Adnexitis: symptoms and treatment, causes

What is it - adnexitis is an inflammatory process that affects the appendages of the uterus( ovaries and fallopian tubes).

Isolated ovary damage( oophoritis), or fallopian tubes( salpingitis) is extremely rare, as these organs are located next to each other and have a common blood supply.

The disease can occur in acute and chronic form.

Causes of adnexitis

Adnexitis can develop as a result of the following causative factors:

1. 1) Activation of its own opportunistic microflora that occurs against the background of a decrease in the immunity of
   
2. 2) Infection with pathogenic microorganisms
   
3. 3) A change in the immune reactivity of the organism that leads to an autoimmune lesion of the appendagesuterus( autoimmune oophoritis).

Infection with pathogenic microorganisms occurs in the following ways:

• genital
  
• ascending( from lower genitalia)
  
• hematogenous skid from other organs.

Conditionally pathogenic microorganisms that lead to the development of adnexitis are the following:

• streptococci
  
• staphylococci
  
• Klebsiella
  
• E. coli
  
• Proteins
  
• Pseudomonas aeruginosa
  
• candida and others.

Pathogenic microorganisms that are most often secreted with adnexitis are:

• gonococci
  
• Trichomonads
  
• chlamydia
  
• mycoplasmas
  
• ureaplasms
  
• herpes viruses, etc.

Thus, the infectious-dependent inflammation of the uterine appendages can be bacterial, viral and fungal. All this the doctor takes into account when carrying out antimicrobial therapy.

Symptoms of adnexitis

Symptoms of acute adnexitis are most striking as opposed to chronic. This causes women not to delay the visit to the gynecologist.

The main clinical picture data that allow the diagnosis of acute adnexitis, are the following symptoms:

• pain in the lower abdomen that can give in the foot, rectum
  
• pain while conducting sexual activity
  
• body temperature increase
  
• weakness and malaise
  
• discharge from the genitalpathways with an unpleasant odor
  
• presence of intermenstrual bloody discharge or profuse menstruation, etc.

Based on clinical manifestations, the physician prescribes a preliminary diagnosis and then performs a vaginal examination.

In acute adnexitis it is characterized by the following symptoms:

• enlargement of the uterine appendages
  
• their soreness
  
• the pasty in this area
  
• tractions( movements) beyond the cervix are sensitive.

Chronic adnexitis in the absence of exacerbation of the inflammatory process proceeds almost asymptomatically. However, the appendages of the uterus are a hotbed of a chronic infection, which at any time can worsen. Clinically, this is manifested by symptoms that are characteristic of acute adnexitis.

A prolonged course of the inflammatory process in the uterine appendages leads to the development of infertility. Its pathogenetic basis is as follows:

1. 1) Obstruction of the fallopian tubes
   
2. 2) Reduction of the ovarian reserve( reduces the number of follicles in the ovaries)
   
3. 3) Thickening of the ovary's white shell, which makes it impossible for the egg to leave the follicle.

Diagnosis

Diagnostic search for adnexitis addresses the following issues:

• confirmation of inflammation in the appendages of the uterus
  
• finding out the cause of the disease.

In order to diagnose the presence of adnexitis, the following studies are needed:

• vaginal examination
  
• ultrasound, including sonography( increasing the visualization ability of ultrasound with the help of special solutions)
  
• diagnostic laparoscopy.

Effective treatment is possible only after establishing the exact cause of the disease. For this purpose, diagnostic tests such as:

• polymerase chain reaction or detection of antibodies to causative microorganisms
  
• immunogram for assessing the state of immunity, as well as for verification of autoimmune disorders
  
• , bacteriological examination from the cervical canal with the determination of sensitivity to antibiotics are indicated.

Treatment of adnexitis

Treatment of adnexitis depends on the pathogenetic form of the disease and on the nature of its course. From this point of view, the following treatment schemes can be distinguished in principle:

• treatment of autoimmune oophoritis
  
• treatment of infectious-inflammatory acute adnexitis
  
• treatment of infectious-inflammatory chronic adnexitis.

In the autoimmune lesion of the uterine appendages( the immune system begins to damage the body's own cells), the treatment is aimed at suppressing this inflammatory process. For this, the following are used:

• glucocorticosteroids( hormonal anti-inflammatory drugs)
  
• vitamin preparations
  
• combined oral contraceptives.

Acute adnexitis is treated according to the following rules:

• Antibacterial or antiviral therapy depending on the causative microorganism that caused the development of the inflammatory process
  
• use of non-steroidal anti-inflammatory drugs
  
• vitamins.

In the presence of chronic adnexitis, the role of the etiologic microorganism goes to the background. The first place in pathogenesis is assigned to pathological inflammatory reactions, which are not aimed at destroying microorganisms, but on damage to the ovarian tissue.

Therefore, the treatment of chronic adnexitis is fundamentally different from the treatment of acute adnexitis. It looks like this:

1. 1) Antimicrobial therapy is justified only if etiotropic treatment of acute adnexitis has not been performed, or if there is a significant increase in body temperature
   
2. when exacerbating 2) The main place in conservative therapy is immunostimulating therapy, which allows normalizing the workimmune system
   
3. 3) Use of non-steroidal anti-inflammatory drugs.

Surgical treatment of adnexitis is carried out only in case of development of certain complications. It is indicated in the following cases:

• intraperitoneal bleeding with rupture of the cyst or hydrosalpinx
  
• tubo-thoracic tumor
  
• large cyst
  
• pyosalpinx - purulent ovary duct injury.

In the case when the pathological process was not detected in time and effective treatment was not carried out, a number of complications develop. They pose a threat to both women's overall health and reproductive health. The main complications are as follows:

1. 1) Formation of tubo-ovarian tumors( they consist of the fallopian tube, ovary and a number of located organs in which purulent inflammation develops)
   
2. 2) Infertility
   
3. 3) Inflammatory ovarian cyst
   
4. 4) Hydrosalpinx - fluid accumulation in the uteruspipe with possible suppuration( pyosalpinx)
   
5. 5) Cyst and / or hydrosalpin rupture with development of intra-abdominal bleeding.

How to avoid disease?

Preventive measures for adnexitis are as follows:

• adherence to the rules of genital care( personal hygiene)
  
• condom use for casual sexual relations
  
• in the presence of a single sexual partner it is necessary to give preference to combined contraceptives providing rest to the ovaries
  
• regular visit to the gynecologist
  
• timely diagnosis of the presence of urogenital infections in the body and, if necessary,treatment.

In conclusion, it should be noted that adnexitis is a common pathological process in the practice of a gynecologist. The disease can lead to the development of serious complications.

Therefore, it is required to diagnose it in a timely manner in order to carry out targeted treatment that will avoid negative consequences.

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