Acute inflammatory diseases of the internal genital organs

Inflammatory processes of the pelvic organs (uterus, appendages, peritoneum) are the most common gynecological diseases. Over half of the women seeking help in the women's consultation suffer from inflammation of the internal genitalia, and about 50 % of them require inpatient treatment. In the structure of gynecological hospital diseases, specialized in the provision of emergency medical care, this pathology ranges from 17.8% to 28%, according to our data - 21.6%.

Constantly encountering in their work with such patients, practical doctors should have a clear idea that at present, thanks to the development of new diagnostic methods, the ideas of inflammation pathogens, the state of reactivity of the macroorganism and, consequently, the features of the course and effectiveness of treatment of the disease .

The spectrum of the microbial flora that causes inflammatory processes in the female genitalia is very diverse. The gonococcal infection has not lost its meaning. According to foreign authors, in different regions of the world gonococcus was isolated in 5-65% of women suffering from acute salpingitis.

As before, the role of staphylococci and Escherichia coli is significant. Staphylococcus can be sown from the abdomen in 14.8 %, E. Coli in 8.9% of cases. In recent years, the proportion of non-spore-forming anaerobic flora has significantly increased: the frequency of detection of such flora exceeds 40%. The results of studies by foreign authors indicate the undoubted role of Chlamydia infection in the emergence of not only chronic but also acute forms of inflammatory diseases of the female genital organs: cultural or serological studies confirm the presence of C. Trachomatis in 18-46% of cases. Inflammatory diseases of the pelvic organs can cause Mycoplasma hominis and Ureaplasma urealyticum. The specific weight of mycoplasmal inflammations is 10-15%.

The information given does not exhaust all possible etiological agents leading to inflammatory diseases of the internal genital organs. It is not so rare cases of protozoal and viral infections, there are cases of actinomycosis of the appendages. Endometritis and salpingitis most often cause the following types of microorganisms: gonococci, chlamydia, aerobic and anaerobic streptococci and staphylococci, mycoplasmas, E. Coli, enterococcus, proteus, bacteroides, mycobacterium tuberculosis and actinomycetes.

Domestic and foreign authors unanimously emphasize that in modern conditions the mixed flora, including the association of aerobes and anaerobes, and also the gonococcus, which is often combined with chlamydial infection, often leads to the development of inflammatory processes.

Penetration of infection in the upper parts of the genital apparatus often occurs ascending way from the vagina and cervix. Similarly, an exogenous sexually transmitted infection (the so-called vector-borne diseases) spreads: gonorrhea, chlamydia, mycoplasmosis, viral and protozoal infections. In the same way, representatives of the endogenous microflora, vegetating in the vagina, can penetrate into the uterus and its appendages.

According to modern ideas, in patients and healthy women who live sexually, the microflora of the vagina is characterized by great diversity, differing only in quantitative and qualitative indices. It is represented by aerobes, as graippositive (lactobacilli, corynebacteria, diphteroids, different types of streptococci and staphylococci), and Gram-negative (E. Coli, Klebsiella, Emterobacteria, Proteus). In addition, anaerobic flora is also emerging from the vagina of women, the predominant species of which are peptococci, peptostreptococci, bacteroides, fusobacteria, lactobacilli, etc. At the same time, the anaerobic non-spore-forming flora is markedly prevalent over aerobic flora.

Although the microflora of the lower genital tracts of healthy women is relatively stable, there are changes in its composition associated with the menstrual cycle and other features of the macroorganism. Thus, in the first phase of the menstrual cycle, E. Coli, Bacteroides fragilis is isolated more often than in phase II; increases the intensity of growth of microflora during menstruation.

The mechanism of penetration of pathogens from the lower genital tract to the fallopian tubes has not been sufficiently studied to date. L. Keith et al. (1983) suggest the presence of three variants of penetration: with trichomonads, with spermatozoa, passive transport due to the sucking effect of the abdominal cavity.

Through the undamaged protective system of the cervix, gonococci, which have an increased virulence, can easily penetrate. For the invasion of pyogenic nonspecific infection, "entrance gates", i.e., damage to tissues, are required. These conditions are created during childbirth, abortion, such instrumental interventions as hysterosalpingography, hysteroscopy, hydrotubation. Particular importance is given to intrauterine contraception. IUD leads to erosion of the endometrial surface, local increase in fibrinolytic activity and production of prostaglandins contributing to the spread of infection.

At present, many authors pay attention to the increase in the likelihood of developing actinomycosis when using IUD. The frequency of detection of Actinomyces israelii is affected by the type of contraceptive and the duration of its stay in the uterus. The presence of copper in the IUD facilitates the suppression of factors that enhance the growth of these anaerobic microorganisms.

Chances for the development of actinomycosis increase in women who have been using CMC for more than 2 years.

It was said above that the infection of the upper parts of the reproductive apparatus, including the fallopian tubes, ovaries, the peritoneum of the small pelvis, occurs in an ascending way. However, the infection can spread through the lymphatic and venous vessels of the uterus or through the main bloodstream, as well as from neighboring pelvic organs or the abdominal cavity. It should be noted that the spread of infection by hematogenous and lymphogenous pathways in the conditions of early antibacterial treatment is limited.

As a result of the action of the damaging agent, the response of the organism occurs, both directly in the center of introduction, and the general - with the involvement of various systems and organs. In the lesion, an inflammatory process develops, manifested in the destruction of the parenchyma with the release of biologically active substances, in vascular reactions with exudation, phagocytosis, physico-chemical changes, and a parallel increase in proliferative processes. The nature of the microbial flora affects the nature of pathogenetic changes in the lesion focus. Thus, the inflammation of the appendages, caused by anaerobic infection, proceeds with extensive destruction of the tissue and the formation of abscesses. Chlamydial infection leads to an intensification of infiltrative and proliferative processes, contributing to the development of an extensive adhesion process. The general reaction of a woman's organism to the introduction of an infectious agent includes a change in the functions of the peripheral and central nervous system, hormonal homeostasis, regional and general hemodynamics and hemorheology. Inflammatory changes in female genital organs significantly change the immune and nonspecific protective properties of the body. As is known, the state of immunity is assessed by the number and functional activity of T and B lymphocytes. In the acute inflammatory process of the internal genital organs against a background of a relative decrease in the number of peripheral blood lymphocytes, a slight decrease in the T-lymphocyte content and a marked increase in B-lymphocytes occur. An acute inflammation is characterized by a decrease in the functional activity of T-lymphocytes, which can be traced to a decrease in the ability of lymphocytes to blast-transformation, especially when the long-lasting chronic inflammatory process exacerbates, especially in women over 35 years old, and against peripheral blood leukocytosis exceeding 10 × 10 ⁴ g / l. In the acute course of inflammatory diseases of internal sexual opganas, the content of all major immunoglobulins: IgA, IgM and IgG in the blood serum increases substantially. For the primary acute inflammation, a more pronounced increase in IgM level is characteristic, and with increasing duration of the process, the content of IgG increases.

Symptoms of pelvic inflammatory diseases and the tactics of their therapeutic approaches depend not only on the nature of the infectious agent, the age and previous state of women's health, possible invasive diagnostic, therapeutic and other interventions on the genital apparatus, but also on the localization of the lesion.

[1], [2], [3], [4], [5]