Adnexitis or salpingo-oophoritis is the inflammation of fallopian tubes and ovaries usually referred to as uterine appendages. It is one of the most common pathologies among gynecological disorders. Adequate and timely adnexitis treatment is crucial for preventing infertility.
Mechanism of disease development consists of two stages:
- Colonization of the vaginal and uterus flora with pathogenic bacterial strains;
- Infection ascends up to involve appendages.
How exactly infection passes through the whole reproductive system at the current level of medical science is left unknown.
A major factor favoring the infection to affect the appendages is the mucus which is able to change its characteristics. Its deficiency and some transformations cause the development of pathogenic flora and it begins to move towards the uterine appendages.
Factors decreasing protective abilities of the mucus:
- Long-term use of antibiotics;
- Hormone imbalance;
- Immunodeficiency disorders;
- Unprotected sexual intercourse resulting in foreign micro flora penetrating into vagina;
Pregnant women rarely have the symptoms of adnexitis because the mucus barrier becomes thicker and does not allow pathogenic strains penetrate to vaginal or uterus tissues. Adnexitis can proceed in two forms: acute and chronic and may be bilateral and unilateral.
Causes of adnexitis
There are various infectious agents causing the disease. Most often inflammation in female reproductive system cause unilateral or bilateral adnexitis because of the following bacteria:
- Streptococcal and staphylococcal flora;
- Infectious agents of gonorrhea (gonococci);
- Fungal agents (most often Candida);
- Escherichia (collibacillus);
- Mycobacterium tuberculosis.
There are no direct causes for adnexitis, but there are factors that promote infection development in uterine appendages:
- Sexual intercourse during the periods when the mucus protection of the genital system is weak and infectious agents penetrate to uterine appendages causing inflammation.
- Artificial termination of pregnancy (abortion) is the most common cause of adnexitis. The disease may develop as a complication after the abortion and in case a woman does not observe the rules for rehabilitation during the post-operative period.
- Exposure to low temperatures reduces the level of immune and bacterial protection of genital system and this can lead to acute adnexitis.
- Any inflammatory diseases of the lower genital tract. If untreated, the infection will affect other organs and eventually the uterine appendages.
- Inflammatory diseases of other systems of the organism may be complicated by unilateral or bilateral adnexitis.
- Any sexually transmitted infections eventually will cause inflammation including the inflammation of the uterine appendages.
- Copper T as a method of contraception may also be a risk factor for adnexitis symptoms. The risk of uterine appendages inflammation is even greater when Copper T is not removed and replaced in time.
- Stress and nervous tension can also predetermine inflammation. Here we may also include chronic fatigue.
Symptoms of adnexitis in women
Adnexitis can manifest itself in acute or chronic form. Depending on the expansion of the problem there is a left-lateral and right-lateral adnexitis. Clinical presentation of the acute and chronic disease is different and depending on whatever uterine appendages are affected (one or both) the symmetry of manifestations will also be different.
Symptoms of the acute disease:
- General signs of inflammation (weakness, high fever at 40 °C, dizziness and headache, asthenia, nausea and vomiting);
- Attacks of pain or constant pain localized in the lower abdomen and may spread to the hip, low back or mimic rectal pain.
- In some cases, a woman may experience difficulty with urination.
Some specialists also distinguish subacute adnexitis, but not everyone clearly understands what it means. In this case, clinical presentation is completely the same as with acute disease but it is less prominent.
Symptoms of chronic disease
In most cases, the reason for chronic disease is the absence or insufficient adequate adnexitis therapeutic regimen. Only in rare cases resistance of microorganisms to the therapy is responsible for chronization.
Aggravation of chronic adnexitis is characterized by the same clinical presentation as with the initial form of pathology. One of the most distinctive symptoms is a high fever.
The symptoms of chronic unilateral and bilateral adnexitis:
- Lower abdominal pains are constant and may spread to the sacrum; pains are aggravated during defecation;
- Pain and discomfort during sexual intercourse;
- Menstrual disorders (changed amount of blood secretion) and severe pain during the periods;
- Mucoid discharge with purulent admixture, scandy period;
- Fever and common signs of inflammation.
In chronic left or right adnexitis, the pain is located in the left or right side, respectively, but during the acute phase, it is not always possible to objectively evaluate sensations.
Untreated chronic adnexitis complications
Unfortunately, complications of this disease frequently occur. For this reason, it is especially important to consult a doctor and choose optimal adnexitis therapy with proper medications.
Complications of the disease:
- Pelvic adhesions;
- Purulent ovarian tissue destruction (formation of abscesses);
- Formation of purulent cavities in the fallopian tube or serous infiltration;
- Fallopian tubes abscesses;
- Pelvic peritoneum inflammation developing into peritonitis;
- Ectopic pregnancy;
- Loss of libido.
Proper identification of symptoms and adnexitis treatment choices may not always be possible as the disease may be asymptomatic or subacute and a woman in these cases does not usually seek medical attention. As a rule, adnexitis is diagnosed when the disease already caused infertility.
Diagnosis of acute and chronic bilateral adnexitis (or unilateral)
Clinical presentation is often not enough to make a diagnosis as it is not specific and may represent any inflammation of reproductive system.
Additional methods of investigation:
- Bimanual pelvic examination;
- Inflammatory smears;
- Ultrasound investigation;
- Laparoscopy (to detect purulent cavities);
- Pelvic contrast-enhanced x-ray (to detect adhesions);
- Functional tests (in menstrual disorders);
- Laboratory examinations (non-specific inflammatory processes).
Treatment of acute and chronic adnexitis
Most often all forms of the disease require conservative treatment, but in neglected cases when adhesions affect the patency a patient should undergo an operation to excise the adhesions.
Home treatment for adnexitis is indicated in mild and moderate cases. Sometimes a woman should be hospitalized.
General treatment for acute and chronic disease:
- Adnexitis treatment with broad-spectrum antibiotics. When the results of antibiotic susceptibility test are ready, a patient continues to take the medicine or is indicated more effective preparation. Adnexitis treatment with antibiotics is crucial for fast and full recovery.
- Use of immunomodulators helps to increase protecting abilities of the organism.
- In adnexitis antiinflammatory and antihistamine suppositories are indicated.
- Detoxication therapy with isotonic solutions is indicated for intoxication syndrome.
- Vitamin therapy is useful to increase body resistance and to replenish lost nutrients.
- Treatment of acute and chronic adnexitis with analgesics is only symptomatic and can not be used as a primary therapy.
The difference in curing chronic adnexitis is that it additionally requires drug-free therapy:
- Residential treatment center;
- Massage therapy;
- Peloid procedures;
- Mineral and healing waters.
Home remedies for adnexitis
Herbal adnexitis treatment and other home remedies can not replace medical therapy, but it is effective adjunctive treatment accelerating recovery.
Herbal infusions are the most useful nonconventional remedy. They help to detoxify the body and eliminate the toxins.
Patients with adnexitis are recommended to drink a lot including lime flower, birch or cranberry infusions. These infusions may also be used for syringing.
Diet with foods rich in vitamins will give a tonic effect.
Early detection of adnexitis, its adequate therapy are important factors for preventing infertility and reducing the risk of ectopic pregnancy.