge, general malaise, weakness, constant fatigue, irritability, lethargy. Body temperature does not rise above 37C. But at the same time, dangerous consequences for women’s health occur - adhesions in the pelvis and infertility. All this is due to the progressive adhesive process after suffering and untreated acute inflammation of the ovaries.
Therefore, chronic oophoritis is often detected when a woman goes to the gynecologist because the left or right ovary hurts, colitis in the side and lower back, as well as because of the inability to get pregnant or the menstrual cycle has become irregular.
Symptoms of chronic ovarian inflammation, such as various menstrual irregularities, pain or severe discomfort after sexual intercourse, deterioration in well-being after it, and infertility, will cause a woman to be wary and ultimately consult a gynecologist. Sexual dysfunction occurs in 50-70% of cases and manifests itself in the absence or change in sexual desire, lack of orgasm, vaginismus, pain during sexual intercourse, which in turn is closely related to the degree of decrease in ovarian function.
SYMPTOMS OF CHRONIC OVARIAN INFLAMMATION:
- Various menstrual cycle disorders;
- Pain or severe discomfort after sexual intercourse;
- Miscarriage;
- Miscarriages in early gestation;
- Inability to conceive a child (infertility);
- Violations of sexual reactions (changes in sexual desire, lack of orgasm);
- Decreased hormonal function of the ovaries.
WHAT IS OOPHORITIS DANGEROUS FOR WOMEN'S HEALTH?
The greatest threat is posed by bilateral chronic inflammation of the ovaries. Its symptoms are usually not as pronounced as in the acute form. The woman periodically feels practically healthy; treatment, if carried out, is not completed. The reasons for exacerbations of chronic oophoritis are colds, physical or mental stress, indigestion, infections of the genitourinary system... The result is dysfunction - a disruption in the production of female sex hormones. In this condition, there is pain, irregular onset of menstruation, fluctuations in their intensity and duration, which ultimately leads to disruption of the ovulation process and the possibility of conception, up to its complete impossibility.
DIAGNOSTIC METHODS
Important! Every woman and girl experiences ovarian pain differently. It all depends on age, the presence of chronic diseases, pain threshold and other individual characteristics of the body. If for some time there has been shooting in the ovary, pulling in the stomach and lower back, in addition there may be nausea, weakness, fatigue or even a slight increase in body temperature, the woman should urgently see a doctor! Such symptoms of possible ovarian inflammation require testing and examination. Laboratory diagnostics and tests for inflammation of the appendages in gynecology are of paramount importance, because allow you to accurately determine the cause of oophoritis and the stage of the process (acute or chronic).
ANALYSIS FOR OOPHORITIS:
- Vaginal microflora smear;
- PCR tests for STIs from the cervix;
- Bacteriological culture with selection of antibiotics;
- Study of discharge from the fallopian tubes;
- Puncture of the posterior vaginal fornix;
- Ultrasound HSG (for tubal patency in the presence of salpingitis);
- Clinical blood test + ESR.
- ELISA blood tests for antibodies to major infections.
HOW TO TREAT OVARIAN INFLAMMATION
The treatment tactics for ovarian inflammation depend on the degree of development of the inflammatory process. In the acute form of oophoritis, therapy is carried out in a gynecological hospital. Along with antibiotics, the patient is prescribed bed rest, painkillers, ice on the lower abdomen, vitamins and restorative medications. If necessary, use medications aimed at eliminating signs of intoxication. In order to prevent adhesions and the development of retroflexion - backward bending of the uterus, absorbable drugs are used. Local treatment in the form of suppositories and creams is also widely used. It enhances the effect of the main treatment of ovarian inflammation in women.
In some cases, if the infection is too extensive to treat, or there is a risk of organ rupture and infection spreading, surgery may be required, which may involve removing part or all of the ovary, fallopian tube, or even the uterus.
Physiotherapeutic methods are widely used at the rehabilitation stage to consolidate the results of basic therapy. During the period of remission, when pain in the ovaries has subsided, physiotherapy, mud therapy, and gynecological massage are especially useful. Self-medication or the absence of normal rehabilitation therapy, in principle, is fraught with the transition of the disease to a chronic form, as well as the development of complications, including infertility.
How to treat chronic oophoritis?
When treating chronic ovarian inflammation in women outside the acute stage, antibiotics are not used. An important part of therapy is the regulation of hormonal disorders and restoration of the proper two-phase menstrual cycle. The procedures in this case are aimed at eliminating the source of chronic infection, correcting the receptor apparatus of the uterus and appendages and restoring their normal functioning as much as possible. During exacerbations of the disease, immunomodulators are used to restore immunity.
EXPERT OPINION.
According to gynecologists, treatment of oophoritis with a combination of medications and folk remedies has a special therapeutic effect. However, not only your desire to undergo ovarian treatment, but the ability of a specialist to help in this difficult matter are of paramount importance. Since both probable disorders in the female organs and possible methods and techniques for influencing them may be different, the individual, informal approach of a specialist who has a sincere desire to help you in this matter comes to the fore! What are the possibilities in this regard, what kind of traditional medicine can our clinic offer in the treatment of ovarian inflammation, especially its chronic form in remission, we will tell you further.
FOLK TREATMENT OF OVARIAN INFLAMMATION
Physiotherapy in combination with gynecological massage, mud therapy, leeching, injections and Laennec droppers occupy an important place in the treatment of chronic ovarian inflammation. The clinic’s doctors will select procedures for each patient individually, taking into account the duration of the process, age, and contraindications.
Below in the table you can see information about gynecologists, one of the best specialists in Moscow for the treatment of ovaries in women. Our doctors have helped dozens, if not hundreds, of women to effectively cure oophoritis, competently and wisely combining medications and additional options for influencing chronically inflamed ovaries.
Today the clinic accepts:
Bezyuk Laura Valentinovna Obstetrician-gynecologist, gynecologist endocrinologist, specialist in gynecology of children and adolescents. Ultrasound. STI. Reproductive medicine and rehabilitation. Adnexitis, oophoritis. Physiotherapy |
Vakhrusheva Diana Andreevna Obstetrician-gynecologist, endocrinologist, ultrasound diagnostics. Inflammation of the ovaries, infections. Contraception. Physiotherapy. Anti-aging intimate medicine and aesthetic gynecology |
Pelvic inflammatory disease in women (PID) is a group of diseases (independent nosological forms) of the upper parts of the reproductive tract of a woman, which may include a combination of endometritis, salpingitis, oophoritis, tubo-ovarian abscess and pelvic peritonitis.
In the United States, approximately one million women are diagnosed with pelvic inflammatory disease, and 250,000 of them are hospitalized each year with this diagnosis, and 115,000 undergo surgery for PID. Sexually active women under the age of 25 are most at risk. WHO estimates that 40% Women with untreated gonococcal or chlamydial infection will develop pelvic inflammatory disease and one in four of them will experience infertility.
N70.0 |
Acute salpingitis and oophoritis |
N70.1 |
Chronic salpingitis and oophoritis |
N71.0 |
Acute inflammatory disease of the uterus |
N71.1 |
Chronic inflammatory disease of the uterus |
N73.0 |
Acute parametritis and pelvic cellulitis |
N73.1 |
Chronic parametritis and pelvic cellulitis |
N73.3 |
Acute pelvic peritonitis in women |
N73.4 |
Chronic pelvic peritonitis in women |
N73.6 |
Pelvic peritoneal adhesions in women |
N74.3 |
Gonococcal inflammatory diseases of the female pelvic organs |
N74.4 |
Inflammatory diseases of the female pelvic organs caused by chlamydia |
What are the causes of PID?
In 60% of cases, the cause of PID is sexually transmitted infections. According to WHO (June 2000), chlamydia and gonorrhea are noted in 65–70% of all cases of PID
Etiological factor |
Frequency and response |
N. gonorrheae 40 -50% |
|
C. trachomatis 30% |
|
Anaerobic infection |
|
Gram-negative bacteria (E. coli, etc.) |
|
Actinomyces israelii |
Very common when using intrauterine devices (IUD) |
detection rates vary considerably |
|
Herpes and adenovirus infections |
|
Not identified |
Risk factors for developing PID
PID is more likely to occur in sexually active women of childbearing age under 25 years of age than in women over 25 years of age. This is due to the immaturity of their cervical structures, which serve as a barrier to ascending infection and reduce susceptibility to sexually transmitted infections associated with PID.
The more sexual partners a woman has, the greater her risk of developing PID. Also, the risk of developing PID is high in a woman whose sexual partner has more than one sexual partner. Single women have a higher risk of developing PID than married women
Women who regularly use douches are at higher risk of developing PID compared to women who do not douche. Research shows that frequent douching changes the vaginal flora (microorganisms that live in the vagina) from normal to pathogenic (harmful), and may allow bacteria from the vagina to spread into the upper reproductive organs.
Previously suffered PID
Women who use intrauterine devices (IUDs) have a higher risk of developing PID than women who use other contraceptives or do not use them at all. However, this risk can be reduced if the woman is tested and treated for sexually transmitted infections before inserting an IUD. .
How does PID occur?
There is no exact average time frame for the development of PID. In some cases, PID develops acutely within a few days after infection; in other cases, PID can develop several months after infection. In the vast majority of cases (75% of cases), infection occurs in an ascending manner in the presence of cervicitis and vaginitis. Factors contributing to the occurrence of PID are delayed or incorrect treatment, self-medication of the underlying disease, immunological disorders, concomitant diseases. In some cases, the causes of PID are not clear.
What are the signs of PID?
There are no strictly specific symptoms of PID; in most cases, the signs are either absent or mild. All clinical symptoms of PID are quite varied and can be divided into the following groups:
Group of symptoms |
Description |
Pain syndrome |
The most common periodic pain in the lower abdomen, |
Menstrual irregularities |
They are also one of the common symptoms of PID. |
Sexual dysfunction |
changes in libido, anorgasmia, vaginismus, dyspareunia |
Vaginal discharge |
leucorrhoea: often mucopurulent, mucous |
Dysuric syndrome |
frequent urination with a tingling feeling, |
General symptoms |
increased body temperature, weakness, general |
What are the complications of PID?
Early diagnosis and adequate treatment can prevent complications of PID. If left untreated, PID can cause damage to a woman's reproductive organs.
Tubal infertility
Bacteria that cause infection can invade the fallopian tubes and cause an inflammatory process there, which leads to scarring, which leads to a change in the normal movement of the egg into the uterus. When the fallopian tubes are completely blocked by scar changes, the sperm cannot fertilize the egg and the woman becomes infertile. Tubal infertility occurs in 15-20% of women with PID
Ectopic pregnancy
If the fallopian tubes are partially blocked by scar tissue or an inflammatory process, fertilization of the egg by a sperm can occur directly in the tube itself and pregnancy will begin to develop there. As a result, an ectopic pregnancy develops, which ends in a rupture of the fallopian tube with sharp pain, internal bleeding and can lead to the death of the woman. Ectopic pregnancy develops in 12-15% of women with PID.
Chronic pelvic pain
Scarring of the fallopian tubes and other pelvic structures can cause chronic pelvic pain that lasts for many months and years. Chronic pelvic pain occurs in 18% of women with PID.
Tubo-ovarian abscess
Tubo-ovarian abscess is a severe form of purulent-inflammatory diseases of the pelvic organs. With a tubo-ovarian abscess, the fallopian tube and ovary are welded together, forming a single inflammatory tubo-ovarian formation filled with pus. Tubo-ovarian abscess is one of the causes of death in women from PID.
Pelvioperitonitis
Pelvioperitonitis is inflammation of the pelvic peritoneum. It is a serious complication of PID, often leading to sepsis. Develops secondary to damage to the uterus, fallopian tubes and ovaries when pathogenic microorganisms penetrate from them through contact, hematogenous and lymphogenous routes
How does PID affect pregnancy?
Pelvic inflammatory diseases are one of the main causes of spontaneous abortion, premature birth and the birth of low-weight children. Complications of pregnancy and childbirth occur in up to 50-70% of pregnant women with PID. Pelvic inflammatory diseases are also considered one of the main causes of postpartum endometritis.
How is PID diagnosed?
Many methods for diagnosing PID have been proposed. An acceptable and modern (data as of 2006) is the approach to PID proposed by the National Center for Disease Control and Prevention (USA).
Diagnostic criteria for PID (CDC, USA) 2006
Minimum |
Additional |
Reliable |
Pain on palpation in the lower Pain in the appendage area Painful cervical traction |
Temperature above 38.3°C Abnormal discharge from the cervix or vagina Increasing ESR Increased C-reactive protein levels Laboratory confirmation of cervical infection caused by gonococci and chlamydia. |
Histopathology: detection of endometritis on endometrial biopsy Ultrasound showing thickened, fluid-filled fallopian tubes with free fluid or a tubo-ovarian mass in the peritoneal cavity Detection of signs during laparoscopy consistent with PID |
Detection of gram-negative intracellular diplococci is an indication for culture or PCR testing for N. gonorrhoeae. It is recommended to use PCR diagnostics for the detection of N. gonorrhoeae or C. trachomatis
How to treat PID
Antibiotics are used to treat PID. However, antibiotic therapy
cannot completely reverse damage that has already occurred in a woman's reproductive organs. Antibiotic therapy can prevent severe damage to the reproductive organs. The later a woman begins treatment for PID, the more likely she is to become infertile or have a future ectopic pregnancy due to tubal damage. Because of the difficulty in precisely identifying the microorganisms that affect the reproductive organs, PID is usually treated with at least two antibiotics, which are effective against a wide range of infectious agents.
Standards for the treatment of salpingitis and oophoritis
Treatment protocols for salpingitis and oophoritis
Salpingitis and oophoritis
Profile: obstetrics and gynecology.
Stage: hospital
Purpose of the stage: stopping the inflammatory process.
Duration of treatment: 10 days.
ICD code:
N70 Salpingitis and oophoritis
N70.0 Acute salpingitis and oophoritis
N70.1 Chronic salpingitis and oophoritis
N70.9 Salpingitis and oophoritis, unspecified.
Definition: Salpingitis and oophoritis are inflammatory diseases of the uterine appendages (tubes, ovaries).
Classification:
With the flow:
Spicy
Subacute
Chronic Risk factors:
any intrauterine interventions, such as insertion of intrauterine devices,
surgical termination of pregnancy;
multiple sexual partners;
sex without barrier methods of contraception and during menstruation;
past history of inflammatory diseases of the female genital organs
(there remains a possibility of persistence of a chronic inflammatory process with previously undetected “hidden” infections and the development of vaginal dysbiosis);
hypothermia.
Admission: planned, emergency.
Indications for planned and emergency hospitalization:
The patient is young and has no children.
Doubts about the diagnosis.
Severe feverish reaction.
Tuboovarian abscess.
The impossibility of organizing outpatient treatment or its insufficient effectiveness.
In case of an acute process, emergency hospitalization.
The required scope of examinations before planned hospitalization:
Serological screening for syphilis
General blood test (6 parameters)
General urine analysis
Determination of RHCG (for differential diagnosis)
Examination of native smears from the vaginal vault, urethra, and cervical canal.
Abdominal or transvaginal ultrasound of the uterus with adnexa helps in diagnosing mass formations of the adnexa, normal or ectopic pregnancy, especially if severe pain interferes with bimanual examination of the pelvic organs.
Using ultrasound data, one can judge the dynamics of the disease and the effectiveness of the therapy.
Diagnostic criteria:
- Fever.
The severity of clinical manifestations varies among patients, and the disease may even be asymptomatic.
Objective data:
Laboratory research:
- Determination of the concentration of C-reactive protein in the blood (increased).
- General urine analysis (for differential diagnosis).
- Complete blood count (increased ESR, leukocytosis).
Differential diagnosis:
- Acute appendicitis.
- Ectopic pregnancy.
- Ovarian cyst.
- Endometriosis.
- Urinary tract infection.
Diagnostic principles:
1. History (complaints)
- Bilateral pain in the lower abdomen.
- Pathological discharge from the genital tract.
- Dysfunctional uterine bleeding.
- Fever.
2. Objective data:
- Pain in the cervix and body of the uterus.
- An increase in the size of the ovary or the definition of a tubo-ovarian formation and its painfulness.
- With the development of perihepatitis, pain is detected in the upper abdomen on the right.
- Mucopurulent discharge from the genital tract.
List of main diagnostic measures:
1. Determination of the concentration of C-reactive protein in the blood
2. General urine test
3. Determination of hCG
4. Tests for chlamydial and gonorrheal infections
5. Pap smear
6. Smear to determine the degree of purity
7. General blood test
8. BAC culture from the cervical canal for sensitivity to antibiotics
9. 3-hour thermometry.
List of additional diagnostic measures:
1. ECG
2. Coagulogram
3. Biochemistry of blood
4. Laparoscopy
5. Ultrasound of the pelvic organs
6. HbsAg
7. Anti HCV.
Treatment tactics:
1. Antibacterial therapy.
Broad-spectrum antibiotics are used, taking into account antibiotic sensitivity.
3-4 generation cephalosporins in combination with broad-spectrum tetracycline or macrolides and metronidazole.
Alternative drugs: fluoroquinolones in combination with metronidazole and broad-spectrum tetracycline.
Parenteral administration is used until clinical improvement and continues for another 48 hours, then switched to oral administration.
Duration is at least 7 days, in severe forms up to 14 days.
2. Desensitizing therapy.
3. Infusion therapy.
4. Prevention and treatment of mycoses.
5. The IUD should be removed.
6. All sexual partners of the patient must be examined and, if necessary, treatment prescribed.
7. For the treatment and prevention of mycosis during long-term massive antibiotic therapy, itraconazole oral solution 200 mg 2 times a day for 7 days.
List of essential medications:
1. Cephalosporins 3-4 generations, macrolides, fluoroquinolones taking into account sensitivity to antibiotics, amp., table.
2. Doxycycline 100 mg, caps
3. Metronidazole 100ml, fl
4. Metronidazole 250 mg, tablet
5. Itraconazole oral solution 150 ml - 10 mg\ml
6. Itraconazole 100 mg, caps
7. Dextran solution for infusion in a bottle of 200 ml, 400 ml
8. Glucose solution for infusion, flask 400ml
9. Crystalloid solutions 400 mg bottle
10. Ascorbic acid injection solution 5%, 10% in ampoule 2 ml, 5 ml
11. Fluconazole, caps 150 mg.
Criteria for transfer to the next stage of treatment: disappearance of pain, normalization of temperature and menstrual cycle, normalization of laboratory parameters and vaginal data.
Chronic oophoritis(ophoritis) is a long-term, asymptomatic inflammation of one or both ovaries.
Unlike acute, diagnosis and treatment of chronic inflammation of the uterine appendages has a number of features.
The course of oophoritis is more often primary chronic nature - the disease develops gradually, without obvious clinical manifestations, seriously complicating diagnosis and timely treatment. Chronic inflammation is periodically complicated by exacerbations.
In rare cases, the disease begins clinically acutely, and then, with inadequate treatment or the influence of other factors, takes a subacute or chronic form.
![](https://i0.wp.com/promatka.ru/wp-content/uploads/2018/05/ooforit-skhema.jpg)
ICD-10 code
N70.1 Chronic oophoritis/salpingitis
N70.9 Oophoritis/salpingitis, unspecified
Chronic unilateral oophoritis - what is it?
If the inflammatory process affects only one ovary (the other remains healthy), then the painful condition is one-sided.
Long-term inflammation of the left ovary is called chronic left-sided oophoritis, and the right ovary is called chronic right-sided oophoritis.![](https://i1.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%9F%D1%80%D0%B0%D0%B2%D0%BE%D1%81%D1%82%D0%BE%D1%80%D0%BE%D0%BD%D0%BD%D0%B8%D0%B9-%D0%BE%D0%BE%D1%84%D0%BE%D1%80%D0%B8%D1%82-2-min.jpg)
Chronic bilateral oophoritis - what is it?
Long-term, low-grade inflammation of both ovaries is called chronic bilateral oophoritis.Without treatment, chronic oophoritis in women often becomes a source of ectopic pregnancy, infertility, and acute surgical pathology
Consequences of chronic oophoritis- Decreased ovarian function, anovulation, menstrual irregularities
- Dishormonal diseases of the genital organs
- Spontaneous miscarriage
- Ectopic pregnancy
- Adhesive process
- Infertility
- Persistent pain syndrome
- Involvement of neighboring organs in the chronic inflammatory process: bladder, intestines, etc.
- Purulent tubo-ovarian "tumor"
- Ovarian abscess
- Piovar
- Peritonitis
Causes of chronic oophoritis
- Infection: germs, viruses, fungi.
- Autoimmune inflammation, develops as a result of: chronic diseases of the genital area, radiation, hormonal disorders, enzymatic defects, etc.
1.Genital:
- Sexually transmitted infections
- Long-term wearing of an intrauterine device
- Bacterial vaginosis
- Urogenital diseases of the sexual partner
- Abortion
- Complicated childbirth
- Gynecological therapeutic and diagnostic procedures: hysteroscopy, hysterosalpingography, etc.
- Sexual intercourse during menstruation
2. Non-gynecological pathology:
- Obesity
- Inflammation of the urinary system
- Anemia
- Hypovitaminosis, vitamin deficiency
- Intestinal dysbiosis
- Immunodeficiency, decreased body resistance
- Site of chronic infection (tonsillitis, stomatitis, sinusitis, etc.)
3.Social factors:
- Early onset of sexual activity
- Frequent change of sexual partners, active sex life
- Unfavorable living conditions, alcoholism, drug addiction
- Stress
- Sedentary lifestyle
- Features of the infectious pathogen
- Violation of general/local immunity
- Chronic gynecological diseases, including dishormonal diseases
- Untreated/undertreated acute oophoritis or adnexitis
Risks of exacerbation of chronic oophoritis
Causes of exacerbation chronic inflammation of the appendages:
- Hypothermia
- Overwork
- Psycho-emotional stress
- Physical overload
- General disease or condition leading to decreased immunity
- Poor intimate hygiene
- Use of vaginal hygienic tampons, douching
Exacerbation of chronic oophoritis is always associated with weakened immunity and increased pathogenic properties of the pathogen
What causes oophoritis?
Nature of infection | Frequent pathogens |
STIs - infections, sexually transmitted | Chlamydia (30% of cases) Gonococci (40%) Trichomonas (20%) Ureaplasma (mycoplasma) |
Commensal microbes or opportunistic microflora, inhabiting the human body, including the vaginal environment |
Escherichia coli Enterococci Proteus Klebsiella Bacteroides Staphylococcus Streptococci Peptococci Peptostreptococcus Gardnerellas etc. |
Viruses, including sexually transmitted |
Herpes virus type 2 Cytomegalovirus |
Fungi | Candida Actinomycetes |
Tuberculosis | Mycobacterium tuberculosis |
How do microbes enter the ovary?
Pathogenic microorganisms enter the uterine appendages in three ways:
- Ascending - the infection spreads from the vagina and/or uterine cavity through the fallopian tube to the ovary.
- Descending - microorganisms penetrate the ovary from the peritoneum (appendix, sigmoid and/or rectum, etc.)
- Hematogenous - pathogenic agents are delivered to the ovary via blood/lymph flow from a distant site.
In 80% of cases, the source of infection in chronic oophoritis is the vagina
Symptoms of oophoritis
Signs of chronic ovarian inflammation in remission phase:
- Menstrual irregularities:
- amenorrhea
- irregular menstrual cycle - Infertility
- Chronic pelvic pain syndrome
- Decreased ability to work, irritability, mood instability, sleep disturbance
Outside of exacerbation, chronic oophoritis can be asymptomatic
or with minor, erased clinical manifestations
Signs | Subacute inflammation of the appendages | Chronic inflammation of the appendages |
Chills, fever | No | No |
Body temperature | Normal/Not higher than 38 degrees | Norm |
Abnormal vaginal discharge | Sometimes | No |
Painful periods | Sometimes | Sometimes |
Sharp cutting pain in the lower abdomen | Sometimes | No |
Dull aching pain in the lower abdomen | Yes sometimes | Yes |
Pain during uterine displacement during bimanual examination | Yes | No |
Enlargement of the appendages, determined by palpation | Sometimes | No/Heaviness |
White blood cell count | Normal/ Slightly above normal | Norm |
Acceleration of ESR | Moderate | Sometimes |
Where does it hurt during oophoritis?
Outside of an exacerbation of the disease, pain may be absent or manifested by unpleasant sensations in the lower abdomen during straining or during sexual intercourse
In the subacute period, during exacerbation:
- Localization of pain: in the lower abdomen, in the groin area, in the sacrum.
- Nature of pain: dull, aching.
- The pain intensifies:
- after physical activity
- in case of hypothermia
- during any acute non-gynecological diseases (colds, sore throat, bronchitis, cystitis, etc.)
- in stressful situations
- before and/or during menstruation
— after a gynecological examination (bimanual examination)
- during or after sexual intercourse
Diagnosis of the disease
It is difficult even for an experienced clinician to recognize chronic or subacute oophoritis that occurs with erased symptoms.
Outside of exacerbation of chronic oophoritis, laboratory parameters (general blood count, urine test, blood biochemistry, etc.) do not change.
Bimanual examinationData from a “two-handed” gynecological examination are not enough to make a diagnosis.
In some cases, the examination does not find any deviations from the norm.
In others, it reveals limited mobility of the uterus and/or pain, heaviness, and compaction in the area of the uterine appendages.
UltrasoundUltrasound examination of the pelvic organs in the diagnosis of chronic oophoritis is ineffective (≈55%).
Indirect echo signs of oophoritis(identified in only half of patients):
- Increased ovarian size
- Ball-shaped form of an inflamed ovary
- Fuzzy contours, thickening of the outer membrane of the ovary
- Echo heterogeneity or hypoechogenicity of the ovarian stroma
- Absence or poor visualization of follicles in the ovary
- Free fluid in the pelvis
- Pain during transvaginal ultrasound
This is a bacteriological examination of a smear from the urethra, vagina and cervical canal.
Examination of smears under a microscope can detect a large number of leukocytes (a sign of inflammation), dysbacteriosis, pathogenic microorganisms (STIs)
PCR diagnosticsIf necessary, an ultra-precise examination of vaginal discharge is carried out for ureaplasma, mycoplasma, chlamydia, cytomegalovirus, herpes virus, HPV, etc. using the polymerase chain reaction method.
CT or MRI of the pelvis with contrastComputer or magnetic resonance imaging with intravenous contrast is a good help to clarify the diagnosis of chronic oopharitis, to distinguish it from tumors and other diseases of the appendages.
Needle biopsy of the ovaryOvarian biopsy followed by histological examination is the gold standard for diagnosing autoimmune chronic oophoritis.
LaparoscopyLaparoscopy is the most effective method for detecting chronic oophoritis.
Indications for therapeutic and diagnostic surgery:
- Persistent pain syndrome that is not amenable to drug treatment
- Suspicion of a dangerous complication of chronic oophoritis
- Infertility
How to treat chronic oophoritis of the ovary?
/consultation with a doctor is required/
![](https://i1.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%9B%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D0%B5-%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%B3%D0%BE-%D0%BE%D0%BE%D1%84%D0%BE%D1%80%D0%B8%D1%82%D0%B0-min.jpg)
Treatment of chronic oophoritis in remission is carried out on an outpatient basis (at home)
AntibioticsAntibacterial therapy for chronic inflammation of the ovaries, as a rule, is not used, or is prescribed in individual cases
Indications for the treatment of chronic inflammation of the appendages with antibiotics:
- Rational antibiotic therapy has not previously been carried out
- Period of exacerbation of the disease
- Prescription of therapeutic actions that aggravate the chronic inflammatory process: administration of staphylo- or gonova vaccines, physiotherapy, etc.
Drugs for the treatment of oophoritis
Antifungal treatmentPrescribed according to indications, according to an individual scheme:
- while taking antibiotics,
- for the treatment of mycoses of the urogenital tract.
Most often used:
- Fluconazole
- Introconazole
Anti-inflammatory and at the same time analgesic treatment of chronic oophoritis is carried out with drugs from the NSAID group.
For example:
- Diclofenac (tablets 50 mg) – orally, 1 time per day
+Diclofenac (100 mg suppositories) – rectally, at night - Naproxen (tablets 50 mg) - orally, 1 time per day
+Naproxen (50 mg suppositories) - rectally, at night - Nimesulide - 100 mg 2 times a day, after meals (for severe pain)
To reduce inflammatory reactions, histamine H1 receptor blockers are prescribed, for example:
- Suprastin – 1 tablet 1-2 times a day
- Tavegil – 1 tablet 1-2 times a day
- Cetirizine - 1 tablet 1 time per day
- Loratadine - 1 tablet 1 time per day
Vitamins are used to increase the body's protective properties and prevent relapse of the disease.
- Vitamin B1 - 1 ml intramuscularly, 10 injections, every other day
- Vitamin B6 - 1 ml intramuscularly, 10 injections, every other day
- Vitamin A - capsules of 5000 IU, 1 capsule 10-15 minutes after meals for a weekly course
- Vitamin C - orally 50 - 100 mg, 3-5 times a day for a two-week course
- Vitamin E - orally 50 - 100 mg, 1-2 times a day, weekly course
The most popular:
- Wobenzym – 5-7 tablets 3 times a day for 2-4 weeks
- Magnesia (magnesium sulfate) 25% – intramuscularly, 5 ml, 1 time per day, for 1-3 weeks
- Serta (serratiopeptidase) - 5-10 mg, 3 times a day after meals, for 2-4 weeks
To maintain healthy vaginal microflora, prevent and treat intestinal dysbiosis, probiotics are prescribed.
Inside:
- Linux
- Bifiform
- Acipol
- Normobakt
- Buck-set forte
- Bifidum, etc.
Locally, in the form of vaginal suppositories/capsules:
- Lactozhinal
- Lactonorm
- Vagilak et al.
Features of the treatment of bilateral oophoritis
An important component of the complex treatment of chronic oophoritis is to increase the immune reactivity and nonspecific defenses of the body.
Immunostimulants are prescribed individually, after consultation with an immunologist, strictly as prescribed - there are contraindications!
- Levamisole – as an immunomodulator, with a proven decrease in the activity of the T-immune system, orally according to an individual regimen.
- Pyrogenal - intramuscularly, 1 time per day, every other day or at two-three-day intervals in an individual dose, a monthly course. Prescribed for prolonged recurrent oopharitis, also for resorption of adhesions.
- Thymalin or T-activin– used according to an individual scheme for the correction of combined immunodeficiencies, autoimmune and allergic diseases.
- Lykopid is a highly effective synthetic immunomodulator that stimulates all forms of anti-infective defense. For chronic oophoritis, take 1 mg 1-2 times a day for a 10-day course.
- Tamerit (Galavit ®) is an immunomodulator with an anti-inflammatory effect. It is used in the form of intramuscular injections according to an individual scheme.
- Polyoxidonium – has an immunostimulating and detoxifying effect. It is used according to indications: in the form of injections, tablets, rectal suppositories - according to an individual scheme.
- Bestim (0.1 mg) is an effective drug for restoring immunological reactivity and complex treatment of chronic viral infections, chlamydia, tuberculosis. It is administered intramuscularly 1 time per day. Course of treatment: 5 injections.
To support the functions of the immune system and strengthen antiviral immunity in the complex therapy of chronic oophoritis, interferon preparations and their inducers are used according to indications.
For example:
- Cycloferon - in the form of intramuscular injections
- Neovir – as an immunostimulant, for the treatment of pelvic inflammation
- Viferon - in the form of rectal suppositories for oophoritis
- Reaferon – capsules, orally, according to an individual regimen
(in the absence of contraindications)
- Electrophoresis of iodine, zinc, copper - on the appendage area
- Ultraphonophoresis - on the area of the appendages
- Ultraviolet irradiation of the bikini area
- Magnetic laser therapy
- Low frequency magnetic therapy
- Ozone therapy, etc.
Methods of nonspecific anti-inflammatory therapy improve microcirculation, prevent the formation of microthrombi and necrosis in the pathological focus, and activate all parts of local immunity.
UV bloodIn case of intolerance to drug treatment, many researchers consider ultraviolet irradiation of blood to be a promising direction in the treatment of chronic oophoritis.
![](https://i0.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%A3%D0%A4%D0%9E-%D0%BA%D1%80%D0%BE%D0%B2%D0%B8-min.jpg)
There is clinical evidence of the successful immunocorrective effect of plasmapheresis in patients with chronic oophoritis.
Therapeutic exercises for chronic oophoritis
Congestion in the abdominal cavity contributes to impaired microcirculation, the appearance of hypoxia, decreased local immunity, and the development of chronic inflammation and adhesions.
Regular physical therapy eliminates these phenomena, heals the genitourinary area, and strengthens the pelvic floor muscles.
Folk remedies for the treatment of oophoritis
Mumiyo![](https://i2.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%9C%D1%83%D0%BC%D0%B8%D1%91-%D0%BF%D1%80%D0%B8-%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%BC-%D0%BE%D0%BE%D1%84%D0%BE%D1%80%D0%B8%D1%82%D0%B5-min.jpg)
What it is?
Mumiyo (mountain oil) is a resinous substance formed in the mountains. It is a natural complex of organic biologically active substances. It has a powerful immunostimulating effect, enhances the processes of hematopoiesis and regeneration.
Where to get:
It is safer and more reliable to purchase ready-to-use mumiyo at a pharmacy.
How to use:
Take once a day: 0.2-0.5 g in the morning, strictly on an empty stomach, with water (50-100 ml) or warm milk. Course of treatment: 1-2 months.
![](https://i2.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%9D%D0%B0%D1%80%D0%BE%D0%B4%D0%BD%D1%8B%D0%B5-%D1%81%D1%80%D0%B5%D0%B4%D1%81%D1%82%D0%B2%D0%B0-%D0%BE%D1%82-%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%B3%D0%BE-%D0%BE%D0%BE%D1%84%D0%BE%D1%80%D0%B8%D1%82%D0%B0-min.jpg)
For chronic inflammation of the appendages, it is useful to take a general tonic based on bioactive juice from aloe leaves, which increases the body's resistance to infection.
What you need:
Aloe juice – 100 g
Walnut kernels - 1 cup
Natural honey – 300 g
Fresh lemon – 3 pieces.
How to do:
Cut off the leaves of indoor aloe (15 cm or more in length). Place them in a paper bag and keep them in the refrigerator for 7 days to increase the activity of biological substances.
Then mince the aloe leaves and squeeze through cheesecloth. Boil the resulting juice for 3 minutes. Cool. Mix with chopped nuts and other ingredients. Keep refrigerated.
How to use:
Take 1 teaspoon 30 minutes before meals 3 times a day for a month. The course of treatment can be repeated.
![](https://i1.wp.com/promatka.ru/wp-content/uploads/2018/05/%D0%BA%D0%BE%D1%81%D1%82%D1%8F%D0%BD%D0%B8%D0%BA%D0%B0-%D0%BF%D1%80%D0%B8-%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%BC-%D0%BE%D0%BE%D1%84%D0%BE%D1%80%D0%B8%D1%82%D0%B5-min.jpg)
Kostyanika is a little-known effective folk remedy for inflammatory diseases of the female genitourinary system.
What you need:
Drupe leaves and stems – 2 tablespoons
How to do:
Pour boiling water over the raw materials. Heat in a water bath for 30 minutes. Cool, strain, add warm boiled water to obtain the original volume (250 ml). Keep refrigerated.
How to use:
Take 2 tablespoons 30 minutes before meals 3 times a day for 3 weeks. After a 7-day break, the treatment course can be repeated.
In the structure of gynecological morbidity, acute inflammation of the uterine appendages takes first place. Isolated inflammation of the fallopian tubes is rare in clinical practice. Most often in women, inflammation of the fallopian tubes and ovaries occurs. It can be combined with inflammation of the uterus. Less common, according to statistics, are suppurative processes in the uterus and appendages with possible generalization of infection.
SALPINGOOPHORITIS
Salpingo-oophoritis- an infectious inflammatory process of nonspecific or specific etiology with localization in the fallopian tubes and ovaries. This is the most common inflammatory disease of the pelvic organs.
SYNONYMS
Adnexitis, salpingitis.
ICD-10 CODE
N70.0 Acute salpingitis and oophoritis.
N70.1 Chronic salpingitis and oophoritis.
N70.9 Salpingitis and oophoritis, unspecified.
EPIDEMIOLOGY
Isolated inflammation of various parts of the pelvis is rare, since they are closely related anatomically and physiologically. In this regard, it is difficult to obtain accurate statistical data on the spread of salpingoophoritis (as well as on pathologies of other parts of the pelvis). Nevertheless, about 40% of patients are hospitalized in hospitals due to acute processes or exacerbations of chronic diseases of the genital organs. About 60% of patients visit antenatal clinics for inflammation. Complications after suffering salpingo-oophoritis are known.
- Every fifth woman who has had salpingo-oophoritis, suffers from infertility.
- Ectopic pregnancy is 5–10 times more likely.
- In 5–6% of patients, purulent complications arise that require hospital treatment and surgical intervention (often with removal of the fallopian tubes).
Adhesive process(a consequence of chronic inflammatory diseases) leads to anatomical disorders and pelvic pain, which can affect sexual relations.
PREVENTION OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
PID is caused by STI pathogens (N.gonorrhoeae, C.trachomatis), aerobic and anaerobic opportunistic microorganisms, fungi, viruses, pyogenic microflora, therefore the prevention of these infections requires periodic and mandatory examinations (pregnant women and those planning pregnancy, inpatients, dispensary groups and risk groups - teenagers, employees of child care institutions, children's hospitals, etc.). Promotion of contraceptive methods and safe sex is necessary.
SCREENING
Adolescent girls, workers in kindergartens, nurseries, orphanages, boarding schools, and dispensary groups with infertility and recurrent inflammatory processes are subject to examination for hidden infections. All patients undergo bacterioscopic, bacteriological examinations and PCR.
CLASSIFICATION OF INFLAMMATORY DISEASES OF THE UTERINE APPENDIXES
- Acute nonspecific (or specific) salpingoophoritis.
- Exacerbation of nonspecific salpingoophoritis.
- Chronic nonspecific salpingoophoritis.
ETIOLOGY (CAUSES) OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
Nonspecific (nongonorrheal) salpingo-oophoritis is caused by pathogenic and opportunistic pathogens. Among them: Staphylococcus aureus and Staphylococcus epidermidis, group B streptococci, enterococci, Escherichia coli, Staphylococcus epidermidis, chlamydia, bacteroides, peptococci, peptostreptococci. Most often, a mixed infection is observed.
PATHOGENESIS OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
Inflammatory processes of the fallopian tubes and ovaries have a common pathogenesis. Initially, all signs of inflammation appear on the mucous membrane of the fallopian tubes (endosalpinx): hyperemia, microcirculation disorders, exudation, edema, cellular infiltration. Then the inflammation spreads to the muscular lining of the fallopian tube, causing swelling.
The tube thickens and lengthens, palpation becomes painful. Microbes, along with the contents of the tube, enter the abdominal cavity, affecting the serous cover of the tube and the surrounding peritoneum. Perisalpingitis and pelvioperitonitis occur. After the ovarian follicle ruptures, pathogens enter, infect the granulosa membrane of the follicle, and an inflammatory process occurs in the ovary (salpingoophoritis). When suppuration occurs, a tubo-ovarian tumor forms (see below).
In the fallopian tube, an adhesive process occurs very quickly in the ampullary section due to thickening of the fimbriae and exudation. The adhesive process also occurs at the mouth of the pipe. The secretion accumulates in the tube with the formation of hydrosalpinx (it can exist for a long time as a chronic pathology). The adhesive process occurs due to the gluing of inflammatory fallopian tubes (especially their fimbrial section) with the peritoneum of Douglas, adjacent intestinal loops, and appendicular process (secondary appendicitis often occurs).
CLINICAL PICTURE (SYMPTOMS) OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
The first symptom of acute salpingoophoritis is severe pain in the lower abdomen, accompanied by an increase in temperature to 38 ° C (sometimes with chills), deterioration of the general condition, there may be dysuric phenomena, and sometimes bloating. When examined with the help of speculum, inflammatory endocervicitis and serous-purulent discharge can be detected. During a bimanual examination, it is impossible to clearly identify the appendages, but the area of their examination is sharply painful, swelling and a pasty consistency are not uncommon. The blood picture shows a shift in the leukocyte formula to the left, an increase in ESR.
The proteinogram shows dysproteinemia with a predominance of globulin fractions, an increase in the level of Reactive protein. Intoxication phenomena occur - a state of moderate severity, weakness, headache, loss of appetite, and sometimes dyspeptic disorders. An acute inflammatory process can result in complete recovery with timely and adequate treatment.
Acute salpingoophoritis can become a subacute or chronic process with frequent exacerbations and last for years. Clinical manifestations are not so bright then. The temperature reaction can be low-grade or normal, the pain is dull, aching, localized in the lower abdomen and lower back. Complaints of dyspareunia and infertility are common. Bimanual examination is less painful, but the uterus and appendages are less mobile, and advancement beyond the cervix is painful. In the blood during a chronic process, as a rule, the ESR is slightly increased. Changes occur when the process intensifies.
DIAGNOSTICS OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
Based on the following anamnesis data:
- complicated childbirth, abortion;
- intrauterine invasive manipulations;
- scraping;
- hysteroscopy;
- insertion and removal of the IUD;
- casual sexual contacts, etc.
HISTORY AND PHYSICAL EXAMINATION
In acute inflammation, bimanual examination is always painful (especially the area of the appendages), since the pelvic peritoneum is involved in the process (sometimes with symptoms of irritation). In the chronic process, on the contrary, sclerosis and fibrosis of the fallopian tubes with the formation of adhesions in the pelvis make the appendages inactive. Their pain is often determined.
LABORATORY RESEARCH
In an acute process, there are no specific changes in the tests (moderate leukocytosis with a shift to the left, an increase in ESR), and in a chronic process, only an increase in ESR is often detected. The main importance is attached to bacterioscopic and bacteriological examination of material from the cervical canal, vagina and urethra. The goal is to identify pathogens and determine their sensitivity to antibiotics.
INSTRUMENTAL RESEARCH
The echographic method does not provide clear information about acute salpingoophoritis. Only thickening of the fallopian tubes and adhesions in the pelvis can be diagnosed. With pelvioperitonitis, a small amount of fluid accumulates in the pouch of Douglas. You can also determine the tumor-like form of hydrosalpinx or pyosalpinx.
It is better to use an ultrasound with a vaginal probe. CT or MRI may be used, especially in the differential diagnosis of ovarian tumors.
DIFFERENTIAL DIAGNOSTICS
Acute salpingoophoritis often needs to be differentiated from acute surgical pathologies (acute appendicitis, surgical peritonitis, intestinal tumors, intestinal or renal colic). At the same time, the use of laparoscopy allows for early topical diagnosis and selection of the correct treatment tactics.
Consultations between a surgeon and a urologist are often extremely necessary, especially in urgent cases of differential diagnosis.
EXAMPLE OF FORMULATION OF DIAGNOSIS
Exacerbation of chronic bilateral salpingoophoritis with the formation of right-sided hydrosalpinx and adhesions in the pelvis.
TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
TREATMENT GOALS
- Relief of acute salpingo-oophoritis or exacerbation of chronic.
- Clinical laboratory examination.
INDICATIONS FOR HOSPITALIZATION
There is always an acute process or an exacerbation of a chronic one.
NON-DRUG TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
Practiced during a chronic process or during post-hospital rehabilitation during an acute process. Physiotherapeutic methods are mainly used: UHF, magnetic therapy, electrophoresis with zinc, magnesium, hyaluronidase, etc., diadynamic currents, sanatorium treatment (radon baths and irrigations, thalassotherapy).
DRUG TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
The principle of treatment is antibiotic therapy, which is prescribed empirically, taking into account the most likely pathogens. Antibacterial treatment regimens for PID should ensure elimination of a wide range of pathogens (see section “Etiology of PID”). First-line regimens include a combination of third-generation cephalosporins (cefotaxime, ceftriakone) with metronidazole, the prescription of inhibitor-protected aminopenicillins (amoxicillin/clavulanic acid, etc.); lincosamides in combination with third-generation aminoglycosides, fluoroquinolones (ciprofloxacin, ofloxacin) can be used as alternative regimens. with metronidazole, carbapenems. Given the high risk of chlamydial infection, patients are simultaneously prescribed doxycycline or macrolides.
Antibacterial therapy for PID, as a rule, begins with intravenous administration of drugs followed by a transition to oral administration (stepped therapy). In mild forms of PID, patients are treated on an outpatient basis, in which case it is preferable to take oral medications with high bioavailability. Antibiotics are combined with detoxification therapy: saline solutions, 5% glucose solution ©, rheopolyglucin ©, hemodez ©, polydez ©, mafusol ©, vitamins are administered intravenously , protein preparations, etc.
According to indications, analgesics, local anti-inflammatory drugs in the form of suppositories, and ice on the stomach are prescribed. When the general condition stabilizes and the acute process subsides, phonophoresis is performed with calcium, copper or magnesium (in a cycle).
SURGICAL TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS
At the initial stage, diagnostic laparoscopy is used. In case of an acute inflammatory process, it is advisable to inject an antibiotic solution into the abdominal cavity (ampicillin 1 g per 20 ml of saline). Subsequently, surgical treatment is resorted to in the absence of effect from conservative drug therapy and the formation of purulent tubo-ovarian formations.
Diagnostic and treatment schemes for salpingoophoritis in detail.
INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS
Consultation with specialists (surgeon, urologist) is indicated:
- at the first stage - for differential diagnosis;
- during treatment - in the absence of treatment effect or the appearance of combined symptoms associated with pathology of other organs.
APPROXIMATE DURATION OF DISABILITY
For salpingo-oophoritis, the period of inpatient treatment is 7–10 days.
FOLLOW-UP
Post-hospital rehabilitation (outpatient follow-up treatment using absorbable, restorative physiotherapy and sanatorium-resort treatment) in order to restore reproductive function and anatomical and physiological relationships of the pelvic organs.
INFORMATION FOR THE PATIENT
The patient must complete the full course of anti-inflammatory treatment for an acute process or exacerbation of a chronic one. It is necessary to conduct courses of anti-relapse treatment, use sanatorium balneotherapy, and use contraceptive methods. If an STI is detected in a partner, treat it and conduct a follow-up examination of the couple.
FORECAST
Favorable for life. Problems, as a rule, are associated with menstrual, sexual and reproductive functions.