Salpingitis (pipe) and Oophoritis (ovary) are called the most secret female diseases, because they are hidden even from loved ones. Women share with each other about menstrual disorders that have arisen, even about such a difficult diagnosis as breast cancer, but it is rarely recognized that they have inflammation of the fallopian tubes and ovaries.

This disease caused by cocci, Mycobacterium tuberculosis or other pathogens can prevent conception and a girl cannot become pregnant. There are no self-help groups. A woman thinks that physically she has become worse than others, and this makes her feel unhappy and unprotected. These are not male, but exclusively female problems.

It must be admitted that salpingitis and oophoritis is an inflammatory process of the ovaries and fallopian tubes. It is impossible to divide the types of illness into “bad” and “good”, they are only divided into forms:

1. sharp;
2. subacute;
3. chronic, with a tendency to recur and exacerbate.

Treatment of diseases can take place in different ways. For example, in order to cure an acute form, it is recommended to go to the hospital (at least 10 days). The hospital provides round-the-clock bed care: cryo procedures, antibiotics, intramuscular injections of pyrogenal, longidase, sulfonamides. Having removed painful spasms during hospitalization, having achieved a normal temperature, the disease allows you to proceed to physiotherapy.

At this stage mud, candles, ultrasonic procedures are recommended, you can drink homeopathic medicines prescribed by a doctor. Treatment in the early stages will make it possible to avoid the formation of adhesions. Adhesions, in turn, can lead to obstruction of the fallopian tubes, which threatens infertility.

Salpingitis and oophoritis: what is it

The history of salpingitis, which in translation means (salpingos "pipe") and oophoritis (oophoron "ovary") goes back to the Middle Ages, when the fallopian tubes were first discovered and described. This is one of the few gynecological ailments inherent in humans and animals with a similar anatomy.

In women, salpingitis and oophoritis appear after various bacteria and cocci begin to enter the tubes, and a little later, into the ovaries. You need to understand that cocci, like E. coli, seep from the uterus in an ascending way, and mycobacterium tuberculosis is carried precisely by the blood that passes through the lungs and other organs.

In the event that acute inflammation develops, the entire epithelial cover of the tubes is disturbed, therefore microorganisms uncharacteristic for them seep inside, which leads to soldering with the ovaries into one integral formation. The disease is accompanied by recurring painful sensations in the lower abdomen, in the lumbar region, accompanied by spasms before defecation, leading to a failure of menstruation or their cessation.

Often women turn to the Internet for help, read forums, look at Wikipedia, trying to determine the diagnosis. The consequences of self-medication with folk remedies, pills that helped a neighbor are catastrophic. The lack of competent appointments can lead to hydrosalpinx, purulent complications, and as a result, to the inability to become pregnant.

Salpingitis and oophoritis can turn into a chronic form of inflammation of the appendages - Adnexitis or Salpingoophoritis, in which their symptoms appear and the necessary treatment is carried out:.

Oophoritis and salpingitis can be acute. A woman is able to independently suspect the disease if she encounters the following symptoms:

• spontaneously occurring one-sided (2-sided) pain in the lower abdomen, especially after menstruation;
• malaise, accompanied by lethargy, headache;
• subfebrile temperature above 38.1 ° C and reaches 38.5 ° C;
• tense, muscle spasms in the abdomen.

In the clinic, when examining the vagina, enlarged appendages are clearly palpable, a painful fallopian tube (or tubes) is diagnosed.

The diagnosis is determined on the basis of the medical history obtained (complications after abortion or difficult delivery, unprotected sex, tuberculosis): the results obtained as a result of laboratory tests.

In the event that suspicion falls on a disease such as gonorrhea, then specific pre-examinations are carried out (a smear on the flora). To identify tuberculous salpingitis, it is necessary to examine blood cultures during menstruation or the introduction of a special preparation of tuberculin, there are also other methods.

subacute

Treatment with medicines and suppositories with anti-inflammatory action () gives positive results and translates the disease into a subacute stage. The woman's condition stabilizes, the pain disappears, the temperature returns to normal. The blood formula will show a decrease in leukocytes, although the ESR will remain at a high level - 50 mm or more per hour at a rate of 2-15 mm / h.

Vaginal examination shows a decrease in uterine edema. In the stage of remission, ultrasound is performed, which allows diagnosing pathological changes in the reproductive system: metro endometritis, cysts.

2-sided salpingitis arises from the fact that the mucous membrane is affected, which progressively, layer by layer, captures the fallopian tubes, disrupts their peristalsis.

All this threatens with complications and can lead to the fact that a woman cannot become pregnant or lead to an ectopic pregnancy. Often there is an accumulation of serous fluid in the lumen of the fallopian tube or accumulation of pus, leading to serious complications. The disease is often chronic, covering not only the tubes, but also the ovaries. Adhesions form, which leads to a painful condition and the inability to become pregnant. There are certain signs of inflammation of the appendages in a woman:

The ovaries are a paired organ, they belong to the female reproductive system, are responsible for a number of functions:

1. menstrual;
2. childbearing;
3. sexual;
4. secretory.

With inflammation of the ovaries, all these physiological presses are violated. Oophoritis in gynecology is common, today this disease is observed even in adolescent girls 14-18 years old. Oophoritis is not an independent disease, it is accompanied by salpingitis, the causative agents of which are infections against the background of coc. If you start treating oophoritis in a timely manner, you can avoid diseases such as adenomyosis, colpitis. The consequences can be so deplorable that pregnancy will be impossible even with IVF.

The causes of diseases are banal:

• weak immunity and untreated infections;
• diseases of the endocrine system;
• smoking;
• stress;
• unprotected sex.

Most recall that pains appear constantly, for this, at home, women use herbs to alleviate syndromes, for example: Kalanchoe, upland uterus, fortunately, in pharmacies, the price for them is low. Sometimes they themselves choose drug treatment (they drink Unidox Solutab), and sometimes the symptoms disappear.

In fact, self-medication is ineffective and dangerous, the disease does not disappear, its signs indirectly remind of themselves all the time: sometimes with unnatural secretions, sometimes with itching and thrush. Diseases transferred on the legs lead to a general deterioration in the health of a woman, including left-sided or right-sided (and more often - 2 tbsp.) Salpingitis and oophoritis.

Symptoms of salpingitis and oophoritis

The symptoms of these two diseases are similar, the diagnosis should be made by a doctor after a comprehensive examination. The disease oophoritis is always associated with the ovaries. In order to understand that a disease has arisen, you need to know the symptoms of a common and chronic bilateral disease:

1. violation of menstruation;
2. pulling pains appear in the lower abdomen;
3. infertility.

Chronic bilateral oophoritis is a long period of disease of both ovaries, in which their functions are severely affected.

Women are shown an annual visit to the gynecologist, where the doctor conducts an examination, analyzes complaints, prescribes tests (smears, blood for hidden viruses), MRI, HSG, ultrasound. In the latter case, echo signs provide accurate endometrial data, confirming or excluding endometritis. Now there is an opportunity to do laparoscopy with varying degrees of neglect of salpingitis and oophoritis.

Laparoscopy is a method in surgery, with the help of which an operation is performed through small holes, the video shows how this happens.

Treatment of salpingitis and oophoritis

After learning about the diagnosis, women are most often interested in such points:

• how much the disease is treated;
• whether it is contagious;
• Be sure to go to the clinic or it is enough to conduct physiotherapy.

It is impossible to unambiguously answer these questions. It all depends on the etiology (autoimmune or infectious) and the stage, age of the woman (menstruating or post-menopausal). You need to know if the treatment was carried out before and if the procedures did not give a positive result, what are the reasons.

Tablets

Tablets are usually prescribed in combination with suppositories, it can be both antibiotics and anti-inflammatory or antimicrobial. Both chemical and vegetable. The usual course is 5 to 7 days. A list of tablets and suppositories can be found in the table.

Candles

After the appearance of these ailments in women, they always provoke vaginal inflammation, which is removed by vaginal means - suppositories. It is not recommended to choose medicines on your own, because candle treatment should be directed exactly to your disease.

Candles are divided into:

1. antimicrobial;
2. antifungal;
3. immunomodulating;
4. combined type.

By choosing the wrong drug, you will not achieve improvement, but only aggravate the condition. The doctor usually selects medications from a list based on test results.

Folk methods

Women are interested in whether it is possible to use folk remedies for salpingitis and oophoritis? It is impossible to cure completely with herbs alone, but this is an excellent adjuvant therapy.

Decoctions of chamomile, Kalanchoe, boron uterus have a local anti-inflammatory effect. Depending on the method of preparation, the herbs can be drunk, used as a douche, or bathed with them (juniper infusion).

If you monitor your health, then basically you can avoid many diseases, you need to follow the basic rules:

• have one sexual partner or use a condom;
• correctly and on time to carry out treatment after childbirth, if there was a rupture of the perineum and neck;
• do not self-medicate, do not treat the vagina without the doctor's recommendations;
• prevent abortion;
• take care of hygiene.

Expert opinion. Gynecologist, has been practicing in Volgograd for more than 17 years: Grineva V.P.
According to statistics in Russia, every third couple faces difficulties in conceiving. And the problem is not only in the illiteracy of children who begin an early sexual life, but also in the usual neglect of their health. Despite the availability of gynecological services, many women go to the doctor when the disease threatens with complications. In order not to regret missed opportunities, it is necessary to take care of health from youth, remember about contraception, give up bad habits, and not self-medicate. Early diagnosis allows you to get rid of salpingitis and oophoritis, while maintaining the main female function - childbearing.

Inflammatory diseases in the reproductive organs significantly reduce fertility. Acute salpingitis and pregnancy are incompatible, but after the inflammation subsides, the chances of a desired conception increase. It is possible to get pregnant after a course of treatment for salpingitis, but on condition that all the doctor's prescriptions are fulfilled in full, and the control ultrasound shows positive changes in the fallopian tubes. In chronic salpingitis with frequent exacerbations, the risk of ectopic pregnancy and complicated normal pregnancy increases, so you need to listen to the doctor's opinion and protect yourself from conception at a time when the likelihood of complications is high.

What is dangerous salpingitis for conception

In acute salpingitis, anatomical changes occur in the fallopian tube (edema, narrowing of the lumen, accumulation of inflammatory fluid), which determine the high risk of the following complications:

• ectopic pregnancy;
• tubal obstruction leading to infertility;
• the entry of microbes into the ovary with the formation of oophoritis, which causes ovulation disorders;
• infection of the embryo, which will lead to a miscarriage.

In chronic salpingitis with minimal inflammatory changes, the risk of pathology is much lower, but it is impossible to guarantee a favorable conception. If any inflammatory process in the area of ​​the fallopian tubes is detected, then the conception should be planned: only after the course of treatment can preparations for bearing the fetus begin.

What is the prognosis for pregnancy

Restoration of reproductive ability after antimicrobial therapy does not occur immediately. A period of time is needed for the necessary changes to occur in the fallopian tubes. The prognosis for pregnancy is worse in acute complicated salpingitis with delayed diagnosis and treatment: in this case, even after a full course of antimicrobial therapy, it is necessary to prevent conception for 6-12 months. If an acute inflammatory process is detected in a timely manner, then after a course of antibiotics, you can prepare for pregnancy in 3-6 months. In chronic salpingitis in the stage of persistent remission, it is necessary to check the patency of the fallopian tubes in order to reduce the risk of complications. With favorable results of the examination, you can prepare for the conception of the desired baby.

How to properly prepare for pregnancy

With any variant of salpingitis, it is advisable to follow all the doctor's recommendations for preconception preparation. Before conception, the following examinations must be performed:

• vaginal swabs for purity;
• PCR for chronic sexually transmitted infections (chlamydia, viruses, mycoureaplasma);
• bacterial culture from the cervical canal for specific and nonspecific infections;
• transvaginal ultrasound.

The presence of symptoms is of great importance for diagnosis. When a woman is worried about constant or recurrent pain in the lower abdomen and vaginal discharge, then there is no need to rush to become pregnant. It is optimal to consult a doctor and do all the necessary examinations to detect pathology.

Against the background of typical symptoms, if pathological changes are detected in the analyzes or if changes are detected during ultrasound scanning, the treatment recommended by the gynecologist should be started. The entire period of therapy must be protected so that an unplanned conception does not occur.

In chronic long-term salpingitis without any unpleasant manifestations, except for anti-inflammatory therapy, it is necessary to create conditions for conception. To do this, the doctor will prescribe a special therapy that improves blood flow in the pelvic organs and ensures the preparation of the uterus for the appearance of a fertilized egg. After a successful pregnancy, you should immediately begin the preservation treatment prescribed by your doctor.

It is possible to become pregnant with salpingitis, but due to the high risk of complications, it is necessary to plan conception, creating maximum conditions for a favorable pregnancy.

An important factor in therapy is the optimal course of antibacterial treatment in terms of time and drugs. Only after getting rid of the infection and subsiding inflammation in the fallopian tubes, you can conceive the desired baby.

In the structure of gynecological diseases, inflammatory processes in the ovaries and fallopian tubes take 1st place. This is the most common infectious pathology in young sexually active women.

Infectious and inflammatory diseases of the ovaries and fallopian tubes in 60% of cases are the reason for the woman's visit to the antenatal clinic, and in 40% of cases - the cause of hospitalization. The most common symptoms of oophoritis and salpingoophoritis are pain in the lower abdomen, pathological discharge from the genital tract, fever.

For the treatment of this pathology, antibacterial drugs, NSAIDs, antispasmodics and surgical methods are used. Now let's talk more about the causes, risk factors, diagnosis and treatment of these diseases.

To understand the severity of this pathology, take a look at the following statistics:

1. 1 20% of infertile women have had salpingo-oophoritis in the past.
2. 2 After the illness, the probability of an ectopic pregnancy increases by 10%.
3. 3 Up to 6% of cases of oophoritis and / or salpingitis end in purulent complications that require emergency surgical intervention.
4. 4 Most often, pathology is diagnosed at the age of 17-28 years. That is, predominantly sexually active young women suffer.

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  1. Basic concepts

  Oophoritis is understood as an infectious and inflammatory process localized in the female genital gonads (ovaries).

  Note that due to the anatomical location, isolated oophoritis is extremely rare. Almost always, the fallopian tube (salpingoophoritis), and sometimes the ligamentous apparatus of the appendages (adnexitis) is also involved in the inflammatory process.

  According to the nature of the course of the infectious process, oophoritis can be:

  1. 1 Sharp;
  2. 2 Subacute;
  3. 3 Chronic;
  4. 4 Exacerbation of chronic salpingo-oophoritis and/or oophoritis.

  According to the etiology, inflammation can be:

  1. 1 Nonspecific. In this case, the cause of inflammation is the representatives of the normal vaginal flora of a woman (conditionally pathogenic microorganisms): Escherichia coli, Proteus, Enterococcus, Peptostreptococcus, Haemophilus influenzae, Gardnerella, etc.
  2. 2 Specific:
     • Chlamydia -.
     • Mycoplasmas -,.
     • Viruses - HSV 2, CMV, HIV.
     • Other bacteria - Mycobacterium tuberculosis, .
     • The simplest -.

  2. Etiology

  As we mentioned earlier, the cause of the disease can be a specific and non-specific infection.

  The most common pathogens are representatives of the normal microflora:

  1. 1 Staphylococci.
  2. 2 streptococci.
  3. 3 Escherichia coli.
  4. 4 Proteus.
  5. 5 and many others.

  In nonspecific inflammation, polymicrobial associations are more often found. In 15-20% of cases of oophoritis and salpingitis, the pathogen cannot be identified at all.

  With specific inflammation, most often detected (30%), (50%), Mycoplasma hominis (in 30% of cases), cytomegalovirus infection (diagnosed in 20.4% of cases).

  3. Risk factors

  There are genital, extragenital and social risk factors for oophoritis / salpingo-oophoritis.

  Genital (that is, associated with the female reproductive system) include:

  1. 1 Infections transmitted through sexual contact (including history).
  2. 3, cervical.
  3. 4 Medical and instrumental abortion.
  4. 5 Interventions involving instrumental expansion of the cervical canal (hysteroscopy, hysterosalpingography, diagnostic and therapeutic curettage of the uterine cavity).
  5. 6 Insertion of an intrauterine device within the last 6 weeks increases the risk of an inflammatory process by 2-9 times.
  6. 7 In vitro fertilization.

  Extragenital risk factors:

  1. 1 Endocrine pathology.
  2. 2 Reception of systemic glucocorticosteroids.
  3. 3 Urinary tract infections.
  4. 4 Immunodeficiency states (taking cytostatics, HIV infection).

  Social factors that increase the incidence of this pathology:

  1. 1 Chaotic sex life.
  2. 2 Change of regular sexual partner (especially during the previous 3 months).
  3. 3 Early onset of sexual life.
  4. 4 Chronic stress.
  5. 5 Non-traditional sexual contacts.
  6. 6 Forced sexual intercourse (including history).

  In pathogenesis, one can note a set of reasons that provide conditions for the onset of an infectious process.

  4. Pathogenesis

  The female urogenital tract is normally protected by several natural barriers that prevent infection from entering the overlying organs. They are:

  1. 1 Closure of the labia.
  2. 2 The acidic environment of the vagina, which is provided by lactobacilli. This requires an optimal level of nutrient substrate (glycogen) and an equilibrium state of the vaginal microflora.
  3. 3 Regular desquamation of the vaginal epithelium. When the epithelium is rejected, pathogenic microorganisms are also removed.
  4. 4 The presence in the cervical canal of cervical mucus (mucus plug), which contains mucopolysaccharides, lysozyme, immunoglobulins.
  5. 5 Desquamation of the functional endometrium according to the menstrual cycle.
  6. 6 Contraction of the muscular layer of the fallopian tubes (peristalsis) and flickering of the ciliated epithelium towards the uterine cavity also contribute to the elimination of pathogens.

  Under the influence of risk factors, natural barriers are destroyed, which leads to the penetration of infection and the reproduction of microorganisms.

  In the pathogenesis of oophoritis, both the ascending mechanism of the spread of infection and the hematolymphogenic mechanism are important.

  As mentioned above, isolated oophoritis is quite rare. In this case, the infection is most often introduced from nearby organs:

  1. 1 From the rectum and sigmoid colon with the development of left-sided oophoritis, and then salpingitis.
  2. 2 From the appendix with the development of right-sided oophoritis and salpingitis.

  The ascending route of infection is realized in the presence of risk factors, impaired function of the barriers of the urogenital tract, described above. In such cases, there is no normal elimination of the pathogen from the lower parts of the reproductive system, so the infection penetrates deeper.

  Pathogenic microorganisms begin the production of exo- and endotoxins, pathogenicity factors. Inflammation of the ovaries occurs with five classic, described by Hippocrates, signs: edema, hyperemia (redness), microcirculation disorder, dysfunction and pain syndrome.

  Very quickly, the infectious process from the ovaries passes to the fallopian tubes with the development of an adhesive process in them.

  In the presence of an active immune response to inflammation, adequate antibiotic therapy, the symptoms gradually subside, the infectious agent is eliminated and recovery occurs.

  The pathogenesis of a chronic process is distinguished by the launch of an autoimmune reaction. That is, in response to the primary introduction of the pathogen, the body is not able to provide full protection and respond with a normal immune response.

  5. Main symptoms

  Symptoms of acute oophoritis and salpingitis, as a rule, are pronounced, significantly worsen the patient's condition.

  These include:

  1. 1 Increase in body temperature up to 38C and above, symptoms of general intoxication (chills, weakness, headache).
  2. 2 Intense pain in the lower abdomen. When the right ovary is affected, they speak of right-sided oophoritis. With the localization of pain on the left - about the left side. Pain during oophoritis is quite strong, radiating to the lower back, coccyx, perineum.
  3. 3 In the presence of mucopurulent discharge from the vagina, inflammation of the fallopian tubes (salpingoophoritis) should be suspected. Pathological discharge is observed in 75% of patients with salpingitis and oophoritis.
  4. 4 Pain when urinating.
  5. 5 Expressed, its impossibility.
  6. 6 Abnormal uterine non-cyclic bleeding may be a sign of concomitant endometritis.
  7. 7 Bloating, nausea, vomiting.
  8. 8 Experts believe that acute gonococcal and chlamydial infections have more pronounced symptoms than nonspecific salpingo-oophoritis.

  With an exacerbation of a chronic process, the following symptoms are observed:

  1. 1 Increase in body temperature to subfebrile numbers (37-38 degrees), moderate intoxication (minor headache, malaise, weakness).
  2. 2 Signs of chronic oophoritis and salpingoophoritis include dull or aching pain in the lower lateral abdomen. Their irradiation to the lower back, sacrum is possible.
  3. 3 Violations (damage to the ovarian tissue leads to a violation of the full maturation of the follicle).

  Outside the acute stage, chronic oophoritis and salpingitis are asymptomatic. A woman may be disturbed by mild pains in the lower abdomen, often of a pulling nature. It is difficult for her to indicate the localization of pains, to characterize them.

  The most common complaint in women with long-term chronic bilateral oophoritis / salpingo-oophoritis is the complaint of the impossibility of conception.

  6. Diagnostic measures

  6.1. Anamnesis

  When collecting an anamnesis, it is necessary to clarify the time of onset of symptoms, their connection with any medical intervention, casual sexual contacts. The doctor will definitely ask if this is the first time a woman has experienced such symptoms.

  Of great importance is information about concomitant extragenital pathology, recently transferred infectious diseases (including ARVI).

  Competent collection of anamnesis, full provision of information by the patient allows narrowing down the range of necessary diagnostic manipulations and prescribing adequate drug therapy.

  6.2. Gynecological examination

  When examining the vagina in the mirrors are observed:

  1. 1 Pathological discharge.
  2. 2 Hyperemia of the mucous membrane, swelling of tissues.
  3. 3 Pain when installing mirrors.

  These signs are associated with concomitant colpitis and / or cervicitis. But this cannot be evidence of damage to the overlying structures of the urogenital tract.

  According to the latest European, American, Russian recommendations, reliable minimum diagnostic criteria for a bimanual examination are:

  1. 1 Pain during palpation of the appendages on the side of the lesion (on the right - with the right-sided, on the left with the left-sided, on both sides - with bilateral oophoritis).
  2. 2 Pain when the cervix is ​​displaced.
  3. 3 In an acute inflammatory process, a bimanual examination is usually difficult due to the sharp pains that occur and the natural resistance of the woman. But if the examination was successful, then the doctor will find edematous, compacted, enlarged ovaries.
  4. 4 In a chronic process, pain on palpation is not so intense, so examination is possible. Adnexa of the uterus are somewhat painful on palpation, taut, dense to the touch. It is possible to identify rounded formations in the area of ​​​​the appendages (hydrosalpinx, tubo-ovarian formations).
  5. 5 One of the signs of the adhesive process is the retroposition of the body of the uterus (Russian national recommendations, 2015).

  6.3. Pregnancy test

  One of the diagnostic methods necessary for adequate differential diagnosis of oophoritis and salpingoophoritis is a pregnancy test. Ectopic (tubal, ovarian, abdominal) pregnancy can occur with similar clinical symptoms. The pregnancy test must be negative.

  6.4. Microscopic smear on flora

  The results may indicate the presence of:

  1. 1 Specific inflammation - if present in a smear or.
  2. 2 Nonspecific inflammation - with an increase in the number of leukocytes in the smear (10 or more) and predominance over rod.
  3. 3 - if there are "key cells" in the smear.

  6.5. Clinical and biochemical blood tests

  The results of the KLA may indicate the presence of an inflammatory process in the body:

  1. 1 increase in the level of leukocytes;
  2. 2 increase in ESR;
  3. 3 increase in the level of C-reactive protein.
  4. 4 violation of protein balance (dysproteinemia) with a predominance of globulins (a sign of acute inflammation).

  6.6. Seeding the contents of the cervical canal

  With bakposev of the contents of the cervical canal, it is possible to detect the causative agent of the infectious process and assess its sensitivity to antibacterial drugs.

  6.7. PCR diagnostics

  The contents of the vagina and cervical canal is the most sensitive and specific method for assessing not only the qualitative, but also the quantitative composition of the flora.

  This diagnostic method is relevant in the presence of latent infections (chlamydia, mycoplasmosis, viral infections). It is these pathogens that are often the cause of chronic oophoritis and salpingo-oophoritis.

  6.8. Ultrasonography of the pelvic organs

  Ultrasound criteria for inflammation in the ovaries and fallopian tubes are:

  1. 1 The presence of fluid in the retrouterine space (with chronic oophoritis, the study is carried out only from 4 to 11 days of the menstrual cycle).
  2. 2 Presence of fluid in the fallopian tubes.
  3. 3 Thickening of the fallopian tubes.
  4. 4 Enlargement of the ovary.
  5. 5 Visualization of tubo-ovarian formation, abscess.

  With ultrasonography, the blood supply to the ovaries and fallopian tubes is also assessed using dopplerometry. The presence of pathology is indicated by an increase in their blood supply due to vasodilation against the background of an inflammatory reaction.

  6.9. Laparoscopy

  Diagnostic laparoscopy is the most informative, but at the same time the most invasive and expensive method for verifying oophoritis and salpingitis. When it is carried out under general anesthesia, a laparoscope is inserted into the abdominal cavity, which allows visualization and assessment of the state of the pelvic organs.

  With laparoscopy, removal of tubo-ovarian formations, chromohydrotubation (assessment of the viability of the fallopian tubes with a liquid), assessment of the condition of the ovaries, detection and, if possible, dissection of adhesions are possible.

  As already mentioned, this procedure is a full-fledged operation and is more often performed either in inflammatory processes that do not respond to long-term conservative therapy, or if there are indications for emergency surgical intervention.

  7. Treatment tactics

  The main goals of oophoritis treatment are:

  1. 1 Complete elimination of the pathogen.
  2. 2 Prevention of process chronization (with acute oophoritis).
  3. 3 Elimination of pain syndrome.
  4. 4 In case of exacerbation of a chronic process - its relief and achievement of remission.
  5. 5 In chronic asymptomatic course - prevention of complications.

  The severe course of the disease with severe intoxication, the lack of effect of outpatient treatment are indications for hospitalization (CDC Sexually Transmitted Diseases Treatment Guidelines, 2015).

  The ineffectiveness of conservative therapy in the hospital after 72 hours is an indication for surgical intervention (level of evidence - IIC).

  At the moment, the following regimens for the use of antibacterial drugs are recommended for the treatment of oophoritis and salpingo-oophoritis (see Table 1).

  

  Table 1 - Schemes for the use of antibiotics for oophoritis and salpingo-oophoritis according to Russian clinical protocols and CDC recommendations. Expand the table to view

  The main principles that any of the above treatment regimens must meet are:

  1. 1 Assigned empirically combinations of antibacterial drugs should have a wide spectrum of action and be active against all possible pathogens.
  2. 2 Empiric antibiotic therapy is prescribed only for acute inflammatory process, for chronic oophoritis, treatment is prescribed only according to the results of bacteriological examination and PCR.
  3. 3 Exacerbation of chronic oophoritis is treated according to the same principles as the acute process, with the appointment of empirical antibiotic therapy.
  4. 4 All patients should be screened for sexually transmitted infections, including HIV (LE-IVC).
  5. 5 Patients with mild and moderate forms of the course of the disease can be treated on an outpatient basis, subject to strict adherence to all doctor's recommendations.
  6. 6 In the treatment of oophoritis, the use of local forms of drugs (suppositories, vaginal tablets) is ineffective. Vaginal suppositories and ovules are used only in the presence of concomitant colpitis, cervicitis or bacterial vaginosis.
  7. 7 If allergic reactions occur to injectable drugs, discontinue use immediately and switch to one of the alternative regimens (Evidence level Ib, A).
  8. 8 In the absence of positive dynamics against the background of ongoing therapy within 72 hours, the treatment regimen should be changed.

  Evaluation of the effectiveness of the therapy for acute oophoritis is performed 72 hours after the start of treatment. By this time, the results of bacteriological examination, the sensitivity of the identified microorganisms to the prescribed antibacterial drugs are retrospectively evaluated.

  It must be remembered that with oophoritis, treatment at home with folk remedies and non-traditional methods is unacceptable!

  Without etiotropic treatment, the disease can be complicated by tubo-ovarian abscess, pelvioperitonitis, and infertility. Other complications, including chronic pelvic pain, ectopic pregnancy, tubal infertility (TFI), and IVF failure, may occur in up to 25% of patients with salpingitis and oophoritis.

  8. Oophoritis and pregnancy

  The most common question in women suffering from the disease concerns the possibility of becoming pregnant. The onset of pregnancy is quite possible with any form of inflammation.

  However, oophoritis reduces the likelihood of natural fertilization of the egg. We wrote above that the altered ovary is not able to ensure the full maturation of the follicles and effective ovulation.

  At the stage of pregnancy planning in women with chronic oophoritis, it is important:

  1. 1 Determine the likely causative agent of the disease and achieve its elimination with antibiotics.
  2. 2 Eliminate concomitant extragenital pathology.
  3. 3 Be examined for sexually transmitted infections (both the woman and her partner). If an STI is detected, both partners are treated.
  4. 4 Make sure the normal patency of the fallopian tubes, normal ovulation.

  9. Prevention

  According to European, American and Russian recommendations, one of the main links in the prevention of pathology is the protection of women from genital infections. It implies:

  1. 1 use of condoms;
  2. 2 having a permanent sexual partner;
  3. 3 trusting, close relationship with a partner;
  4. 4 examination for sexually transmitted infections at least once a year.

  In addition, it is necessary:

  1. 1 follow the rules of personal hygiene;
  2. 2 use individual underwear, especially in crowded places (saunas, swimming pools, water parks, etc.);
  3. 3 wear comfortable underwear made from natural fabrics;
  4. 4 immediately contact a specialist if any pathological discharge from the genital tract, pain in the lower abdomen and other signs of PID appear.

In the system of gynecological diseases, oophoritis refers to inflammatory diseases that affect the gonads and the genitourinary system. Poses a serious threat to women's reproductive function.

In medicine, this term is used quite widely - it is applied to pathologies that occur in the form of inflammatory processes, but neither pathologically nor etiologically have anything in common with inflammatory processes.

Inflammatory reactions in the female gonads can develop due to the action of specific pathogens (caused by chlamydia, vaginal trichomonas, mycoplasma or mycobacterium tuberculosis), and against the background of non-specific microorganisms (streptococcal, staphylococcal, due to eschirechia and condid fungi).

Oophoritis does not belong to the idiopathic (independent) form of diseases, the localization of the ovaries makes it impossible for the primary penetration of infectious pathogens into them.

The infection enters the ovaries from the body of the uterus, its isthmus and fallopian tubes. Sometimes this can occur by endogenous drift (through the lymphatic vessels) or hematogenous route (through the blood).

Many factors influence the development of ovarian oophoritis:

• cyclic physiological process (menstruation);
• hypothermia (cold effect);
• surgical and diagnostic procedures;
• artificial abortions;
• intrauterine contraceptives.

The active development of oophoritis is facilitated by:

• endocrine pathologies;
• the presence of chronic infections;
• exhaustion of the body and psychological stress;
• disorderly intimate life (promiscuity);
• unprotected sexual intimacy;
• nicotine addiction.

The clinic of oophoritis is manifested - acute, subacute and chronic course, with symptoms characteristic of a certain phase.

Acute oophoritis

The acute form of inflammatory reactions in the sex glands is manifested by a violation of their functions, swelling and enlargement of the gland.

The uterine fallopian tubes undergo pathological processes, they are soldered to the gonads, forming a single inflamed conglomerate. The process causes tissue fusion of the ovary and the release of a purulent secret from the fallopian tube.

The characteristic symptoms of oophoritis of this form are manifested:

• the development of intoxication in the body;
• smearing purulent vaginal discharge and constant pain in the lower abdomen;
• hyperthermia, fever and lethargy;
• irritability and dislike for sexual intimacy;
• dysfunction of the gastrointestinal tract;
• pain in the outflow of urine;
• muscle and headaches;
• dysfunctional uterine bleeding.

Treatment should take place in a hospital.

Subacute oophoritis

Signs of subacute oophoritis are manifested due to infection with mycoplasmosis or Mycobacterium tuberculosis.

Symptoms are similar to the acute form of manifestation, but have an erased picture. Pathology not treated in time takes a chronic course with periods of remission and exacerbation, complicating treatment.

Chronic oophoritis

The manifestation of chronic oophoritis is promoted by a weakened immune system of a woman. A scenario of the course of the disease without any particular exacerbations and symptoms is possible, when the ovaries are affected by a gonorrheal infection, causing damage to the germinal epithelial tissue of the ovaries with the formation of an adhesive process around them.

Over time, scar tissue forms in the fallopian tubes, obstruction of the tubes and infertility develop. With an exacerbation, typical signs for this form of the disease are added to the already existing symptoms:

• there is a dependence of dull, aching pains in the groin area and in the lower abdomen - they intensify before menstruation, with colds and hypothermia;
• the cycle of menstruation is disturbed;
• there is a copious discharge of leucorrhoea;
• there is no possibility of pregnancy.

Localization of inflammatory reactions

According to the prevalence of the disease, inflammatory reactions in the ovaries are characterized by left / right-sided localization or bilateral ovarian lesions.

- inflammatory reaction processes in the ovaries develop on one side of the abdominal cavity. More often they are the result of gynecological diseases of an infectious nature, medical procedures and manipulations.

Develop under the influence of stress, prolonged hypothermia, with weakened immunity.

Clinical signs are characterized by:

• prolonged subfebrile fever that does not respond to the action of antipyretics;
• localization of pain in the lower peritoneum according to the side of localization;
• the appearance of vaginal leucorrhoea and acyclic bleeding;
• all this is accompanied by irritability and disorder of sexual functions.

Signs of a right-sided lesion are similar to those of appendicitis. With the spread of the inflammatory process from one sex gland to another, bilateral oophoritis develops.

Development clinic with bilateral localization characterized by a strong pulsating pain syndrome in the lower peritoneum and inguinal areas, with frequent irradiation to the sacral region and lower back.

Symptoms of the disease are similar to unilateral localization, but appear according to the clinic, corresponding to an acute or chronic course.

In the chronic course, the symptoms are less pronounced, but this form of the disease is more dangerous, as it contributes to the functional impairment of the sex glands and the development of infertility.

The tactics of treating oophoritis is compiled according to the form of manifestation of inflammatory reactions. Acute and subacute form should be treated in a hospital. Ice compresses are applied to the affected area.

As a drug therapy, oophoritis is treated with drugs that provide:

1. analgesic and antimicrobial action;
2. drugs that suppress the concentration of inflammatory neurotransmitters;

Appointed:

• vitamin and mineral complexes;
• electromagnetic radiation (UV);
• autogenotherapy and biogenic stimulants;
• multivitamins;
• cleansing the body - detoxification;
• injection therapy that contributes to the body's resistance.

Treatment of oophoritis with antibiotics is carried out with exudation or purulent tubo-ovarian tumor formations in the tubes of the uterus and the pelvic cavity. The focus is punctured - exudate or pus is sucked off, and antibiotics and chymotrypsinogens are injected.

In chronic oophoritis, treatment therapy is prescribed according to the indicators of clinical symptoms. The basis of therapy is physiotherapy.

1) In case of exacerbation of chronic inflammation, physiotherapy is prescribed by exposure to magnetic fields, and microwave therapy. With a small exudation - therapy with high-frequency currents.

2) With severe pain symptoms, a physiotherapeutic method of administering drugs using electrophoresis, UV therapy procedures is used.

3) With the predominance of adhesive processes, the treatment is based on the use of pulsed ultrasonic radiation, inductothermoelectrophoresis and inductotherapy. Consolidate the results with sanatorium treatment.

Chronic inflammation of the gonads and pregnancy, a completely unacceptable situation. The very fact of having a disease reduces a woman's ability to become a mother.

After all, the hormonal background of a woman, the ability of the full maturation of the egg and the possibility of its fertilization depend on the normal functioning of the sex glands.

Chronic inflammatory processes provoke changes in the functions of the ovaries, adversely affecting the course of pregnancy and the outcome of delivery.

Sometimes a latent, asymptomatic form of the disease can make itself felt precisely during this period, when there is a functional decrease in the woman's immune defense against the background of an additional load on the body.

An undiagnosed and untreated pathology before the moment of conception can provoke:

• spontaneous miscarriage, against the background of hormonal disorders;
• tubal development of the fetus, when the pathology is combined with inflammation of the fallopian tubes - the formation of adhesions and scar tissue in them prevents the egg from passing into the uterus and fertilization occurs in the fallopian tube;
• infection of a child from infectious foci of a woman, both in the embryonic period and during childbirth.

During pregnancy, full-fledged treatment is impossible, since many methods and drugs are contraindicated in this period. Therefore, it is necessary to treat the disease before pregnancy.

Oophoritis: complications

The most common complications of inflammatory processes of the female gonads are manifested:

1. disorders of the digestive system - various intestinal diseases.
2. Various forms of pathologies of the urinary system - cystitis, pyelonephritis, etc.
3. Endocrine disorders and signs of deterioration in the functions of the central nervous system.
4. Violation of the cycle, delay and soreness of menstrual flow.
5. , tubal pregnancy and infertility.

Classification of oophoritis according to ICD 10

General section: N00-N99 - Diseases of the genitourinary system

Class N70 - Salpingitis and oophoritis

• N70.0 Acute salpingitis and oophoritis
• N70.1 Chronic salpingitis and oophoritis
• N70.9 Salpingitis and oophoritis, unspecified

The term oophoritis is derived from the Greek word oophoron, meaning ovary, and the ending -itis, meaning inflammation. Thus, oophoritis is an inflammatory disease of the ovaries. Most often, not only the ovary is affected, but also the fallopian tube adjacent to it. This condition is called "salpingoophoritis", or "adnexitis". Isolated inflammation of the ovary usually develops against the background of appendicitis.

Causes and mechanism of development

Oophoritis is caused by microorganisms, mainly streptococci, staphylococci, gonococci, Escherichia coli, and Mycobacterium tuberculosis, as well as nonspecific anaerobic pathogens. Most often, they enter the appendages ascending from the vagina through the uterine cavity and tubes. Rarely, the spread of infection through the blood and lymphatic vessels from other organs is recorded. This path is most typical for causative agents of tuberculosis. Microbes enter the vagina and uterine cavity most often during abortion and other manipulations, including when using intrauterine contraception.

It has been proven that the main cause of oophoritis are the causative agents of gonorrhea and chlamydia - sexually transmitted diseases.

Risk factors for this disease are chronic stress, alcoholism, malnutrition, promiscuity, early onset of sexual activity. Increase the risk of developing the disease diabetes mellitus, obesity, anemia, urinary tract infections.

Factors in the development of chronic oophoritis are endogenous intoxication and a secondary decrease in the activity of the immune system that occurs during a protracted course of acute inflammation. Violations of microcirculation and rheological properties of blood are important.

Violation of the hormonal function of the ovaries leads to an imbalance of the entire regulatory system of a woman. As a result, hormonal disorders occur, in particular, hyperestrogenism.

When acute inflammation becomes chronic, autoimmune mechanisms become important. The body begins to produce antibodies against ovarian tissue. Such disorders, especially in combination with chlamydia, lead to depletion of the ovarian reserve. At the same time, prospects as a method of infertility treatment are sharply reduced.

Clinical picture

Gonococci, chlamydia, mycobacterium tuberculosis often cause bilateral oophoritis, and staphylococci, streptococci and Escherichia coli cause a unilateral process.

The clinical course of oophoritis is determined by the causative agent of the disease and the strength of the woman's immunity, as well as the effectiveness and timeliness of treatment. Distinguish between acute and chronic course of the disease.

Acute oophoritis

It is manifested by severe pain in the lower abdomen and in the sacral region, often radiating (“giving off”) to the rectum. Nausea, vomiting, bloating, and constipation often occur. In many cases, there is an increase in body temperature up to 39 ° C, headache, weakness. There are purulent or sanious-purulent discharge from the cervical canal.

Examination reveals pain in the lower abdomen. With the spread of inflammation to the peritoneum, tension of the abdominal muscles appears, a positive symptom of Shchetkin-Blumberg. With a two-handed examination, enlarged, sharply painful appendages can be felt. Nonspecific "inflammatory" changes are observed in the blood - leukocytosis with a shift to the left, an increase in the erythrocyte sedimentation rate.

Similar symptoms persist for up to 10 days, after which the process ends with recovery or passes into the chronic stage.

Complications of acute oophoritis - pelvioperitonitis, abscess in the recto-uterine cavity, pyosalpinx. All these conditions cause a sharp deterioration in the patient's condition and require immediate treatment.

Chronic oophoritis

It can be an acute outcome or from the very beginning have a long course with alternating episodes of remission and exacerbation. The transition of acute inflammation to the chronic form is facilitated by improper treatment, a decrease in the reactivity of the body, and the high pathogenicity of the pathogen. Exacerbation usually occurs 3-5 times a year.

Chronicization is accompanied by inflammatory infiltration of the ovaries and tubes, the development of connective tissue in them, the formation of hydrosalpinx (accumulation of fluid in the fallopian tube). The blood supply to the ovaries weakens, dystrophic changes develop in them, as a result, estrogen production is significantly reduced.

During the period of remission, a woman may not be bothered by anything. Sometimes there are aching pains in the lower abdomen, in the inguinal region, radiating to the rectum and sacrum. The pain syndrome is most often caused by the formation around the ovaries and fallopian tubes. The adhesive process is one of the causes of oophoritis. Women are concerned about irritability, insomnia, depression, autonomic disorders. Premenstrual syndrome is characteristic (intensification of emotional and autonomic disorders, the appearance of pain before the onset of menstruation).

Menstrual bleeding may become heavy and prolonged (menorrhagia). There are also intermenstrual bleeding (metrorrhagia). Tuberculous lesions are characterized by scanty or absent periods (amenorrhea).

In half of the patients, sexual function is disturbed: sexual desire is lost, anorgasmia develops, and pain occurs during intercourse.

The exacerbation is provoked by hypothermia, overwork, and other non-specific adverse factors. Signs of oophoritis become more pronounced, the general condition worsens, fever appears. Often there are mucopurulent discharge from the genital tract. The exacerbation usually lasts for several days.

During the remission period, a gynecological examination determines a slight increase, moderate soreness of the appendages, and limitation of their mobility. During an exacerbation, the appendages are greatly enlarged and painful.

Diagnostics

The diagnosis is made on the basis of the anamnesis (history) and symptoms of the disease. An additional diagnostic method is the pelvic organs and. In doubtful cases, diagnostic laparoscopy is possible - examination of the uterus and appendages using an endoscope through a puncture in the abdominal wall. The latter method is the most informative in the diagnosis of oophoritis and its complications.

Examine the microflora of the cervical canal and vagina. Help in the diagnosis of serological blood tests for chlamydia. If a tuberculous lesion is suspected, the diagnosis is carried out in an anti-tuberculosis dispensary. It includes diagnostic curettage, menstrual blood cultures for mycobacteria, tuberculin tests, metrosalpingography and other methods.

It is necessary to examine the sexual partner, since in most cases the cause of oophoritis is a sexually transmitted disease.

Differential diagnosis is carried out with tubal pregnancy, appendicitis, ovarian apoplexy, ovarian cyst rupture. It must be remembered that a combination of appendicitis and right-sided oophoritis is possible. Therefore, when clinical symptoms of the disease appear, the patient should be examined by a surgeon.

Treatment

Treatment goals:

• elimination of the pathogen;
• pain relief and inflammation control;
• prevention of exacerbations and complications;
• restoration of the altered function of the genital organs;
• correction of violations of the work of other organs.

Treatment of oophoritis can be carried out in a hospital or on an outpatient basis, depending on the severity of the disease. The main indications for hospitalization:

• fever above 38˚C;
• inflammatory tubo-ovarian formation;
• pregnancy;
• the presence of an intrauterine device;
• unidentified diagnosis;
• no effect within 2 days of outpatient therapy.

In acute illness and exacerbation of the chronic process, bed rest, a sparing diet, and ice on the lower abdomen are prescribed.

The main drugs for the treatment of oophoritis are broad-spectrum antibiotics that affect the main possible types of pathogens. The most commonly prescribed inhibitor-protected penicillins, III generation cephalosporins, fluoroquinolones, aminoglycosides, lincosamides, macrolides, tetracyclines. The drug of choice is azithromycin in combination with a cephalosporin. However, depending on the change in the sensitivity of microbes, the choice of drugs may be different. In many cases, it is advisable to combine the listed drugs with metronidazole, which is effective against anaerobic pathogens.

The duration of antibiotic therapy depends on its effectiveness and usually ranges from 7 to 14 days. The drugs can be administered in the form of tablets or parenterally.

With severe fever, deterioration of the general condition, detoxification therapy is carried out. The treatment regimens include non-steroidal anti-inflammatory drugs, antihistamines, immunomodulators, vitamins, probiotics, antifungal drugs. In severe cases, it is possible to use extracorporeal detoxification methods (plasmapheresis).

If there is no effect of treatment within 48 hours, the issue of laparoscopy is decided. This intervention allows you to clarify the diagnosis, drain the pelvic cavity, remove the contents of the tubo-ovarian formation. Severe complications of oophoritis (peritonitis) serve as an indication for laparotomy.

During the period of remission of chronic oophoritis, antibiotics are not prescribed. The basis of therapy at this time are restorative measures and vitamin therapy. Physiotherapy for oophoritis occupies an important place in the treatment of the chronic form of this disease. It includes ultrasound, impulse currents, magnetic field, mud therapy, ozocerite, paraffin. Mineral waters are used in the form of baths or vaginal irrigations. Massage of the abdomen and lower back is used, especially with pain syndrome.

Hormonal disorders are corrected with the help of combined oral contraceptives.

With hyperestrogenism, radon baths, electrophoresis of zinc or iodine are prescribed. Against the background of hypoestrogenism, copper electrophoresis and high-frequency pulsed currents will help better.

Infertility resulting from chronic oophoritis may be an indication for laparoscopic separation of adhesions in the abdominal cavity. In women over 35, the main treatment is in vitro fertilization. Its capabilities are often limited due to damage to the ovarian tissue and depletion of the ovarian reserve.

If oophoritis is a sign of gonorrhea or chlamydia, it is imperative to treat the woman's sexual partner.

Forecast and prevention

In an acute uncomplicated process, the prognosis is usually favorable, the disease ends in recovery. The most common complication is pioovar, or ovarian abscess. This condition requires surgical treatment.

Patients are often interested in the question of whether it is possible to become pregnant with chronic oophoritis. This disease can cause infertility due to the formation of adhesions in the pelvic cavity, as well as due to a decrease in ovarian reserve - healthy ovarian tissue that contains eggs. In addition, the risk increases. According to some data, the frequency of infertility reaches 18% even after a single acute salpingo-oophoritis. In a chronic disease, infertility is already found in 70% of patients.

Persistent infertility is most often caused by tuberculous oophoritis.

Prevention of the disease includes the prevention of abortion, the correct conduct of intrauterine interventions. To avoid exacerbation of oophoritis, a woman should avoid overwork, hypothermia, heavy physical exertion.