Purulent Salpingitis - Symptoms

Most often, purulent salpingitis begins acutely with a rise in temperature, sometimes accompanied by chills, the appearance of pain in the lower abdomen, profuse purulent leucorrhoea and pain when urinating.

Indirect clinical symptoms indicating the likelihood of gonorrheal infection are the following anamnesis data:

• the occurrence of initial symptoms (pathological discharge, dysuric disorders) soon after the onset of sexual activity, remarriage, casual sex;
• the presence of gonorrhea in the husband, currently or in the past;
• the presence of concomitant cervicitis, urethritis or bartholinitis.

In cases where the immediate cause of acute inflammation cannot be established, the patient's medical history contains indications of the presence of chronic recurrent inflammation of the appendages.

Soon, patients develop symptoms of purulent intoxication (weakness, tachycardia, muscle pain, dry mouth), and dyspeptic, emotional-neurotic and functional disorders are added.

Temperature fluctuations may vary - from a slight increase (subfebrile temperature in the evening) to hectic fever. More typical is an evening (at 4 p.m. and later) increase in temperature to 37.8-38.5°C with normal or subfebrile readings in the morning. As a rule, tachycardia corresponds to the temperature (an increase in heart rate by 10 beats/min with a rise in temperature by 1 degree), with a decrease in temperature, the heart rate normalizes or remains slightly elevated (5-10 beats/min more than the initial).

The pains occur acutely. At the onset of the disease, they are usually local in nature, and the patient can clearly indicate the affected area. The typical localization of pain is the left and right hypogastric regions; in the presence of concomitant endometritis, so-called "median" pains are observed. Most often, the pains radiate to the lower back, rectum, and thigh on the side of the predominant lesion. A widespread nature of pain (throughout the abdomen) is observed in patients with concomitant pelvic peritonitis and requires differential diagnosis, primarily with acute surgical diseases of the abdominal cavity.

One of the constant symptoms of purulent salpingitis is pathological leucorrhoea, which is often purulent, less often serous-purulent. As a rule, they are accompanied by purulent discharge from the urethra and cervical canal.

Purulent leucorrhoea can be the main and accompanying symptom of various inflammatory diseases.

The 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. coli, Klebsiella and B. streptococci were also identified in the flora.

The presence of concomitant specific urethritis or cervical cystitis leads to the appearance of dysuric disorders in patients - frequent painful urination in small portions or severe burning during urination. Disorders of the rectum function are most often manifested in the form of a symptom of an "irritable" bowel - frequent loose stools. A frequent complaint is the presence of severe dyspareunia.

Among emotional-neurotic disorders, symptoms of arousal in the form of increased emotional lability predominate.

Currently, the vast majority of foreign researchers consider Chlamydia trachomatis to be the most important participant in the development of inflammation of the internal genital organs.

Clinically, unlike acute gonorrheal salpingitis, the course of inflammation caused by primary chlamydial or mycoplasmal infection has more meager symptoms: subfebrile temperature, mild pain. Pathological leucorrhoea and often dysuric disorders attract attention.

It has been established that chlamydial infection of the urethra and cervical canal in women in 70% of cases is accompanied by a few scanty or complete absence of clinical signs.

The latent clinical course of purulent salpingitis leads to patients seeking medical attention late and, accordingly, to late hospitalization and treatment.

Currently, 84% of inflammatory diseases of the pelvic organs are latent, atypical, and are detected only during examination of women with infertility who have not previously had inflammation of the internal genital organs.

Complications of purulent salpingitis

Selection of adequate antibacterial therapy, laparoscopic sanitation and drainage of the pelvic cavity allow to achieve cure of 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 pelvic peritonitis, formation of abscesses of the utero-rectal space or purulent tubo-ovarian formations.

Common clinical signs of complications are the increase in symptoms of purulent intoxication (the appearance of hectic fever, nausea, vomiting, a constant feeling of dry mouth, severe muscle weakness). In patients with pelvic peritonitis, symptoms of peritoneal irritation appear mainly in the lower abdomen; patients with an abscess of the Douglas pouch developing against the background of pelvic peritonitis complain of a feeling of sharp pressure on the rectum and frequent defecation. Dynamic vaginal examination allows to clarify the type of developing complications of the purulent process.

Vaginal examination in patients with pelvic peritonitis is uninformative due to severe pain on palpation. The pain increases sharply with the slightest movement of the cervix. There is moderate overhang and sharp pain in the vaults, especially the posterior one; it is usually impossible to palpate small volumetric formations in the pelvic area.

During a gynecological examination of patients with an abscess of the utero-rectal (Douglas) space, it is typical to detect in the corresponding anatomical area a pathological formation of uneven consistency, without clear contours, prolapsing through the posterior fornix and the anterior wall of the rectum, and sharply painful upon palpation (the so-called “Douglas cry”).

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