What happens during inflammation
The infection most often rises from below: from the vagina and cervix through the uterine cavity into the tubes, and then to the ovaries and peritoneum of the small pelvis. Therefore, cervicitis and bacterial vaginosis often precede adnexitis.
The inner surface of the fallopian tube is lined with delicate epithelium with cilia that promote the egg. Inflammation damages this epithelium, and when healing occurs, adhesions and scars form. The tube may remain patent, but lose its ability to properly transport the egg.
It is this mechanism that explains two key consequences: tubal infertility and an increased risk of ectopic pregnancy. Moreover, an ectopic pregnancy is possible even with a formally patent tube - due to impaired functioning of the cilia.
Causes and risk factors
- Chlamydia and gonococcus are the leading pathogens
- Mycoplasma genitalium
- Opportunistic and anaerobic flora, often in combination
- Bacterial vaginosis and untreated cervicitis
- Intrauterine interventions: abortion, curettage, hysteroscopy
- Insertion of an intrauterine device, especially for undetected infection
- Childbirth and postpartum complications
- Changing sexual partners and unprotected contacts
- Young age
- Douching
- Hypothermia as a provoking factor against the background of an existing infection
- Appendicitis and inflammatory processes in the intestines - contact path
Symptoms
- Pain in the lower abdomen, usually on both sides, less often on one
- Fever, chills
- Purulent or copious discharge from the genital tract
- Pain during intercourse
- Pain when urinating
- Bloody discharge between periods
- Menstrual irregularities
- Nausea, weakness, bloating
- In the chronic course - constant aching pain, worsening after hypothermia, stress, menstruation
- Sometimes - an erased picture with minimal complaints, especially with chlamydial infection
Complications
- Adhesions in the fallopian tubes and pelvis
- Tubal infertility - the risk increases with each episode experienced
- Ectopic pregnancy
- Chronic pelvic pain
- Hydrosalpinx - accumulation of fluid in a pipe
- Tuboovarian abscess is a purulent formation that requires surgery
- Pelvioperitonitis - spread of inflammation to the peritoneum
- Fitz-Hugh-Curtis syndrome - adhesions around the liver with pain in the right hypochondrium
- Recurrent course
Diagnostics
- Examination by a gynecologist - pain with displacement of the cervix and in the area of the appendages
- Flora smear and microscopy
- PCR for chlamydia, gonococcus, mycoplasma genitalium, trichomonas
- Complete blood count, CRP - assessment of inflammatory activity
- Ultrasound of the pelvic organs - thickened tubes, fluid in the pelvis, tubo-ovarian formations
- A pregnancy test is required to exclude an ectopic
- General urine test to rule out urinary tract infection
- Puncture of the posterior vaginal fornix if purulent contents are suspected
- Diagnostic laparoscopy - with an unclear picture and suspicion of an abscess
- Examination and treatment of a partner when an STI is detected
Treatment
- Antibacterial therapy started as early as possible is a key factor in maintaining tubal patency; the scheme covers chlamydia, gonococcus, and anaerobic flora
- Hospitalization for severe symptoms, high fever, pregnancy, suspected abscess
- Painkillers and anti-inflammatory drugs
- Infusion therapy for intoxication
- Mandatory treatment of sexual partners for STIs
- Sexual rest for the period of treatment
- Removal of the intrauterine device due to its role in the development of inflammation - according to the doctor’s decision
- Laparoscopy with sanitation and drainage for tubo-ovarian abscess
- Separation of adhesions in a chronic process - according to indications
- Physiotherapy and rehabilitation treatment after acute inflammation subsides
- Control examination and assessment of tubal patency when planning pregnancy
Prevention
- Using a condom when having contact with a new or non-regular partner
- Regular screening for sexually transmitted infections
- Timely treatment of vaginitis and cervicitis
- Screening for infections before IUD insertion and intrauterine interventions
- Avoiding douching
- Reliable contraception to prevent abortions
- Immediate treatment for lower abdominal pain with fever
- Complete completion of the prescribed course of treatment, rather than stopping when it improves
Where is treatment in Tashkent
An examination by a gynecologist, ultrasound, laboratory diagnostics and the possibility of inpatient treatment are required, and in case of complications, laparoscopy.
In Tashkent, such care is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have pain in the lower abdomen with a fever, do not wait until Monday and do not warm your stomach. With this disease, the days count, and the cost of delay is the patency of the fallopian tubes. Clinic contacts are below.
