Adnexitis is an inflammation of the uterine appendages, which include the fallopian tubes and ovaries.
Translated from Latin – salpinx means fallopian tube, and ovarium means ovary, therefore another name for adnexitis is salpingo-oophoritis.
Adnexitis, as a rule, affects women of reproductive age (20-35 years).
By the nature of the course, acute, subacute and chronic adnexitis are distinguished.
Depending on the involvement of the appendages in the pathological process on both or on one side, adnexitis can be unilateral or bilateral.
For the reason that led to the onset of the disease, there is a distinction between nonspecific and specific (for example, gonorrheal) adnexitis.
The cause of the development of adnexitis is pathogenic microorganisms.
Specific adnexitis is caused by gonococci, tubercle bacillus, pathogens of diphtheria.
Nonspecific adnexitis develops when streptococci, staphylococci, E. coli, mycoplasma and other bacteria enter the uterus.
The infection can spread ascending through inflammation of the vagina, cervix, or uterus, and descending from other, higher organs (for example, with appendicitis).
The predisposing factors of adnexitis include:
- weakening of the immune system;
- frequent and erratic change of sexual partners;
- unprotected sex during menstruation;
- non-observance of the rules of personal hygiene;
- transferred infectious disease;
- chronic general, including endocrine, diseases;
- abortion and diagnostic curettage of the uterus;
- intrauterine device;
- hysteroscopy of the uterus and metrosalpingography.
The manifestations of the disease depend on its course.
Signs of an acute form
Acute adnexitis and exacerbation of chronic adnexitis are characterized by:
- a sharp increase in body temperature up to 38 – 39 degrees,
- the appearance of signs of intoxication (nausea, vomiting, weakness, lack of appetite),
- pain in the lower abdomen.
Pain in acute adnexitis is of a cutting nature, can be given to the lower back and rectum.
Perhaps the addition of symptoms of urination disorder (cramps during urination, frequency).
On palpation, there is a sharp soreness and tension of the abdominal muscles.
In advanced cases, signs of irritation of the peritoneum may appear (sign of Shchetkin-Blumberg), which indicates peritonitis.
In severe cases, purulent fusion of the uterine appendages (tubo-ovarian formation) develops, which requires urgent surgical intervention.
With untimely or inadequate treatment, acute adnexitis becomes chronic.
Signs of a chronic form
Chronic adnexitis is characterized by periodic aching or pulling pains in the lower abdomen, lower back, which radiate into the vagina, rectum and lower limb.
Dyspareunia (pain during intercourse) is a characteristic symptom of a chronic process.
In addition, due to the formation of adhesions in the pelvic area and changes in ovarian function, menstrual irregularities develop in the form of oligomenorrhea (rare and scanty menstruation) and amenorrhea (absence of menstruation for 6 months or more).
Also, with chronic adnexitis, menstruation becomes painful. Pain in the chronic course of the disease increases after hypothermia, stressful situations, before the onset of menstruation.
During a vaginal examination with acute or exacerbated adnexitis, painful, enlarged ovaries and tubes (due to the accumulation of fluid in them) are palpated in the area of the uterine appendages.
Chronic adnexitis without exacerbation is characterized by the presence of severity in the uterine appendages, dense immobile ovaries, shortening of the vaginal fornix.
Diagnosis of adnexitis is based on the collection of anamnesis, complaints, gynecological examination. The following laboratory tests are also shown:
- general analysis of blood and urine;
- biochemical blood test (C-reactive protein, blood sugar, total protein, etc.);
- smear of vaginal discharge on flora, tank. culture and antibiotic susceptibility testing;
- ultrasound of the pelvic organs;
- laparoscopy (in difficult cases);
- tuberculin test (with suspicion of tuberculosis infection).
Differential diagnosis of adnexitis is carried out with ovarian cysts, external endometriosis, appendicitis and lumbar osteochondrosis.
The same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook. Do not try to heal yourself – consult your doctor.
A gynecologist is engaged in the treatment of adnexitis.
Treatment of the acute form
Patients with acute and exacerbation of chronic adnexitis are hospitalized. Rest, a hypoallergenic diet and cold on the lower abdomen are prescribed (to limit the inflammatory process and relieve pain).
First of all, broad-spectrum antibiotic therapy is shown:
- cephalosporins (kefzol, ceftriaxone),
- penicillins (ampiox, ampicillin),
- fluoroquinolones (ciprofloxacin),
- tetracyclines (doxycycline),
- aminoglycosides (gentamicin) and others.
Antibacterial treatment is carried out within 7-10 days. With the right therapy, no additional medication is required.
Untreated or inadequately treated acute adnexitis leads to chronicity of the process. Possible complications of chronic adnexitis:
- infertility (develops due to obstruction of the fallopian tubes and chronic anovulation);
- the development of the adhesive process up to intestinal obstruction;
- ectopic pregnancy;
- the threat of termination of pregnancy and miscarriages;
- inflammation of adjacent organs (pyelonephritis, cystitis, colitis).
The prognosis for acute and chronic adnexitis is favorable for life. In a chronic process, infertility occurs in 50% of patients.