Adnexitis

In gynecology, inflammation in the appendages (ovaries, fallopian tubes) occupies one of the first positions among diseases of the female reproductive system. Among doctors, inflammation in the fallopian tubes is usually called adnexitis (salpingo-oophoritis).

Among young women, the disease is much more common and occurs for two reasons: penetration of infection into the fallopian tubes and secondary infection during inflammatory processes in other organs (appendicitis, etc.). Inflammation in the appendages is provoked by chlamydia bacteria, streptococci, E. coli, tuberculosis mycobacteria, etc. Usually, bacteria penetrate through the vagina, cervix, less often they end up in the appendages with the blood or lymph flow (usually during the tuberculosis process). Also, the infection can get in during an abortion, diagnostic curettage or other procedures inside the uterus. Usually, inflammation of the ovaries occurs in parallel with inflammation of the fallopian tubes and, therefore, gynecologists perceive inflammatory processes in the small pelvis as one phenomenon.

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Causes adnexitis

Infection in the fallopian tubes is the main cause of adnexitis.

Experts divide adnexitis into several types, depending on which microorganisms provoked the inflammation:

• non-specific, caused by sexually transmitted infections (mycoplasma, chlamydia, etc.) or opportunistic microorganisms (E. coli, streptococci, etc.);
• specific, caused by diphtheria, gonococcal, tuberculosis bacteria.

The infection can enter through the blood or lymphatic system, from the vagina (usually with sexually transmitted infections) or from other internal organs (lungs, kidneys). However, infection in the body does not always lead to inflammation of the appendages, since adnexitis requires the presence of predisposing factors.

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Symptoms adnexitis

Inflammation in the appendages leads to menstrual cycle failures. Discharge usually becomes more scanty, the interval between periods increases, but in some cases, menstruation takes on the character of prolonged and painful bleeding. Symptoms of chronic adnexitis are manifested in possible frequent exacerbations due to weakened immunity, infections, secondary infection. With an exacerbation of the inflammatory process in the appendages, the woman's general well-being may worsen, the temperature rises, painful sensations in the lower abdomen increase, and purulent discharge from the vagina is also possible.

Pain with adnexitis

Adnexitis usually occurs with nagging pain in the lower abdomen, but the disease can be characterized by acute intense pain radiating to the back or coccyx, nausea (vomiting), constipation. When pressing on the abdomen, the woman feels a sharp pain, sometimes with tension in the abdominal muscles.

If such pain occurs, it is important to immediately consult a doctor, since the disease is more treatable in its acute form.

Temperature with adnexitis

High body temperature indicates some inflammatory process in the body. Adnexitis in acute form usually occurs with an increase in body temperature to 39 ^o C, in chronic course of the disease the temperature is most often normal or within 37 ^o C.

Discharge in adnexitis

Inflammation of the appendages leads to the appearance of discharge from the genitals of a greenish or milky color, with an unpleasant odor. It is these discharges that cause irritation, burning and itching of the vagina. The color can be used to determine the infection that provoked adnexitis (with gonorrhea, the discharge is yellowish, purulent, with trichomoniasis - greenish-yellow and blistering).

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Menstruation with adnexitis

Adnexitis leads to menstrual cycle disorders, which is associated with ovarian dysfunction. With adnexitis, female sex hormones are produced in reduced quantities. Usually, menstruation is heavy, very painful, and clots often appear. The disease leads to a failure of the menstrual cycle, the duration of discharge may increase. However, in some cases, the opposite may be true: discharge is scanty and lasts a couple of days.

Bleeding in adnexitis

Adnexitis is often accompanied by prolonged bleeding, which is associated with menstrual irregularities. The cycle is shortened and the discharge becomes more abundant.

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Why is adnexitis dangerous?

Adnexitis can occur with virtually no obvious symptoms, which makes timely detection and treatment difficult.

First of all, the disease is dangerous due to various complications, in particular adhesions between the fallopian tubes and adjacent organs (bladder, uterus, omentum, intestines, etc.). When adhesions occur, purulent formations appear, which eventually lead to an ovarian abscess.

With purulent adnexitis, pus begins to accumulate in the fallopian tubes, forming "sacs" filled with serous or purulent fluid (sactosalpinx). The disease can also be complicated by a tubo-ovarian abscess, when the infection gets into the peritoneum, inflammation, peritonitis and abscesses (rectovaginal, interintestinal, etc.) begin.

With systematically aggravating chronic inflammatory processes in the fallopian tubes, a woman develops sexual dysfunction, in particular pain during intercourse, decreased desire, etc. With incorrect treatment of acute adnexitis, infertility develops in the vast majority of cases, and the risk of ectopic pregnancy also increases.

Forms

The abbreviation ICD is commonly understood as a special reference book with a classification of diseases. This manual was developed by the World Health Organization to systematize, analyze and compare data on diseases, mortality at different times and in different countries.

The ICD of the tenth revision is currently in effect, in which alphanumeric coding systems have begun to be used. By introducing letters and numbers into the coding system, it has become possible to increase the coding structures more than twice.

According to ICD, adnexitis belongs to class XIV (diseases of the female genitourinary system) and has the code N70. This coding includes three subsections:

• N70.0 - acute oophoritis and salpingitis.
• N70.1 - chronic oophoritis and salpingitis.
• N70.9 – oophoritis and salpingitis, unspecified.

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Chronic adnexitis

Adnexitis becomes chronic after incorrect or insufficiently treated acute inflammation. When the disease worsens, the patient's health worsens, the temperature rises, and sexual dysfunction occurs. Patients often experience digestive or urinary dysfunction. With chronic adnexitis, frequent dull pains appear in the abdomen, which can become stronger during sexual intercourse, menstruation, and after physical exercise. With chronic inflammation of the appendages, menstruation is usually scanty and short-lived, but can also be profuse and long-lasting (up to two weeks). With prolonged chronic adnexitis, infertility develops, which usually occurs due to obstruction of the fallopian tubes caused by the adhesion process.

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Chronic bilateral adnexitis

Bilateral chronic adnexitis affects organs on both the left and right sides. Usually, the onset of the disease affects only the fallopian tubes, then inflammation develops in the ovaries. Adnexitis often develops together with other diseases of the genitourinary organs.

Bilateral inflammation in the appendages is provoked by gonorrhea bacteria, tuberculosis mycobacteria, chlamydia, etc.

E. coli, streptococcal, and staphylococcal bacteria most often provoke one-sided inflammation.

Infection often penetrates into the appendages during inflammation of internal organs, both those located nearby (appendicitis) and those located remotely (pneumonia, tonsillitis), and unprotected sex can also be a source of infection. Quite often, the infection penetrates from the lower genital organs (vagina), in particular trichomonads, which can quickly penetrate the fallopian tubes. Spermatozoa can also contribute to infection, especially E. coli.

With bilateral inflammation, abdominal pain, weakness, and fever occur. With prolonged inflammation in the tubes, the risk of ectopic pregnancy or infertility increases due to the formation of adhesions.

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Exacerbation of adnexitis

When the disease worsens, sharp and intense pains appear in the lower abdomen and lower back. In some cases, acute adnexitis occurs with bloating, nausea, and constipation. When palpating the abdomen, the patient feels sharp pain, sometimes there is tension in the abdominal muscles. In the acute form of the disease, the temperature rises to 390C. If the process is neglected, the inflammation can affect the peritoneum, which will ultimately lead to peritonitis and abscess. When pus accumulates in the fallopian tube, the organ can rupture and purulent contents can enter the peritoneum.

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Acute adnexitis

Acute adnexitis develops during a general inflammatory process, due to a decrease in defenses and infection. Bacteria that provoke the disease enter the pelvic organs from a source of infection, which can even be tonsillitis or sinusitis. Infection can also occur during sexual intercourse, menstruation, after interventions in the uterus, in particular abortions or diagnostic operations.

When adnexitis worsens, the temperature rises, muscle pains and headaches appear, the lower back and abdomen (lower part) also begin to hurt quite badly, and urination is impaired. During the examination, the gynecologist determines enlarged and painful appendages. During inflammation of the uterus, a woman may have purulent discharge from the genitals.

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Subacute adnexitis

Adnexitis in subacute form is quite rare, it usually appears with inflammation of tuberculous or mycotic nature. Symptoms of subacute adnexitis are similar to the manifestation of the acute form of the disease, only it has less intensity and frequency (pain, purulent discharge, temperature, etc.).

Purulent adnexitis

Purulent adnexitis is usually a complication of gonorrhea. The disease can be polymicrobial or specific. Also, the causes of the development of purulent inflammation in the appendages can be childbirth, artificial termination of pregnancy, IVF, stress, excessive consumption of alcohol, drugs, various intrauterine operations, frequent changes of sexual partners, anal sex, sexual intercourse during menstruation, hormonal contraceptives. One of the characteristic signs of the disease is aching pain in the abdomen, fever, pain during urination, discharge from the genitals.

In the purulent form of the disease, first of all, the presence of gonorrhea, urethritis and other sexual pathologies in the sexual partner (past or present) is determined.

Purulent adnexitis is manifested by pain in the lower abdomen and rectum, dry mouth, fever, high temperature, weakness, dizziness, rapid heartbeat, pain when urinating, and purulent discharge.

Bilateral adnexitis

Bilateral adnexitis develops as a result of an infectious disease, and the infection can penetrate the fallopian tubes from almost any inflamed organ. With general inflammation, immunity decreases and the infection can freely move to other organs. With frequent sexual intercourse with different partners, intrauterine devices, and uterine surgeries, the risk of developing adnexitis increases.

As with other inflammatory processes of the female genital organs, bilateral adnexitis is manifested by pain, fever, weakness and general malaise, digestive disorders, and nausea.

Untreated (or insufficiently treated) bilateral adnexitis results in painful menstruation and irregular cycles. With bilateral inflammation of the appendages, adhesions appear in the fallopian tubes, which prevent the movement of the egg; in addition, the fertilized egg can attach to the tube, which will lead to an ectopic pregnancy (the most common complication of adnexitis).

Right-sided adnexitis

With right-sided inflammation of the appendages, the organs on the right side are affected. The symptoms have some peculiarities that depend on the nature of the disease. First of all, there are nagging pains in the lower abdomen, lower back, which can intensify during urination, physical exertion, sexual intercourse. Like any other inflammation, adnexitis can occur with a high temperature. In addition, with the disease, there is rapid fatigue, deterioration of general health.

The chronic form of right-sided adnexitis causes menstrual cycle irregularities, a slight increase in temperature, and constant pain in the lower abdomen.

Since the appendix is located in the right part of the peritoneum, the inflammation of which can occur with similar symptoms, it is necessary to seek help from a specialist if any symptoms appear, which will help to avoid serious and life-threatening complications.

A source of inflammation in adjacent organs can cause the spread of infection throughout the body, for example, with appendicitis, the likelihood of pathogenic microflora entering the appendages increases. The risk of inflammation of the appendages is much higher with various surgical interventions in the uterus, for example, during the installation of an IUD or abortion. Some bacteria are in the woman's body and do not manifest themselves in any way until a certain point, but under favorable conditions (decreased immunity), microorganisms become active and, entering the internal genital organs, cause inflammation.

If treatment of adnexitis is started in an acute or subacute form, the recovery process will be much faster, and a number of negative consequences of the disease can be avoided.

Left-sided adnexitis

With left-sided adnexitis, inflammation of the appendages occurs on the left side. Left-sided adnexitis, as in other cases, occurs after infection enters the uterus and fallopian tubes as a result of abortions, childbirth, sexual intercourse, etc. As well as with hypothermia, IUD installation, stress.

As a rule, the symptoms of left-sided adnexitis depend on the cause of the disease, usually it is expressed by pain in the lower abdomen, irritability, fever, painful menstruation, sexual intercourse.

Chronic left-sided adnexitis is the result of untreated (undertreated) inflammation of the appendages in acute form. Chronic adnexitis during periods of remission creates a feeling of complete recovery, however, during exacerbation the disease can proceed with greater intensity.

Left-sided adnexitis leads to dysfunction of the left ovary; the left fallopian tube, as a result of multiple adhesions, becomes impassable for the egg.

Adnexitis in girls

Adnexitis can develop not only in women who are sexually active. Little girls and teenage girls who do not have sexual intercourse are also susceptible to this disease.

Intestinal infections, purulent appendicitis, urinary tract infections - all this and much more can cause inflammation of the appendages. Also, chronic inflammation foci (tonsillitis, otitis, sore throat, caries, etc.) can cause the disease, since the infection can get into any organ with the bloodstream. Usually, the disease is caused by E. coli and staphylococcus.

If a girl is already sexually active, then adnexitis can primarily develop due to infection of the genitals, abortion, or sexually transmitted diseases.

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Pregnancy and adnexitis

Pregnancy is almost impossible with diseased appendages. Adnexitis poses a threat when trying to conceive a child, primarily due to the increased risk of ectopic pregnancy, when it is impossible to do without medical assistance. In addition, the danger of ectopic pregnancy is that it is practically no different from a normal one, and is often detected when the fallopian tube ruptures.

In case of inflammation of the appendages during pregnancy, complications are possible. First of all, if the mother is infected, the risk of intrauterine infection of the child is extremely high. Even if the child is not infected in utero, it can catch the infection during passage through the birth canal. In addition, with inflammatory processes in the female genital organs, the risk of spontaneous termination of pregnancy (miscarriage) increases many times. Also, pregnant women require special treatment, since antibiotics are not used in this condition due to the high risk of pathologies for the fetus.

Is it possible to get pregnant with adnexitis?

Most women who are diagnosed with adnexitis worry about whether it is possible to get pregnant with diseased appendages. Only a gynecologist can answer this question after a full examination of the fallopian tubes. In the absence of adhesions, pregnancy is possible, but pregnancy with diseased appendages is complicated and often ends unfavorably (high risk of miscarriage or ectopic pregnancy).

During pregnancy, a woman's immune system weakens, so chronic adnexitis may become aggravated.

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Diagnostics adnexitis

If adnexitis is suspected, the doctor will first learn the patient's medical history (past abortions, complicated births, intrauterine device, operations for therapeutic or diagnostic purposes, sexually transmitted diseases, frequent change of sexual partners, unprotected sex, poor personal hygiene, diseases of the genitourinary organs, etc.).

After the survey, the specialist begins the examination. If the patient experiences sharp pain during palpation, tense abdominal muscles, then most likely the disease is acute.

Laboratory tests are also mandatory:

• bacterial culture of the vagina, cervical and urethral tests, PCR;
• General blood test.

In case of adnexitis, Gram staining is widely used, which requires the mucous contents of the cervix. This diagnostic allows to detect gonococci. However, in case of chronic adnexitis, this test does not show results, so sometimes provocative methods are used:

• analysis of menstrual blood from the 2nd to the 4th day, when there is a greater chance of detecting pathogenic microorganisms that live deep in the appendages on other days;
• food factor (alcohol, spicy food, etc.);
• biological, chemical, physiotherapeutic provocations (use of special substances or procedures);
• using multiple methods.

Ultrasound examination of the internal organs in the pelvis allows obtaining quite extensive information and assessing the condition of the appendages, identifying neoplasms of pregnancy (intrauterine or normal).

Ultrasound is used when, due to severe pain, the doctor cannot normally palpate and examine the woman.

Also, if necessary, laparoscopy, MRI, and computer diagnostics may be prescribed.

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Diagnosis of chronic adnexitis

In chronic adnexitis, during examination, a specialist determines the lack of mobility of the appendages and muscle tension.

One of the diagnostic methods for suspected chronic adnexitis is hysterosalpingography, which helps determine the patency of the fallopian tubes. This diagnostic involves conducting an X-ray examination of the uterus and adjacent organs.

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Diagnosis of acute adnexitis

Acute adnexitis has symptoms similar to appendicitis. Severe pain, temperature, fever, nausea - all these conditions can occur both with acute inflammation of the appendages and with appendicitis. The cause of the malaise can only be determined in a hospital. Usually, during a gynecological examination, severe sharp pain appears during palpation, which indicates an acute inflammatory process. In some cases, an ultrasound is prescribed to confirm the diagnosis and exclude other pathologies.

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Adnexitis on ultrasound

An ultrasound scan examines internal organs using a special device with ultrasound waves. Current ultrasound machines have a special transvaginal sensor that allows scanning female genitals and obtaining more detailed information about the location and characteristics of the inflammatory process.

Transvaginal ultrasound is the most valuable diagnostic method. Using special sensors inserted into a woman's vagina, a specialist can determine changes in the appendages and existing formations.

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Differential diagnosis of adnexitis

Differential diagnostics allows us to separate adnexitis from such diseases as ovarian cysts, endometriosis, diseases of the genital organs, acute appendicitis, etc. It is important for a specialist to study the obtained tests and ultrasound data as best as possible; a surgeon's consultation is also necessary.

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Treatment adnexitis

During the treatment of inflammation in internal organs, the main emphasis is on suppressing the infection in the body, preventing possible severe consequences of the disease, and restoring the woman’s reproductive function.

With adnexitis, the main thing is to start treatment in time, to carry out step-by-step and complex therapy. Chronic adnexitis is quite difficult to treat, primarily because the cause of the inflammatory process in most cases remains unknown.

The inflammatory process during pregnancy presents some difficulties in treatment, since many effective drugs are prohibited for use during pregnancy. In severe cases, adnexitis treatment is carried out in hospital conditions. Girls under 20 years of age, inflammation in the appendages after intrauterine intervention, suspected purulent complications, immunodeficiency, long-term outpatient treatment that does not give positive results, as well as inflammation during pregnancy, since in this case the risk of fetal infection and pregnancy complications (labor) increases are subject to mandatory hospitalization.

At the onset of the disease, antibacterial therapy is started (preferably intravenously or intramuscularly) - amoxiclav, azithromycin, ofloxacin, etc. When symptoms and inflammatory processes in the appendages subside, antibiotics are prescribed orally.

In chronic cases, combined antimicrobial treatment is prescribed (drugs from different groups). When prescribing antibacterial drugs, the doctor must necessarily order an analysis for the susceptibility of microorganisms.

In addition to antibacterial therapy, anti-inflammatory, immunomodulatory, and antiallergic agents are used to treat adnexitis. Enzyme agents are prescribed to make antibacterial drugs more effective and to prevent adhesions in the pelvic organs.

Surgical treatment is prescribed only when drug treatment does not produce a positive effect, the patient’s general condition is extremely severe, or a purulent complication has begun.

During surgical treatment, they try to preserve the fallopian tubes as much as possible, while completely removing the source of inflammation. If necessary, an additional operation is performed to restore the patency of the fallopian tubes.

During the recovery period after surgery, physiotherapy procedures, spa treatment, and biological stimulants are used. Immunostimulating, resolving, and anti-inflammatory treatments are continued. In some cases, taking into account the results of examinations and the patient's condition, the doctor may prescribe hormonal agents (oral contraceptives).

Folk remedies for this disease are very effective in addition to traditional treatment methods. An enema with chamomile infusion (1 cup boiling water, 1 tablespoon dried flowers) relieves pain in the lower abdomen, inflammation, and swelling. At first, it is recommended to do a cleansing enema with clean boiled water, then do 2-3 enemas with chamomile infusion, after which you need to lie on your side. This treatment is carried out once a day, preferably before bedtime. In severe cases (severe inflammation, pain, etc.), it is recommended to repeat the procedure several times a day.

Vitamins for adnexitis

Adnexitis is a rather serious disease that requires a comprehensive approach to treatment. In addition to antibiotics, antimicrobial drugs, and immunomodulators, taking vitamin supplements is of great importance in treatment. Depending on the woman's condition and susceptibility, vitamins are selected individually. They can use both tablets (capsules) and injections.

Sports for adnexitis

It is recommended to exercise with caution when the appendages are inflamed. Exercises, especially those involving the abdominal muscles, are contraindicated in acute adnexitis.

Adnexitis is almost always painful, so physical exercise can negatively affect a woman's health (pain will increase, bleeding will occur, etc.). In this regard, it is better to postpone sports until complete recovery.

Diet for adnexitis

In acute and subacute forms of adnexitis, it is extremely important to pay attention to proper nutrition and exclude any allergic products from your diet. It is also necessary to control calorie consumption - no more than 2300 per day. The diet should consist of easily digestible products, preferably stewed or boiled.

In case of adnexitis, it is necessary to add foods rich in vitamin C to the diet, which will help to increase the body's defenses and speed up the recovery process (bell peppers, citrus fruits, cranberries, pomegranates, etc.). Digestive system problems can provoke stagnation of feces and inflammatory processes. In addition, antibacterial therapy can further aggravate the situation. To avoid digestive problems, it is necessary to eat more vegetables (boiled or stewed) with a small amount of vegetable oil, fermented milk products. It is also important to drink enough liquid (at least 1.5 liters). It is better to drink still water, fresh juices, juices, unsweetened compotes and green tea. You should also eat lean meats and fish, greens (parsley, spinach, onions, etc.) several times a week.

During an exacerbation of the disease, you need to eat less salty foods, sweets, and foods with a high carbohydrate content. During adnexitis, coffee, cocoa, baked goods, sweets, salty, smoked, spicy foods, canned goods, carbonated sweet drinks, and factory-made juices are completely excluded.

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Prevention

To prevent adnexitis, women are advised to maintain personal hygiene and wear cotton underwear. Adnexitis can also be prevented by dressing appropriately for the weather and not getting too cold. Strengthening the immune system, regular exercise, systematic intake of vitamin complexes, maintaining a healthy lifestyle and proper nutrition are also good preventative measures against inflammatory diseases.

During the acute stage, as well as for a month after the main symptoms have subsided, you should not use tampons.

Adnexitis often develops after an infection enters a woman’s genitals (after casual sex, artificial termination of pregnancy or natural childbirth, etc.), so it is extremely important to monitor your hygiene and follow your doctor’s recommendations after surgical interventions in the uterus.

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Forecast

In most cases, with timely diagnosis and effective treatment, adnexitis passes almost without consequences. But if the disease is caused by an infection (gonorrhea, tuberculosis), as well as with chronic advanced inflammation, there may be quite serious complications, such as infertility.

Adnexitis can be caused by a variety of bacteria, which usually enter the vagina during sexual intercourse. The disease is also promoted by poor hygiene and decreased immunity. Women who are sexually active, have had infectious diseases in the past (trichomoniasis, chlamydia) or have undergone frequent intrauterine interventions (abortions, diagnostic curettage, etc.) are at risk.