Purulent salpingitis: symptoms
Last reviewed: 23.04.2024
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Most often, purulent salpingitis begins acutely with fever, sometimes accompanied by chills, the appearance of pains in the lower abdomen, profuse purulent leucorrhoea and cuts during urination.
Indirect clinical symptoms indicative of the likelihood of gonorrhea are the following history data:
- the emergence of initial symptoms (pathological discharge, dysuric disorders) soon after the onset of sexual activity, remarriage, accidental communication;
- the presence of gonorrhea in the husband now or in the past;
- presence of concomitant cervicitis, urethritis or bartholinitis.
In those cases when the immediate cause of acute inflammation can not be established, the history of patients has indications for the presence of chronic recurrent inflammation of the appendages.
Soon, patients develop symptoms of purulent intoxication (weakness, tachycardia, muscle pains, a feeling of dryness in the mouth), dyspeptic, emotional-neurotic and functional disorders join.
The temperature fluctuations can be different - from a slight increase (subfebrile fever in the evening) to a fever of a hectic type. More characteristic is an evening (at 16 hours and later) temperature increase to 37.8-38.5 ° C with normal or low-grade indicators in the mornings. As a rule, tachycardia corresponds to a temperature (an increase in heart rate by 10 beats / min when the temperature rises by 1 degree), with a decrease in the temperature, the heart rate is normalized or remains slightly elevated (by 5-10 bpm more than the baseline).
Pains are acute. At the onset of the disease, they are usually of a local nature, and the patient can clearly indicate the area of the lesion. Typical localization of pain - the left and right hypogastric areas, with the presence of concomitant endometriometritis, there are so-called "median" pains. Most often the pain radiates to the lower back, rectum and thigh on the side of the primary lesion. The widespread nature of pain (throughout the abdomen) is observed in patients with concomitant pelvioperitonitis and requires a differential diagnosis primarily with acute surgical diseases of the abdominal cavity.
One of the constant symptoms of purulent salpingitis are pathological leukemia, which are often purulent, less often serous-purulent. As a rule, they are accompanied by purulent discharge from the urethra and the cervical canal.
Purulent leucorrhoea may be the main and concomitant symptom of various inflammatory diseases.
Microbiological characteristics of leukorrhea are represented by the following pathogens: N. Gonorrhoeae - 7.3%, U. Urealyticum - 21.2%, M. Hominis - 19.5%, G. Vaginalis - 19.5%, Chlamydia trachomatis - 17%, Candida albicans - 8% and candida-like organisms - 13,6%, Trichomonas vaginalis - 8,5%, actinomyces - 29,7%. Staph, aureus, Esch are also included in the flora. Coli, Klebsiella and B. Streptococci.
The presence of concomitant specific urethritis or cervical cystitis leads to the appearance in patients with dysuric disorders - frequent small incidences of painful urination or strong cuts during urination. Disorders of the function of the rectum are manifested more often in the form of a symptom of the "irritated" gut - frequent loose stools. A frequent complaint is the presence of severe dyspareunia.
Among the emotionally-neurotic disorders, the symptoms of excitation predominate in the form of increased emotional lability.
At present, the overwhelming majority of foreign researchers consider Chlamydia trachomatis to be the most important participant in the development of inflammation of the internal genital organs.
Clinically, in contrast to acute gonorrheal salpingitis, the course of inflammation due to primary chlamydial or mycoplasmal infection has a lesser symptomatology: subfebrile temperature, poorly expressed pain. Pay attention to pathological leucorrhoea and often dysuric disorders.
It has been established that chlamydial infection of the urethra and cervical canal in women is accompanied in 70% of cases by few or no clinical signs.
The aborted clinical course of purulent salpingitis leads to belated treatment of patients to the doctor and, accordingly, to belated hospitalization and treatment.
Currently, 84% of pelvic inflammatory diseases are erased, atypically and is only detected when examining women with infertility who did not previously have inflammation of the internal genitalia.
Complications of purulent salpingitis
Selection of adequate antibacterial therapy, laparoscopic sanation and drainage of the pelvic cavity allows to cure patients with purulent salpingitis. The outcome of the disease in such cases is recovery. However, sometimes the inflammation progresses, is complicated by the development of pelvioperitonitis, the formation of abscesses utero-rectum space or purulent tubo-ovarian formations.
Common clinical signs of complications are the accumulation of symptoms of purulent intoxication (the appearance of hectic fever, nausea, vomiting, a constant feeling of dryness in the mouth, and sharp muscle weakness). Patients with pelvic erythematous predominantly in the lower abdomen appear symptoms of irritation of the peritoneum; patients with a douglas pouch absent in the background of pelvioperitonitis complain of a feeling of sharp pressure on the rectum and rapid defecation. Carrying out a vaginal research in dynamics allows to specify the type of developing complications of the purulent process.
Vaginal examination in patients with pelvic peritonitis is poorly informative because of severe pain during palpation. Soreness increases sharply with the slightest movement behind the cervix. There is a moderate overhang and a sharp soreness of the arches, especially the rear; it is usually not possible to palpate small voluminous formations in the pelvic area.
When gynecological examination of patients with abscess utero-rectum (Douglas) space is characterized by the identification in the appropriate anatomical area of pathological formation of uneven consistency, without distinct contours, prolapse through the posterior arch and the anterior wall of the rectum, sharply painful during palpation (the so-called "Douglas cry"), .
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