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Diagnosis of inflammatory diseases of the pelvic organs. Infectious and inflammatory diseases of the pelvic organs. Possible complications and consequences

The low culture of sex education is often cited as one of the main reasons for its prevalence in Russia. Our women are simply not accustomed to taking care of their intimate health preventively, without waiting for the appearance of alarming symptoms.

Meanwhile, not identified and launched in time pelvic inflammatory disease (PID) can cause very serious consequences for women's health.

According to statistics, more than 100,000 women in the world annually become infertile due to untreated inflammatory diseases of the reproductive organs. In addition, such diseases are often the cause of ectopic pregnancy.

You can avoid complications only by carefully monitoring your condition, regularly visiting and undergoing all the necessary examinations on his recommendation. In "MedicCity" patients have the opportunity to be observed by the best specialists in Moscow and Russia. Our gynecological department is equipped with unique equipment, for example, which makes it possible to detect hidden pathologies at the earliest stages of their development.

The sooner inflammatory diseases of the pelvic organs are detected, the easier and faster the treatment will be.

What is included in the concept of PID

Inflammatory diseases of the pelvic organs (PID ) is a group of diseases caused by pathogenic microorganisms (such as gonococci, cytomegalovirus) and opportunistic pathogens (staphylococci, streptococci, gardnerella,). Often the cause of PID are mixed communities of pathogens.

Of course, the body has protection against pathogenic microbes. This is the acidic environment of the vagina, maintained by lactobacilli, cervical mucus containing lysozyme, IgA. However, natural defense factors are not always able to cope with the infection, and in such cases an inflammatory reaction develops.

Diagnosis of diseases of the pelvic organs

Laboratory diagnostics

Medical statistics show the prevalence of inflammatory diseases of the pelvic organs in our country: more than 65% of women turn to a gynecologist with this particular problem.

Thus, the risk of developing PID is directly related to age, sexual activity, frequency of changing sexual partners, and other factors. Also, the cause of infection can be diagnostic and surgical manipulations on the pelvic organs.

The following factors can be distinguished that provoke the appearance of diseases in the pelvic organs:

lack of a permanent sexual partner;
sex without the use of barrier methods;
non-compliance with the rules of personal hygiene;
intrauterine interventions, including the use of intrauterine devices;
hypothermia, etc.

Ultrasound of the pelvic organs

Diagnosis of diseases of the pelvic organs

Complications in PID

Diseases of the pelvic organs are very insidious, as they can cause formidable complications, such as:

ectopic pregnancy (may occur in every sixth woman with PID);
chronic pelvic pain (affects one in five women with pelvic inflammatory disease);
tubal infertility (diagnosed in every fourth patient);
ovarian dysfunction.

Also, with PID, inflammation of the pelvic peritoneum (pelvioperitonitis) is possible, which often turns into sepsis, tubo-ovarian abscess, which can be fatal.

Pelvic inflammatory disease is a spectrum of inflammatory conditions in the upper reproductive tract in women and can include any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

ICD-10 code

N74* Inflammatory diseases of the female pelvic organs in diseases classified elsewhere

Causes of pelvic inflammatory disease

In most cases, sexually transmitted microorganisms are involved in the development of the disease, especially N. gonorrhoeae and C. trachomatis; however, pelvic inflammatory disease may be caused by microorganisms that are part of the vaginal microflora, such as anaerobes, G. vaginalis, H. influenzae, gram-negative enterobacteria, and Streptococcus agalactiae. Some experts also believe that M. hominis and U. urealyticum may be the causative agents of pelvic inflammatory disease.

These diseases are caused by gonococci, chlamydia, streptococci, staphylococci, mycoplasmas, Escherichia coli, enterococci, and Proteus. Anaerobic pathogens (bacteroids) play a large role in their occurrence. As a rule, inflammatory processes are caused by a mixed microflora.

The causative agents of inflammatory diseases are most often introduced from the outside (exogenous infection); processes are less often observed, the origin of which is associated with the penetration of microbes from the intestines or other foci of infection in the body of a woman (endogenous infection). Inflammatory diseases of septic etiology occur when the integrity of tissues is violated (the entrance gate of infection).

Forms

Inflammatory diseases of the upper genital organs or inflammatory diseases of the pelvic organs include inflammation of the endometrium (myometrium), fallopian tubes, ovaries, and pelvic peritoneum. Isolated inflammation of these organs of the genital tract is rare in clinical practice, since they all represent a single functional system.

According to the clinical course of the disease and on the basis of pathomorphological studies, two clinical forms of purulent inflammatory diseases of the internal genital organs are distinguished: uncomplicated and complicated, which ultimately determines the choice of management tactics.

Uncomplicated forms include:

acute purulent salpingitis,
pelvioperitonitis,

Complicated - all encysted inflammatory tumors of the appendages - purulent tubo-ovarian formations.

Diagnosis of inflammatory diseases of the pelvic organs

The diagnosis is established on the basis of the patient's complaints, the history of life and disease, the results of a general examination and gynecological examination. The nature of morphological changes in the internal genital organs (salpingoophoritis, endometritis, endomyometritis, tubo-ovarian abscess, pyosalpinx, inflammatory tubo-ovarian formation, pelvioperitonitis, peritonitis), the course of the inflammatory process (acute, subacute, chronic) are taken into account. The diagnosis must reflect the presence of concomitant gynecological and extragenital diseases.

All patients during the examination should examine the discharge from the urethra, vagina, cervical canal (if necessary, washings from the rectum) in order to determine the flora and sensitivity of the isolated pathogen to antibiotics, as well as discharge from the fallopian tubes, the contents of the abdominal cavity (effusion), obtained by laparoscopy or abdominal surgery.

To determine the degree of microcirculation disorders, it is advisable to determine the number of erythrocytes, aggregation of erythrocytes, hematocrit, the number of platelets and their aggregation. From the indicators of nonspecific protection, the phagocytic activity of leukocytes should be determined.

To establish the specific etiology of the disease, serological and enzyme immunoassay methods are used. If tuberculosis is suspected, tuberculin reactions should be performed.

Of the additional instrumental methods, ultrasound, computed tomography of small organs, and laparoscopy are used. In the absence of the possibility of performing laparoscopy, the abdominal cavity is punctured through the posterior fornix of the vagina.

Diagnostic notes

Due to the wide range of symptoms and signs, the diagnosis of acute pelvic inflammatory disease in women presents significant challenges. Many women with pelvic inflammatory disease have mild or moderate symptoms that are not always recognized as pelvic inflammatory disease. Therefore, delay in diagnosis and delay in appropriate treatment leads to inflammatory complications in the upper reproductive tract. To obtain a more accurate diagnosis of salpingitis and for a more complete bacteriological diagnosis, laparoscopy can be used. However, this diagnostic technique is often not available in either acute cases or in milder cases where symptoms are mild or vague. Moreover, laparoscopy is unsuitable for detecting endometritis and mild inflammation of the fallopian tubes. Therefore, as a rule, the diagnosis of inflammatory diseases of the pelvic organs is carried out on the basis of clinical signs.

Clinical diagnosis of acute inflammatory diseases of the pelvic organs is also not sufficiently accurate. The data show that in the clinical diagnosis of symptomatic pelvic inflammatory disease, positive predictive values (PPV) for salpingitis are 65-90% compared with laparoscopy as standard. PPVs for the clinical diagnosis of acute pelvic inflammatory disease vary depending on the epidemiological characteristics and type of medical institution; they are higher for sexually active young women (especially adolescents), for patients attending STD clinics, or living in areas with a high prevalence of gonorrhea and chlamydia. However, there is no single history, physical, or laboratory criterion that has the same sensitivity and specificity for diagnosing an acute episode of pelvic inflammatory disease (i.e., a criterion that can be used to identify all cases of PID and to exclude all women without pelvic inflammatory disease). pelvis). When combining diagnostic techniques that improve either sensitivity (find more women with PID) or specificity (exclude more women who do not have PID), this only comes at the expense of the other. For example, requiring two or more criteria excludes more women without pelvic inflammatory disease, but also reduces the number of identified women with PID.

A large number of episodes of pelvic inflammatory disease remain unrecognized. While some women experience PID asymptomatically, others go undiagnosed because a healthcare provider may not correctly interpret mild or nonspecific symptoms and signs such as unusual bleeding, dyspareunia, or vaginal discharge ("atypical PID"). Due to the difficulties of diagnosis and the possibility of a violation of the reproductive health of a woman, even with a mild or atypical course of inflammatory diseases of the pelvic organs, experts recommend that medical workers use the "low threshold" of diagnosis for PID. Even under these circumstances, the impact of early treatment in women with asymptomatic or atypical PID on clinical outcome is unknown. The presented recommendations for the diagnosis of pelvic inflammatory disease are necessary in order to help healthcare professionals to suspect the possibility of the presence of pelvic inflammatory disease and to have additional information for the correct diagnosis. These recommendations are based in part on the fact that the diagnosis and management of other common cases of lower abdominal pain (eg, ectopic pregnancy, acute appendicitis, and functional pain) is unlikely to be worsened if a healthcare provider initiates empiric antimicrobial treatment for pelvic inflammatory disease.

Minimum Criteria

Empiric treatment of pelvic inflammatory disease should be considered in sexually active young women and others at risk of STDs if all of the following criteria are met and there is no other underlying cause for the patient:

Pain on palpation in the lower abdomen
Pain in the appendages, and
Painful traction of the cervix.

Additional Criteria

An overestimation of the diagnostic value is often justified, as misdiagnosis and treatment can lead to serious consequences. These additional criteria can be used to increase the specificity of the diagnosis.

The following are additional criteria that support the diagnosis of pelvic inflammatory disease:

Temperature above 38.3°C,
Pathological discharge from the cervix or vagina,
elevated ESR,
Elevated levels of C-reactive protein,
Laboratory confirmation of N. gonorrhoeae or C. trachomatis cervical infection.

Below are the defining criteria for the diagnosis of inflammatory diseases of the pelvic organs, which prove the selected cases of diseases:

Histopathological finding of endometritis on endometrial biopsy,
Ultrasound with a transvaginal probe (or using other technologies) showing thickened, fluid-filled fallopian tubes with or without free fluid in the abdominal cavity or the presence of a tubo-ovarian mass,
Abnormalities found during laparoscopy consistent with PID.

Although the decision to initiate treatment may be made before a bacteriological diagnosis of N. gonorrhoeae or C. trachomatis infections is made, confirmation of the diagnosis emphasizes the need to treat sexual partners.

Treatment of pelvic inflammatory disease

If acute inflammation is detected, the patient should be hospitalized in a hospital, where she is provided with a therapeutic and protective regimen with strict observance of physical and emotional rest. Assign bed rest, ice on the hypogastric region (2 hours with breaks of 30 minutes - 1 hour for 1-2 days), sparing diet. Carefully monitor the activity of the intestines, if necessary, prescribe warm cleansing enemas. Patients benefit from bromine preparations, valerian, sedatives.

Etiopathogenetic treatment of patients with inflammatory diseases of the pelvic organs involves the use of both conservative therapy and timely surgical treatment.

Conservative treatment of acute inflammatory diseases of the upper genital organs is carried out in a complex manner and includes:

antibacterial therapy;
detoxification therapy and correction of metabolic disorders;
anticoagulant therapy;
immunotherapy;
symptomatic therapy.

Antibacterial therapy

Since the microbial factor plays a decisive role in the acute stage of inflammation, antibiotic therapy is the determining factor during this period of the disease. On the first day of the patient's stay in the hospital, when there are still no laboratory data on the nature of the pathogen and its sensitivity to a particular antibiotic, the presumptive etiology of the disease is taken into account when prescribing drugs.

In recent years, the effectiveness of the treatment of severe forms of purulent-inflammatory complications has increased with the use of beta-lactam antibiotics (augmentin, meronem, thienam). The "gold" standard is the use of clindamycin with gentamicin. It is recommended to change antibiotics after 7-10 days with repeated determination of antibiograms. In connection with the possible development of local and generalized candidiasis during antibiotic therapy, it is necessary to study hemo- and urocultures, as well as prescribe antifungal drugs.

If oligoanuria occurs, an immediate review of the doses of antibiotics used is indicated, taking into account their half-life.

Treatment regimens for pelvic inflammatory disease should empirically eliminate a wide range of possible pathogens, including N. gonorrhoeae, C. trachomatis, Gram-negative facultative bacteria, anaerobes, and streptococci. Although some antimicrobial regimens have been shown to be effective in achieving clinical and microbiological cure in a clinical randomized trial with short-term follow-up, there are few studies evaluating and comparing the elimination of endometrial and fallopian tube infection or the incidence of long-term complications such as tubal infertility and ectopic pregnancy.

All regimens should be effective against N. gonorrhoeae and C. trachomatis, as negative tests for these infections in the endocervix do not rule out infection in the upper reproductive tract. While the need for anaerobic eradication in women with PID is still controversial, there is evidence that it may be important. Anaerobic bacteria isolated from the upper reproductive tract of women with PID and those obtained in vitro clearly show that anaerobes such as B. fragilis can cause tubal and epithelial destruction. In addition, many women with PID are also diagnosed with bacterial vaginosis. In order to prevent complications, the recommended regimens should include drugs that act on anaerobes. Treatment should be started immediately upon establishing a preliminary diagnosis, since the prevention of long-term consequences is directly related to the timing of the appointment of appropriate antibiotics. When choosing a treatment regimen, the physician should consider its availability, cost, patient acceptability, and sensitivity of pathogens to antibiotics.

In the past, many experts have recommended that all patients with PID be hospitalized so that parenteral antibiotic treatment can be administered under medical supervision under bed rest. However, hospitalization is no longer synonymous with parenteral therapy. There are currently no data available that would show the comparative efficacy of parenteral and oral treatment, or inpatient or outpatient treatment. Until data from ongoing studies comparing parenteral inpatient versus oral outpatient treatment in women with PID become available, clinical observational data should be considered. The doctor makes a decision on the need for hospitalization based on the following recommendations, based on observational data and theoretical developments:

Conditions requiring urgent surgical intervention, such as appendicitis,
The patient is pregnant
Unsuccessful treatment with oral antimicrobials,
Inability to comply with or tolerate outpatient oral regimen,
Severe illness, nausea and vomiting, or high fever.
tubo-ovarian abscess
The presence of immunodeficiency (HIV infection with a low CD4 count, immunosuppressive therapy or other diseases).

Most clinicians conduct at least 24 hours of direct observation in the hospital of patients with tubo-ovarian abscesses, after which adequate parenteral treatment should be given at home.

There are no convincing data comparing parenteral and oral regimens. A lot of experience has been accumulated in the application of the following schemes. Also, there are multiple randomized trials demonstrating the effectiveness of each regimen. Although most of the studies used parenteral treatment for at least 48 hours after the patient showed significant clinical improvement, this regimen was administered arbitrarily. Clinical experience should guide the decision to switch to oral treatment, which can be made within 24 hours of the onset of clinical improvement.

Scheme A for parenteral treatment

Cefotetan 2 g IV every 12 hours
or Cefoxitin 2 g IV every 6 hours
plus doxycycline 100 mg IV or po q 12 hours.

NOTE. Given that intravenous administration of drugs is associated with pain, doxycycline should be administered orally whenever possible, even if the patient is in the hospital. Oral and intravenous treatment with doxycycline has similar bioavailability. If intravenous administration is required, the use of lidocaine or other fast-acting local anesthetics, heparin, or steroids, or prolongation of the infusion time may reduce infusion complications. Parenteral treatment may be discontinued 24 hours after the patient is clinically improved, and oral doxycycline 100 mg twice daily should be continued for up to 14 days. In the presence of a tubo-ovarian abscess, many physicians use clindamycin or metronidazole with doxycycline to continue treatment, rather than doxycycline alone, as this contributes to a more effective overlap of the entire spectrum of pathogens, including anaerobes.

Clinical data on second- or third-generation cephalosporins (eg, ceftizoxime, cefotaxime, or ceftriaxone) that can replace cefoxitin or cefotetan are limited, although many authors believe that they are also effective in PID. However, they are less active against anaerobic bacteria than cefoxitin or cefotetan.

Scheme B for parenteral treatment

Clindamycin 900 mg IV every 8 hours
plus Gentamicin - IV or IM loading dose (2 mg/kg body weight) followed by maintenance dose (1.5 mg/kg) every 8 hours.

NOTE. Although the use of a single dose of gentamicin has not been studied in the treatment of pelvic inflammatory disease, its effectiveness in other similar situations is well established. Parenteral treatment may be interrupted 24 hours after the patient has clinical improvement, and then switched to oral treatment with doxycycline 100 mg 2 times a day or clindamycin 450 mg orally 4 times a day. The total duration of treatment should be 14 days.

For tubo-ovarian abscess, many health care providers use clindamycin rather than doxycycline to continue treatment because it is more effective against anaerobic organisms.

Alternative parenteral regimens

There is limited data on the use of other parenteral regimens, but the following three regimens have been in at least one clinical trial and shown to be effective against a wide range of organisms.

Ofloxacin 400 mg IV every 12 hours
or Ampicillin/sulbactam 3 g IV every 6 hours
or Ciprofloxacin 200 mg IV every 12 hours
plus doxycycline 100 mg orally or IV every 12 hours.
plus Metronidazole 500 mg IV every 8 hours.

The ampicillin/sulbactam with doxycycline regimen was effective against N. gonorrhoeae, C. trachomatis, and anaerobes and was effective in patients with tubo-ovarian abscess. Both intravenous drugs, ofloxacin and ciprofloxacin, have been studied as monotherapy drugs. Given the data obtained on the ineffective effect of ciprofloxacin on C. trachomatis, it is recommended to routinely add doxycycline to treatment. Since these quinolones are active only against a subset of anaerobes, metronidazole should be added to each regimen.

oral treatment

There are few data on the immediate and long-term outcomes of treatment, both in the parenteral regimen and in the outpatient regimen. The following regimens provide antimicrobial activity against the most common causative agents of PID, but clinical trial data on their use are very limited. Patients who do not improve with oral treatment within 72 hours should be re-examined to confirm the diagnosis and begin parenteral treatment on an outpatient or inpatient basis.

Scheme A

Ofloxacin 400 mg twice daily for 14 days
plus Metronidazole 500 mg orally twice a day for 14 days

Oral ofloxacin, used as monotherapy, has been studied in two well-designed clinical trials and has been shown to be effective against N. gonorrhoeae and C. trachomatis. However, given that ofloxacin is still not sufficiently effective against anaerobes, the addition of metronidazole is necessary.

Scheme B

Ceftriaxone 250 mg IM once
or Cefoxitin 2 g IM plus Probenecid 1 g orally once at a time
or Other third-generation parenteral cephalosporin (eg, ceftizoxime, cefotaxime),
plus doxycycline 100 mg orally twice a day for 14 days. (Use this circuit with one of the above circuits)

The optimal choice of cephalosporin for this regimen has not been determined; while cefoxitin is active against more anaerobic species, ceftriaxone is more effective against N. gonorrhoeae. Clinical trials have shown that a single dose of cefoxitin is effective in obtaining a rapid clinical response in women with PID, however, theoretical data indicate the need to add metronidazole. Metronidazole will also effectively treat bacterial vaginosis, which is often associated with PID. No data have been published on the use of oral cephalosporins for the treatment of PID.

Alternative outpatient regimens

Information on the use of other outpatient regimens is limited, but one regimen has received at least one clinical trial showing efficacy against a wide range of pathogens in pelvic inflammatory disease. When amoxicillin/clavulanic acid was combined with doxycycline, a rapid clinical effect was obtained, however, many patients were forced to interrupt the course of treatment due to undesirable symptoms from the gastrointestinal tract. Several studies have evaluated azithromycin in the treatment of upper reproductive tract infections, however, these data are not sufficient to recommend this drug for the treatment of pelvic inflammatory disease.

Detoxification therapy and correction of metabolic disorders

This is one of the most important components of treatment aimed at breaking the pathological circle of cause-and-effect relationships that occur in purulent-inflammatory diseases. It is known that these diseases are accompanied by a violation of all types of metabolism, the excretion of a large amount of fluid; there is an imbalance of electrolytes, metabolic acidosis, renal and hepatic insufficiency. Adequate correction of the identified violations is carried out jointly with resuscitators. When carrying out detoxification and correction of water-electrolyte metabolism, two extreme conditions should be avoided: insufficient fluid intake and overhydration of the body.

In order to eliminate these errors, it is necessary to control the amount of fluid introduced from the outside (drink, food, medicinal solutions) and excreted in the urine and other ways. The calculation of the introduced risk should be individual, taking into account the indicated parameters and the patient's condition. Correct infusion therapy in the treatment of acute inflammatory and purulent-inflammatory diseases is no less important than the prescription of antibiotics. Clinical experience shows that a patient with stable hemodynamics with adequate replenishment of BCC is less susceptible to the development of circulatory disorders and the occurrence of septic shock.

The main clinical signs of the restoration of BCC, the elimination of hypovolemia are CVP (60-100 mm of water column), diuresis (more than 30 ml / h without the use of diuretics), improvement of microcirculation (skin color, etc.).

Anticoagulant therapy

With widespread inflammatory processes, pelvioperitone, peritonitis, thromboembolic complications are possible in patients, as well as the development of disseminated intravascular coagulation (DIC).

Currently, one of the first signs of DIC is thrombocytopenia. Reducing the number of platelets to 150 x 10 3 /l is the minimum that does not lead to hypocoagulable bleeding.

In practice, the determination of the prothrombin index, platelet count, fibrinogen level, fibrin monomers, and blood clotting time is sufficient for the timely diagnosis of DIC. For the prevention of DIC and with a slight change in these tests, heparin is prescribed at 5000 IU every 6 hours under the control of blood clotting time within 8-12 minutes (according to Lee White). The duration of heparin therapy depends on the speed of improvement of laboratory data and is usually 3-5 days. Heparin should be given before clotting factors are significantly reduced. Treatment of DIC, especially in severe cases, is extremely difficult.

Immunotherapy

Along with antibacterial therapy in conditions of low sensitivity of pathogens to antibiotics, agents that increase the general and specific reactivity of the patient's body are of particular importance, since generalization of infection is accompanied by a decrease in cellular and humoral immunity. Based on this, complex therapy includes substances that increase immunological reactivity: antistaphylococcal gamma globulin and hyperimmune antistaphylococcal plasma. Gamma globulin is used to increase nonspecific reactivity. An increase in cellular immunity is facilitated by drugs such as levamisole, taktivin, thymogen, cycloferon. In order to stimulate the immune system, efferent therapy methods (plasmapheresis, ultraviolet and laser blood irradiation) are also used.

Symptomatic treatment

An essential condition for the treatment of patients with inflammatory diseases of the upper genital organs is effective pain relief using both analgesics and antispasmodics, and inhibitors of prostaglandin synthesis.

It is mandatory to introduce vitamins based on the daily requirement: thiamine bromide - 10 mg, riboflavin - 10 mg, pyridoxine - 50 mg, nicotinic acid - 100 mg, cyanocobalamin - 4 mg, ascorbic acid - 300 mg, retinol acetate - 5000 units.

The appointment of antihistamines (suprastin, tavegil, diphenhydramine, etc.) is shown.

Rehabilitation of patients with inflammatory diseases of the upper genital organs

Treatment of inflammatory diseases of the genital organs in a woman necessarily includes a set of rehabilitation measures aimed at restoring the specific functions of the female body.

To normalize menstrual function after acute inflammation, medications are prescribed, the action of which is aimed at preventing the development of algomenorrhea (antispasmodics, non-steroidal anti-inflammatory drugs). The most acceptable form of administration of these drugs are rectal suppositories. Restoration of the ovarian cycle is carried out by the appointment of combined oral contraceptives.

Physiotherapeutic methods in the treatment of inflammatory diseases of the pelvic organs are prescribed differentially, depending on the stage of the process, the duration of the disease and the effectiveness of the previous treatment, the presence of concomitant extragenital pathology, the state of the central and autonomic nervous system and the age characteristics of the patient. The use of hormonal contraception is recommended.

In the acute stage of the disease, at a body temperature below 38 ° C, UHF is prescribed for the hypogastric region and the lumbosacral plexus according to the transverse method in a non-thermal dosage. With a pronounced edematous component, combined exposure to ultraviolet light on the panty zone in 4 fields is prescribed.

With a subacute onset of the disease, the appointment of a microwave electromagnetic field is preferable.

With the transition of the disease to the stage of residual phenomena, the task of physiotherapy is to normalize the trophism of suffering organs due to changes in vascular tone, the final relief of edematous phenomena and pain syndrome. For this purpose, reflex methods of exposure to currents of supratonal frequency are used. D "Arsonval, ultrasound therapy.

When the disease passes into the remission stage, heat and mud therapy procedures (paraffin, ozocerite) are prescribed for the area of the panty zone, balneotherapy, aerotherapy, helio- and thalassotherapy.

In the presence of chronic inflammation of the uterus and its appendages in the period of remission, it is necessary to prescribe resolving therapy using biogenic stimulants and proteolytic enzymes. The duration of rehabilitation measures after acute inflammation of the internal genital organs is usually 2-3 menstrual cycles. A pronounced positive effect and a decrease in the number of exacerbations of chronic inflammatory processes are observed after spa treatment.

Surgical treatment of purulent-inflammatory diseases of the internal genital organs

Indications for surgical treatment of purulent-inflammatory diseases of the female genital organs are currently:

Lack of effect during conservative complex therapy for 24-48 hours.
Deterioration of the patient's condition during a conservative course, which can be caused by perforation of a purulent formation into the abdominal cavity with the development of diffuse peritonitis.
Development of symptoms of bacterial toxic shock. The volume of surgical intervention in patients with inflammatory diseases of the uterine appendages depends on the following main points:
1. the nature of the process;
2. concomitant pathology of the genital organs;
3. the age of the patients.

It is the young age of patients that is one of the main points that determine the adherence of gynecologists to sparing operations. In the presence of concomitant acute pelvioperitonitis With purulent lesions of the uterine appendages, the uterus is extirpated, since only such an operation can ensure the complete elimination of the infection and good drainage. One of the important points in the surgical treatment of purulent inflammatory diseases of the uterine appendages is the complete restoration of normal anatomical relationships between the organs of the small pelvis, abdominal cavity and surrounding tissues. It is necessary to make an audit of the abdominal cavity, determine the condition of the appendix and exclude interintestinal abscesses with a purulent nature of the inflammatory process in the uterine appendages.

In all cases, when performing an operation for inflammatory diseases of the uterine appendages, especially with a purulent process, one of the main principles should be the principle of mandatory complete removal of the focus of destruction, i.e., inflammatory formation. No matter how gentle the operation is, it is always necessary to completely remove all tissues of the inflammatory formation. Preservation of even a small portion of the capsule often leads to severe complications in the postoperative period, recurrence of the inflammatory process, and the formation of fistulas. During surgical intervention, drainage of the abdominal cavity (colyutomy) is mandatory.

The condition for reconstructive surgery with preservation of the uterus is primarily the absence of purulent endomyometritis or panmetritis, multiple extragenital purulent foci in the pelvis and abdominal cavity, as well as concomitant severe genital pathology (adenomyosis, fibroids) established before or during the operation.

In women of reproductive age, if there are conditions, it is necessary to perform extirpation of the uterus with the preservation, if possible, of at least part of the unchanged ovary.

In the postoperative period, complex conservative therapy continues.

Follow-up

In patients receiving oral or parenteral treatment, significant clinical improvement (eg, decrease in temperature, decrease in abdominal muscle tension, decrease in tenderness during examination of the uterus, appendages and cervix) should be observed within 3 days from the start of treatment. Patients in whom such improvement is not observed require clarification of the diagnosis or surgical intervention.

If the physician has opted for outpatient oral or parenteral treatment, follow-up and evaluation of the patient should be carried out within 72 hours using the above criteria for clinical improvement. Some experts also recommend repeat screening for C. trachomatis and N. gonorrhoeae 4–6 weeks after completion of therapy. If PCR or LCR is used to control cure, then a second study should be carried out one month after the end of treatment.

Management of sexual partners

Examination and treatment of sexual partners (who were in contact in the previous 60 days before the onset of symptoms) of women with PID is necessary because of the risk of reinfection and the high probability of detecting gonococcal or chlamydial urethritis in them. Male sexual partners of women with PID caused by gonorrhea or chlamydia often do not have symptoms.

Sexual partners should be treated empirically according to the treatment regimen for both infections, regardless of whether the causative agent for pelvic inflammatory disease has been identified.

Even in clinics where only women are seen, health care providers should ensure that men who are sexual partners of women with PID are treated. If this is not possible, the healthcare provider treating a woman with PID needs to be sure that her partners have received appropriate treatment.

Special remarks

Pregnancy. Given the high risk of adverse pregnancy outcomes, pregnant women with suspected PID should be hospitalized and treated with parenteral antibiotics.

HIV infection. Differences in the clinical manifestations of PID in HIV-infected and uninfected women are not described in detail. Based on early observational data, it was assumed that HIV-infected women with PID were more likely to need surgery. Subsequent, more comprehensive review studies of HIV-infected women with PID noted that even with more severe symptoms than HIV-negative women, parenteral antibiotic treatment of these patients was successful. In another trial, the results of microbiological studies in HIV-infected and uninfected women were similar, except for a higher incidence of concomitant chlamydial infection and HPV infection, as well as cellular changes caused by HPV. Immunocompromised HIV-infected women with PID require more extensive therapy using one of the parenteral antimicrobial regimens described in this guideline.

Infectious and inflammatory diseases of the pelvic organs (STIs)

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Infectious and inflammatory diseases of the pelvic organs (STIs)

Sexually transmitted infectious diseases represent not only a medical, but also a social and psychological problem in modern society.

WHO estimates that globally, more than 340 million men and women aged 15 to 49 are newly infected with bacterial and protozoal sexually transmitted infections (syphilis, gonorrhea, chlamydial genital infections and trichomoniasis) every year. Therefore, timely detection, prevention and control of STIs are important aspects of public health protection.

STD infections

Sexually transmitted infections can be asymptomatic or have no symptoms, and they can cause severe complications such as infertility, ectopic pregnancy, chronic illness, and even premature death. In unborn and newborn children, chlamydial infections, gonorrhea, and syphilis can cause severe and often life-threatening consequences, including congenital diseases, neonatal pneumonia, and low birth weight. Human papillomavirus infection increases the likelihood of developing cervical cancer, the second leading cause of death in women worldwide from cancer, which kills 240,000 women each year. The risk of contracting or transmitting HIV is greatly increased.

Sexually transmitted infections include:

Papillomavirus infection.
Urogenital chlamydia.
Urogenital trichomoniasis
Genital herpes
Mycoplasma infection
Cytomegalovirus infection

STD symptoms

Despite the difference in the biological properties of these pathogens, they all cause similar symptoms and diseases of the urogenital tract.

Symptoms caused by these pathogens can be as follows:

discharge from the genital tract (from milky, cheesy to yellow-green frothy discharge)
itching, burning
swelling of the tissues of the vagina and vulva (external genitalia)
rashes on the external genital organs in the form of vesicles, which later open with the formation of erosions
finger-shaped or warty growths single, multiple and confluent (in the form of cauliflower) formations
dyspareunia (discomfort or soreness in the vulva and pelvis that occurs during sexual intercourse)
dysuria (discomfort or pain when urinating)

One of the first signs of a possible STI infection is discharge from the genital tract. This symptom can be caused by a number of diseases.

Trichomoniasis

However, the current course of trichomoniasis is distinguished by the erased signs of the inflammatory process, which appear only with a thorough examination of the patient by a doctor. Periodic exacerbations may occur, which are most often caused by sexual intercourse, alcohol consumption, a decrease in body resistance, and ovarian dysfunction.

Urogenital chlamydia(Chlamydial Genitourinary Infections)

A highly contagious infectious disease affecting mainly the genitourinary system, caused by certain serotypes of chlamydia (Chlamydia trachomatis), sexually transmitted, leading to the development of inflammatory changes in the organs of the genitourinary system and having a significant impact on the generative function of a woman. For example, chlamydia is detected in 80% of women who were sexual partners of men infected with chlamydia. Patients who do not have pronounced symptoms of the disease represent a special epidemiological danger in these infections. The disease is the cause of the formation of a pronounced adhesive process of the small pelvis, tubal-peritoneal infertility.

Urogenital mycoplasmas

Urogenital mycoplasmas (ureaplasma urealytica, ureaplasma parvum, mycoplasma genitalium, mycoplasma hominis) are conditionally pathogenic microorganisms, but under certain conditions they can cause diseases such as urethritis, prostatitis, pyelonephritis, arthritis, postpartum endometritis, pathology of pregnancy, fetus and newborn, sepsis and others. These microorganisms are identified as possible etiological agents of non-specific non-gonococcal urethritis, inflammatory diseases of the pelvic organs and bacterial vaginosis.

Genital herpes

Chronic, relapsing, viral disease, transmitted mainly through sexual contact. The main causative agent of genital herpes in most cases (70-80%) is the herpes simplex virus type 2 (HSV-2). Herpes simplex virus type 1 (HSV-1) - usually causes lesions of the lips, face, hands, torso, however, in recent years, the frequency of genital herpes caused by this type of virus has increased (20-30% of cases), which, apparently, is associated with change in sexual behavior.

Infection occurs through sexual contact with a partner who has a clinically significant or asymptomatic herpes infection. The entrance gates are intact mucous membranes and damaged skin.

Cytomegalovirus infection

A widespread infection circulating in the human population is cytomegalovirus infection (CMVI). In the first year of life, antibodies to CMV are found in 20% of children, in children attending kindergartens, the prevalence of infection is 25-80%, in the adult population, antibodies to CMV are found in 85-90% of the population. The relevance of the study of CMVI is due to the fact that cytomegalovirus can cause adverse consequences after infection in newborns and children of the first year of life, whose mothers had an infection during pregnancy. The source of infection can be a virus carrier, a patient with an acute form (in case of primary infection) or a patient during an exacerbation of the infection. The main routes of infection transmission are airborne, sexual, contact, oral, parenteral, enteral and vertical routes, while the transmission of viruses can be carried out through all biological fluids and excretions of the body (saliva, urine, etc.). When it enters the body, the virus, after the initial infection, can remain in the body for life. The infection may be asymptomatic (carrier) due to the fact that the virus is protected by lymphocytes from the action of specific antibodies and interferon.

papillomavirus infection

Human papillomavirus infection (PVI) Human papillomavirus infection (HPV) - initiates a number of diseases of the genital organs associated with the human papillomavirus (HPV). Human papillomavirus infection (PVI) is one of the most common in the world today. The virus is not limited to the traditional risk group and HPV-associated diseases are common in all sectors of society. Almost all people who are sexually active can be attributed to the risk group for infection with the human papillomavirus. In the world, about 630 million people are infected with HPV. Already 2 years after the onset of sexual activity, up to 82% of women are considered infected with the virus. The peak of HPV infection occurs at a young age (16-25 years) - adolescents and young women, representing the most sexually active part of the population. Cofactors for HPV infection are early onset of sexual activity, frequent change of sexual partner, other sexually transmitted infections, and smoking.

Long-term infection with certain (oncogenic) types of human papillomavirus (HPV) can cause cervical cancer in women and anogenital cancer in both sexes.

Vulvovaginal candidiasis

Vulvovaginal candidiasis (thrush) is not a sexually transmitted disease, due to infection of the vulva and vagina with yeast-like fungi of the genus Candida, their overgrowth. These microorganisms are natural inhabitants of the human body, but under certain conditions they can multiply rapidly and cause trouble. Approximately 75% of women experience at least one episode of vulvovaginal candidiasis in their lifetime, and 25% of women have had vulvovaginal candidiasis for many years.

The following factors can provoke the development of candidiasis: antibiotic treatment, pregnancy, the use of oral contraceptives, decreased immunity, diabetes mellitus, wearing tight-fitting synthetic clothing, frequent use of tampons, a high-calorie diet rich in carbohydrates (flour products and sweets). A woman is disturbed by abundant vaginal discharge, often white, with “milky” color plaques; itching, burning sensation or irritation in the vulva; increased vulvovaginal itching in warmth (during sleep or after a bath); increased sensitivity of the mucosa to water and urine; increased itching and pain after intercourse.

Bacterial vaginosis

Not related to STIs, but is one of the most common vaginal disorders in women of reproductive age - bacterial vaginosis. This is a polymicrobial clinical syndrome that develops as a result of the replacement of normal flora (lactobacilli) in the vagina by a large number of opportunistic pathogens (anaerobic bacteria) and is accompanied by abundant vaginal discharge.

The problem of bacterial vaginosis is currently very relevant, since its causes have not been finally clarified, the methods of treatment are far from perfect, and the number of sick women is steadily growing. According to various authors, 25-45% of women today suffer from this disease. This disease is characterized by a recurrent nature of the course and requires careful diagnosis.

Diagnosis of STIs

Diagnosis is based on data from laboratory and functional research methods.

Modern research methods necessary to determine the tactics of treating a patient:

nucleic acid amplification methods (NAAT - PCR, PCR-real time)
cultural method of research - sowing (isolation of the pathogen in cell culture)

enzyme immunoassay (determination of specific antibodies to pathogens in the blood)
microscopic examination of discharge (vagina, urethra)
cytological research method
clinical analysis of blood and urine;
biochemical blood test and urinalysis;
Ultrasound of the pelvic organs;
determination of the immune status (interferon status with determination of the sensitivity of interferon-producing cells to immunomodulators)
aspiration of the contents of the uterine cavity, if necessary

The choice of tactics and method of treatment is determined by the doctor based on the results of the examination of the patient.

One of the most common gynecological pathologies is pelvic inflammatory disease in women. Pelvic inflammatory disease is diagnosed annually in every three hundred women. About 15% of women with this diagnosis may become infertile. Most often, this pathological condition is provoked by a sexually transmitted infection: chlamydia and gonorrhea. Young women who have not managed to cross the twenty-five-year milestone and are promiscuous are at the greatest risk of getting sick.

Main symptoms

Gynecologists distinguish the following symptoms of pelvic inflammatory disease in women:

If a woman does not pay attention to the primary symptoms, the situation may worsen and develop into a more severe form that will be difficult to treat.

Many inflammatory symptoms are unbearable and debilitating. The patient becomes difficult to carry out daily activities, work or study. Against the background of fatigue and weakness, the body temperature rises. Irritability and tearfulness appear, the menstrual cycle is disturbed.

The main provoking factors

Pelvic inflammation is provoked by:

frequent change of sexual partners;
difficult childbirth and pregnancy;
prolonged wearing of the uterine spiral;
uterine scraping;
intrauterine interventions;
termination of pregnancy for 12-24 months.

Another provoking factor is non-compliance with the rules of personal hygiene. This applies to women who use other people's towels, carelessly refer to public toilets and rarely wash themselves during menstruation.

The main infectious pathogens of the pathological condition include gram-negative enterobacteria, staphylococci, anaerobic microorganisms, E. coli, enterococci, mycoplasmas, proteus and streptococci.

What are the complications

Due to incorrect or untimely therapy, such a dangerous complication develops as a violation of the patency and elasticity of the uterine tubes. Some women become infertile. The risk of infertility increases with each subsequent inflammatory episode.

The danger of an ectopic pregnancy lies in the destruction of the walls of the uterine tube. This process is accompanied by severe pain. Internal bleeding occurs, which can lead to the death of a woman. A less serious consequence is chronic pelvic pain syndrome. It has been present for several years.

The main forms of pathology

Gynecologists distinguish the following inflammatory processes:

oophoritis;
salpingitis;
vaginitis;
pelvioperitonitis;
parametritis;
vaginosis;
bartholinitis.

Oophoritis is an inflammatory process that affects the ovaries. Its course is combined with salpingitis or inflammation of the fallopian tubes. It is acute, subacute and chronic. The main symptoms are excruciating pain in the groin, lower abdomen and lower back. The acute form is characterized by fever, chills, the presence of severe pain in the abdomen, as well as intoxication of the body.

With vaginitis, the lining of the vagina becomes inflamed. The pathological process develops against the background of the penetration of protozoa and bacteria into the body. It is characterized by a painful burning sensation in the genitals. The acute form is characterized by symptoms such as copious discharge with the smell of rotten fish and pain.

When inflammation affects the serous cover of the pelvic peritoneum, a woman is diagnosed with pelvioperitonitis. This pathology is characterized by the appearance of a strong fever, which is accompanied by chills and intoxication. The abdomen swells, the muscles of the abdominal wall tense. There are so-called peritoneal symptoms or symptoms of "acute abdomen".

The inflammatory process that occurs in the external structures of the uterus and has a purulent-infiltrative character is defined as parametritis. It is a consequence of difficult childbirth, complicated abortion and gynecological surgery. At the same time, the temperature rises, the person complains of malaise and the appearance of painful sensations in the lower abdomen.

Vaginosis is provoked by an infection, but does not have an inflammatory nature. This disease is characterized by pain during intercourse, vaginal dryness, spasms and a decrease in lactoflora. Sometimes with vaginosis, it is completely absent.

With inflammation of the large gland of the vaginal vestibule, bartholinitis is diagnosed. This pathological process develops in women older than 20 years. Today, every fiftieth woman is diagnosed with such a diagnosis.

How can you help

If acute inflammation is diagnosed, the woman is shown hospitalization in a hospital. The patient is assigned strict bed rest. The patient undertakes to adhere to a sparing diet. The activity of her intestines is under strict medical supervision. Sometimes the patient's condition involves the appointment of cleansing non-cold enemas.

Medicines such as Metronidazole, Clindamycin, Tinidazole are prescribed. Valerian and bromine preparations bring great benefits to the body. Also, the patient may be prescribed the use of sedative drugs.

When the doctor resorts to conservative therapy, he prescribes the passage for the patient:

symptomatic treatment;
immunotherapy;
anticoagulant treatment;
detox treatment;
antibacterial treatment.

Also, violations of metabolic processes are corrected. Some cases require immediate surgical intervention. The operation is prescribed in the presence of a tubo-ovarian abscess and when the disease "does not respond" to antimicrobial drugs.

A woman should carefully monitor compliance with the rules of intimate hygiene. Turning to the doctor, she is obliged to indicate each “suspicious” sign. This will help to correctly diagnose the pathology. The sexual partner must also undergo treatment.

Inflammatory diseases of the pelvic organs are very common in gynecology. They are a consequence of or accompany infections of the female reproductive organs. The cause of PID is the causative agents of sexually transmitted infections: fungi, viruses, pyogenic microflora, pathogenic and opportunistic microorganisms.

Symptoms of inflammatory diseases of the female genital organs are often mild, without pain and discomfort. If the pathology is not detected in time and treatment is not started, PID will lead to irreversible damage to the uterus, ovaries, fallopian tubes and will cause serious gynecological and obstetric complications.

Etiology and classification of PID

Inflammatory diseases of the pelvic organs occur as a result of the upward spread of infection from the vagina and cervical canal to the uterine mucosa, fallopian tubes, ovaries and peritoneum.

Most often, the infection is transmitted sexually. Aerobic and anaerobic bacteria, chlamydia, mycoplasmas, gonococci, and sometimes several microorganisms at once penetrate the upper reproductive system with the help of spermatozoa.

The causative agents of septic infection can enter the genitals through the blood or lymph from distant foci of inflammation, for example, with follicular tonsillitis, otitis, purulent appendicitis.

Diseases that are caused by sexually transmitted infections are called specific. These include trichomoniasis, chlamydia, gonorrhea, syphilis, herpetic and papillomavirus infections, and others.

The cause of nonspecific inflammatory diseases are conditionally pathogenic microorganisms: staphylococci, Escherichia coli, streptococci, Pseudomonas aeruginosa, fungi and others. Normally, they are in the microflora of the body in an inactive state, but under certain conditions they become dangerous and cause disease.

There are pathologies of the lower and upper parts of the small pelvis. Diseases of the lower sections:

Vulvitis is inflammation of the vulva.
Bartholinitis - inflammation of the large gland of the vestibule of the vagina.
Colpitis (vaginitis) is an inflammatory process of the vaginal mucosa. Often combined with vulvitis, urethritis.
Endocervicitis - inflammation of the mucous membrane of the cervical canal.
Cervicitis is an inflammation of the cervix.

Diseases of the upper sections:

Endometritis is an inflammation of the inner lining of the uterine cavity.
Salpingitis is an inflammation of the fallopian tubes.
Oophoritis - inflammation of the ovary.
Salpingoophoritis or adnexitis - inflammation of the uterine appendages: tubes, ovaries, ligaments.
Parametritis - inflammation of the connective tissue around the uterus.
Pelvioperitonitis - inflammation of the pelvic peritoneum.
Tuboovarian abscess - purulent inflammation of the uterine appendages.

The causes of the occurrence and development of pathologies are:

previous infectious diseases;
injuries, mechanical damage to the pelvic organs;
inflammatory processes in neighboring organs: appendicitis, colitis, cystitis, urethritis, ICD;
improper use of intravaginal tampons;
surgical interventions during abortion, diagnostic curettage of the uterine cavity, the introduction of an intrauterine device;
endocrine disorders;
reaction to local contraceptives;
prolonged uncontrolled use of antibiotics or hormonal drugs.

Provoking factors are hypothermia, constant stress, frequent colds, inadequate and irrational nutrition.

Clinical manifestations of PID

There are acute and chronic stages of inflammatory diseases of the pelvic organs. The acute stage is rare. Symptoms in which you need to urgently undergo a gynecological examination:

pulling and aching pain in the lower abdomen or lower back;
itching and burning in the vulva;
the appearance of sores, blisters, warts or spots near the entrance to the vagina, the anus, on the vulva;
enlarged inguinal lymph nodes;
violation of menstrual function: delays, heavy and painful periods;
yellowish or greenish purulent discharge from the vagina with a pungent odor;
pain when urinating;
discomfort during intercourse;
general weakness, fever (sometimes up to 40 ° C), nausea, vomiting.

More often, the disease does not manifest itself for a long time, the woman feels healthy for several weeks, months or even years. During this time, the disease passes into the chronic stage. Therefore, women need to be examined by a gynecologist at least once a year.

Diagnosis and treatment of pelvic inflammatory disease in women

During the examination, the doctor reveals pain on palpation of the abdomen, uterus and appendages, takes a smear from the cervix and vagina for microflora, prescribes general blood and urine tests, and swabs for genital infections.

Not always smears and other tests reveal an infection, then an ultrasound of the pelvic organs is prescribed to determine inflammation of the fallopian tubes.

In some cases, tissue biopsy may be required to confirm the diagnosis. Especially indicative is laparoscopy, which allows you to assess the condition of the internal organs using a visual examination.

For the treatment of IUMP in women, complex therapy is used. In mild uncomplicated cases, the specialist prescribes medication at home. If the disease is acute, or therapy is ineffective within 48 hours, hospitalization is required.

The therapeutic course necessarily includes the use of broad-spectrum antibiotics and anti-inflammatory drugs. If necessary, the patient is prescribed painkillers, antifungal and antihistamines, as well as local procedures (douching, use of vaginal suppositories), restorative physiotherapy.

Treatment must be completed in full, following all the doctor's prescriptions, in order to avoid the recurrence of the disease.

If a sexually transmitted infection is detected, both partners should be treated. During this period, it is recommended to refrain from intimate relationships. After completion of the course of treatment, a follow-up examination is carried out.

A surgical operation is performed in the absence of the effect of drug treatment of purulent-inflammatory diseases, when the inflammatory process is complicated by the development of an abscess or phlegmon.

Folk remedies can increase immunity, relieve the symptoms of inflammation: relieve pain, itching. They do not kill pathogens. Collections of medicinal herbs for oral administration, douching, vaginal tampons and baths are used only after consultation with your doctor.

You can not use traditional medicine before making a diagnosis. This can make diagnosis difficult.

Possible consequences

If PID is not treated in time and completely, serious violations of the functions of the reproductive organs can occur. Even minor damage to the fallopian tubes can cause adhesions. The adhesions block the normal progression of eggs into the uterus. If the adhesions completely block the fallopian tubes, sperm cannot fertilize the egg and the woman becomes infertile.

In addition, a damaged fallopian tube can block the egg, and after fertilization by a sperm cell, it does not enter the uterine cavity. If a fertilized egg begins to grow in the tube, it will lead to an ectopic pregnancy. WB can cause a severe painful syndrome, life-threatening profuse bleeding, therefore, immediate medical attention is required.

Previously untreated PID can lead to pathologies such as threatened miscarriage, premature birth, intrauterine infection of the fetus, intrauterine growth retardation, postpartum endometritis.

A long-term inflammatory process causes purulent complications, which require surgical intervention, up to the removal of the fallopian tubes and uterus.

Adhesions in the fallopian tubes and other pelvic organs can lead to chronic pelvic pain. Adhesions cause discomfort during intercourse, sports, or ovulation.

The inflammatory process can affect adjacent organs and cause diseases such as proctitis, cystitis, pyelonephritis, paraurethritis and others.

Prevention of PID

To reduce the risk of inflammatory diseases of the pelvic organs, regularly, at least once a year, undergo gynecological examinations for the timely detection of signs of pathology of the pelvic organs.

Eliminate promiscuous sexual intercourse, use barrier contraception, observe genital hygiene: wash your face in the morning and evening, before and after intimate contact, do not use other people's personal hygiene products.

Intrauterine devices are a risk factor. It is especially dangerous to use them for women who have not given birth.

After swimming in a natural reservoir, immediately change a wet swimsuit to a dry one to avoid colds and infection in the vagina.

During your period, use tampons only in an emergency and change them every 3 hours. During this period, sexual intercourse and swimming in natural reservoirs should be excluded. Take a shower instead of a bath.

Proper nutrition helps to increase the body's defenses. Food should be varied. Include enough proteins, vegetables and fruits in your diet.

Avoid abortion and do not self-medicate.

Inflammation of the pelvic organs is the most common condition when women visit a gynecologist. Inflammation of the vagina (vaginitis) and inflammation of the vulva (vulvitis) most often occur together, this process is called vulvovaginitis or colpitis, inflammation of the uterine appendages - fallopian tubes and ovaries - is most common among women who turn to a gynecologist, bartholinitis (inflammation of the gland of the vestibule of the vagina) occurs less often. A separate inflammation of the fallopian tube (salpingitis) or inflammation of only the ovaries (oophoritis) is very rare, more often the inflammatory process is spread to both the tubes and the ovaries (salpingoophoritis) and can be combined with inflammation of the uterus (endometritis), inflammation of the cervix (cervicitis). This is because the genitals in the pelvis are very closely related and inflammation of one leads to inflammation of another organ.

Causes of inflammatory diseases of the pelvic organs

Usually, the inflammatory process in the pelvis is of an infectious origin. Often, starting in the vagina, the inflammatory process goes higher - into the uterus and fallopian tubes, ovaries. Therefore, it is so important to treat vulvovaginitis in a timely and correct manner, preventing it from developing into more serious diseases. A non-specific (non-horrheal) inflammatory process is caused by pathogenic (chlamydia, spirochete, viruses) and opportunistic microorganisms, that is, they are normally present on the mucous membranes of the genital organs and are activated, for example, with a decrease in immunity (staphylococci, streptococci, E. coli, fungi, mycoplasma, gardnerella, etc.). Most often, the infection is mixed.

Note the fact that inflammatory diseases of the female genital organs can also occur with an allergy to any component of the sperm after unprotected intercourse.

Hypothermia can cause inflammation of the uterus, appendages and ovaries only indirectly, provoking a decrease in immunity, in which microbes that have previously entered the genital tract begin to multiply intensively. The same applies to taking drugs that cause the death of some microorganisms and provoke the growth of others. Also, inflammation of the appendages and ovaries can provoke complicated childbirth, abortion, curettage, HSG, hysteroscopy, IUD, chronic endocrine diseases, worms.

The conditions that violate the barrier mechanisms of protection against the penetration of infection into the genital tract and cause the development of the inflammatory process include:

Birth injuries of the perineum, causing the gaping of the genital slit and contributing to the unimpeded penetration of pathogenic microorganisms from the external genital organs into the vagina.
Prolapse of the walls of the vagina.
Mechanical, chemical, thermal factors that have a damaging effect on the epithelium of the vaginal mucosa. These include violation of hygiene rules, frequent douching, the introduction of chemical contraceptives into the vagina, etc. In this case, there is an increased desquamation of the surface layer of the epithelium or dystrophic changes in it. In such cases, the amount of glycogen necessary for the life of Dederlein sticks decreases, the acidity of the vaginal contents decreases, and the formation of secretory immunity factors is disrupted.
Ruptures of the cervix, causing the gaping of the external pharynx or the occurrence of ectropion, while the bactericidal properties of cervical mucus are violated. Isthmic-cervical insufficiency (organic or traumatic) has the same value.
Childbirth, abortion, menstruation. In this case, the cervical mucus, the contents of the vagina are washed out with blood, along with immune defense factors and lactic acid bacteria, and the vagina becomes alkalized. Microorganisms that freely penetrate into the uterus find optimal conditions for their vital activity on a vast wound surface.
An aggravating effect is the use of disinfectants during childbirth and abortion, which completely destroy the saprophytic autoflora of the vagina and create favorable conditions for the introduction of pathogenic microorganisms.
Intrauterine contraceptives. There is evidence of a violation of the bactericidal properties of cervical mucus, while the infection penetrates into the cervical canal and the uterine cavity through the threads of intrauterine devices.
The use of tampons during menstruation. By adsorbing blood, they create optimal conditions for the rapid reproduction of pathogenic microorganisms and inhibition of the protective mechanisms of the vagina. Especially dangerous is the use of these tampons in countries with a hot climate, where in some cases it leads to the development of fulminant sepsis.

Symptoms and signs of pelvic inflammatory disease

Symptoms of inflammation of the vulva and vagina

redness, sometimes swelling and itching, leucorrhoea (vaginal discharge). Already by the nature of the discharge from the vagina, one can indirectly assume the causative agent of inflammation.

Symptoms of inflammation of the appendages

If inflammation of the appendages occurs for the first time or during an exacerbation of chronic inflammation, the first symptom is severe pain in the lower abdomen. Pain with inflammation of the appendages and ovaries is often accompanied by fever, poor health, urination and stool disorders, and increased gas formation in the intestines may occur. Symptoms of inflammation are sometimes accompanied by symptoms of intoxication - weakness, headache, dizziness. When viewed on a gynecological chair, the tubes and ovaries are very painful. Symptoms of acute inflammation of the appendages and ovaries can be confused with acute appendicitis, peritonitis, intestinal tumors, intestinal or renal colic. Acute inflammation of the appendages can result in a complete recovery without complications only in the case of immediate adequate treatment!

Symptoms of inflammation of the endometrium of the uterus

spotting (mucopurulent liquid, sometimes with an unpleasant odor), pain in the lower abdomen, radiating to the lower back and especially strong during menstruation, heavy and prolonged menstruation, temperature from subfibrile to very high. With gonorrheal endometritis, of all the symptoms, only spotting or bleeding by the type of prolonged menstruation can be observed.

Symptoms of inflammation of the female genital organs appear a few days after infection or immediately after hypothermia.

A symptom of any disorder in the female reproductive system, including inflammation, is a violation of the menstrual cycle.

Symptoms of chronic inflammation

With untimely treatment or if it was not possible to identify the causative agent of the disease, the acute inflammatory process becomes subacute or chronic. Symptoms of chronic inflammation are more blurred. This condition can last for years and usually leads to infertility. Concomitant symptoms - normal or subfibrile temperature (37 -37.4), pain is not strong, increases during menstruation.

Diagnosis of inflammatory diseases of the pelvic organs

You can't make a diagnosis based on a blood test alone. The main analysis for inflammation is a bacterioscopic or bacteriological examination of material from the cervical canal, vagina and urethra to find the causative agent of inflammation and determine its sensitivity to antibiotics. Ultrasound is used to clarify the diagnosis. In difficult cases, it is necessary to consult a surgeon and a urologist.

Preparing for a gynecological examination:

Wash the external genitalia with boiled water without detergents, in any case do not use douching, this will make it very difficult to diagnose the causes of inflammation and the causative agent may remain undetected, which will lead to incorrect treatment. Read more about preparing for a gynecological examination and how a gynecological examination works.

Treatment of inflammatory diseases of the pelvic organs

With vulvovaginitis, outpatient treatment. In case of acute inflammation of the appendages and endometrium or exacerbation of chronic inflammation with severe symptoms, treatment in a hospital. For mild forms of inflammation, treatment is carried out at home.

Drug treatment of inflammation of the female genital organs

Antibiotic treatment is prescribed depending on the identified pathogens, but most often antibiotic treatment in the acute period of inflammation is carried out taking into account all possible pathogens. Treatment of salpingo-oophoritis in the hospital begins with intravenous administration of drugs, later they move on to antibiotics (drugs taken orally). If the treatment is prescribed on an outpatient basis (at home), pills or "shots" are more often prescribed.

If the stomach hurts a lot, analgesics are prescribed, according to indications - local anti-inflammatory drugs in the form of suppositories and ointments, ice on the stomach.

The course of treatment with antibiotics and anti-inflammatory drugs must be completed in full and exactly as many days as the doctor prescribes. With incomplete treatment or a decrease in the recommended dosages of drugs against the background of the absence of symptoms, the inflammation will soon begin again.

Also, in some cases, it is necessary to undergo a course of anti-relapse treatment using spa treatment and physiotherapy.

If an infection is detected, the partner must be examined and, if necessary, treated. At the time of treatment of inflammation, in any case, it is recommended to refrain from intimate life.

Some antibiotics should not be taken with alcohol. Refrain from alcohol during treatment.

Non-drug treatment of inflammatory diseases of the pelvic organs (inflammation of the vagina, appendages, uterus)

Non-drug treatment is carried out only in the chronic course of inflammation or after the treatment of acute inflammation. Magnetotherapy, electrophoresis, diadynamic currents, radon baths, thalassotherapy are used for treatment. When the condition stabilizes after conservative treatment, phonophoresis is performed with calcium, copper or magnesium.

Surgical treatment of inflammatory diseases of the pelvic organs (inflammation of the vagina, appendages, uterus)

Surgical treatment of salpingo-oophoritis is carried out in the absence of the effect of conservative treatment and in the detection of purulent formations of the tubes and ovaries. At the initial stage, laparoscopy is used.

Complications of inflammatory diseases of the pelvic organs

Untreated vulvovaginitis turns into endometritis or salpingo-oophoritis, formidable with its complications:

After undergoing salpingo-oophoritis, the chance of ectopic pregnancy is 5-10 times higher due to the formation of adhesions and narrowing of the fallopian tubes;
After salpingo-oophoritis, especially chronic, there is a higher chance of infertility. The inflammatory process leads not only to the formation of adhesions, but also to a violation of the secretion (production) of sex hormones by the ovaries;
Purulent complications may occur, in which surgical intervention is necessary, up to the removal of the fallopian tubes and uterus!

Prevention of inflammatory diseases of the pelvic organs

The most common cause of inflammation of the pelvic organs is the causative agents of sexually transmitted infections (fungi, viruses, pyogenic microflora, pathogenic and opportunistic microorganisms). Therefore, the prevention of inflammation is safe sex using a condom, fidelity of the sexual partner, personal hygiene and a visit to the gynecologist for preventive examinations in order to early identify the causative agents of inflammation.

Be careful in the sauna - many microorganisms remain viable for a long time in a warm, humid environment. Do not use other people's personal hygiene products - towels, toothbrushes. Some microorganisms, such as Candida fungi, are often passed on during oral sex.

Folk remedies for the treatment of inflammatory diseases of the pelvic organs

Folk remedies for the treatment of inflammation are used only outside the exacerbation and only after or in parallel with drug treatment. Listed below are only doctor-approved folk remedies for inflammation for oral and douching. In no case do not use folk remedies until the diagnosis is made by the doctor! This can make it difficult to diagnose or even make it impossible to determine the causative agent of inflammation. None of the known folk remedies is capable of destroying pathogenic microorganisms inside the body! The action of folk remedies for the treatment of inflammation is aimed at alleviating the symptoms of inflammation, relieving pain, itching, increasing immunity, this treatment is preventive and restorative.

Collections of medicinal herbs for oral administration, douching, vaginal tampons and baths for inflammatory diseases of the female genital organs, leucorrhea (colpitis, vulvitis, cervicitis).

Dosage is in "parts"

Folk remedy for inflammation with chamomile and goose cinquefoil: Chamomile flowers - 1, cinquefoil goose grass - 1.
1 tablespoon of the mixture pour 1 liter of boiling water, leave for 20 minutes, strain. For douching and baths with vulvovaginitis.

Astringent folk remedy for inflammation: Oak bark - 1, chamomile flowers - 1, nettle leaves - 3, highlander bird grass - 5.
2 tbsp. spoons of the mixture pour 1 liter of boiling water, insist, strain. For douches, vaginal baths and tampons.

Folk remedy for inflammation: Mallow flowers - 1, oak bark - 1, sage leaves - 1.5, chamomile flowers - 1.5, walnut leaves - 2.5
2 tablespoons of the mixture pour 1 liter of boiling water, insist, strain. For douches, vaginal baths and tampons.

Folk remedy for inflammation: Linden flowers - 2, chamomile flowers - 3
4 tablespoons of the mixture pour 200 ml of boiling water, leave for 15-20 minutes, cool, strain. Apply for douching in the morning and evening.

Folk remedy for inflammation: Sage leaves - 1, wild mallow flowers - 1, black elderberry flowers - 1, oak bark - 1
5 tablespoons of the mixture pour 1 liter of boiling water, leave for 15-20 minutes, cool, strain. Apply for douching in the morning and evening.

Folk remedy for inflammation: Oak bark - 3, linden flowers - 2
4 tablespoons of the mixture pour 1 liter of boiling water, leave for 2-3 minutes, cool, strain. Apply for douching in the morning and evening.

Folk remedy for inflammation: Willow bark - 3, linden flowers - 2
4 tablespoons of the mixture pour 1 liter of boiling water, leave for 2-3 minutes, strain, cool. Apply for douching in the morning and evening.

Folk remedy for inflammation: Oak bark - 6, oregano grass - 4, marshmallow leaves - 2 (or marshmallow root -1)
5 tablespoons of the mixture pour 200 ml of boiling water, leave for 2-3 minutes, strain, cool. Apply for douching.

Folk remedy for inflammation: Rosemary leaves - 1, sage leaves - 1, yarrow herb - 1, oak bark - 2.
5 tablespoons of the mixture pour 1 liter of boiling water, leave for 15-20 minutes, cool, strain. For douching.

Folk remedy for inflammation: immortelle baskets - 2, birch leaves - 2, wild strawberry leaves - 2, peppermint grass - 2, yarrow grass - 2, leaf beans - 2, nettle leaves - 3, succession grass - 3, rosehip fruits - 3, rowan fruits - 1.
2 tbsp. spoons of the mixture pour 500 ml of boiling water, leave for 10 hours, strain. Drink 100 ml of infusion 3 times a day.

Folk remedy for inflammation: Birch leaves - 1, black elderberry flowers - 1, oak bark - 3, wild strawberry leaves - 2, linden flowers - 1, mountain ash fruits - 1, tricolor violet flowers - 1, rosehip fruits - 3
2 tbsp. spoons of the mixture pour 500 ml of boiling water, leave for 10 hours, strain. Drink 100 ml of infusion 3 times a day.

Folk remedy for inflammation for douching with trichomonas colpitis. Lavender herb - 1, bird cherry flowers - 1, wormwood herb - 1, marigold flowers - 2, oak bark - 2, cudweed grass - 2, birch leaves - 2, sage herb - 2, chamomile flowers - 3
Pour 1 liter of boiling water over 1 tablespoon of the mixture, leave for 2 hours, strain. Use as a douche at bedtime for 2 weeks.

Collections of herbs for vaginal tampons for inflammation of the pelvic organs:

Collection No. 45. Sage leaves - 1, mallow flowers - 1, black elderberry flowers - 1.
2 tbsp. spoons of the mixture pour 1 liter of boiling water, cool, strain. Apply to vaginal tampons.

Collection No. 46. Althea root - 1, chamomile flowers - 1, mallow flowers - 1, sweet clover grass - 1, flax seed - 3.
1 st. pour a spoonful of the mixture with 200 ml of boiling water and place it in gauze, insert it warm into the vagina at night.

Collection number 47. Chamomile flowers - 1, sweet clover grass - 1, marshmallow leaves - 1
2 tbsp. Spoons of the mixture pour 200 ml of boiling water and placed in gauze, enter hot into the vagina at night.
Other dosage forms:
♦ Kalanchoe juice - bottles 10 ml, 100 ml - irrigation, baths, tampons;
♦ tincture of calendula - douching;
♦ Novoimanin - a preparation from St. John's wort 1% alcohol solution in a dilution of 1: 5-1: 10 for irrigation, vaginal tampons;
♦ sea buckthorn oil - vaginal tampons.

Collections of herbs, folk remedies that improve blood circulation in the pelvis and have antiseptic and desensitizing properties

Collection No. 48. Licorice root - 1, succession grass - 1, Manchurian aralia root - 1, horsetail grass - 2, wild rose fruit - 3, immortelle basket - 1, elecampane root - 1, alder seed - 1
2 tablespoons of the mixture pour 500 ml of boiling water, boil for 5 minutes, leave for 10 hours, strain. Drink 50 ml of infusion 3 times a day after meals.

Collection No. 49. Sage herb - 1, lagohilus leaves - 1, calendula flowers - 1, nettle herb - 1, St. John's wort herb - 1, yarrow herb - 2
3 tablespoons of the mixture pour 1 liter of boiling water, leave for 2 hours, strain. Drink 100 ml of infusion 3 times a day for 2 months.

Collection No. 50. Thyme grass - 2, coltsfoot leaves - 2, calamus rhizome - 2, nettle grass - 1, St. John's wort grass - 1, buckthorn bark - 1
4 tbsp. l. boil the mixture for 5 minutes in 1 liter of water, leave for 20 minutes, strain. Drink 100 ml of infusion 3 times a day for 2 months.

Collection No. 51. Sweet clover flowers - 1, coltsfoot leaves - 1, centaury grass - 1, nettle grass - 1, yarrow grass - 2
1 st. l. pour 500 ml of boiling water over the mixture, leave for 20 minutes, strain. Drink 100 ml of infusion 3 times a day for 2 months.

Collection No. 52. Valerian root - 2, lemon balm leaves - 2, cuff grass - 3, deaf nettle flowers - 3
2 teaspoons of the mixture pour 200 ml of boiling water, cool. Drink 100 ml of infusion 3 times a day for 2 months.

Collection No. 53. Willow bark - 1, birch buds - 1, lagohilus grass - 2
Boil 1 tablespoon of the mixture for 5 minutes in 500 ml of water, leave for 20 minutes, strain. Drink 100 ml of infusion 3 times a day for 2 months.

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