Inflammatory diseases of the pelvic organs. Diagnostics and treatment

Inflammatory diseases of the pelvic organs. Diagnostics and treatment

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Inflammatory diseases of the pelvic organs. Diagnostics and treatment

It should be suspected of pelvic inflammatory diseases if a woman of reproductive age, especially one with risk factors, complains of pelvic or neck pains or unexplained vaginal discharge. The presence of pelvic inflammatory diseases is also possible with irregular vaginal blood discharges, dyspareunia or disuria, the cause of which is unclear. Pelvic inflammatory disease is most likely if there are pains in the lower and lower side of the abdomen and with cervical dislocation. Palpable tumor formation of uterine appendages suggests a tubo-ovarian abscess. Due to the fact that even with minimal symptoms of pelvic infectious diseases can have serious consequences, the suspicion should be high.

If there is suspicion of pelvic inflammatory diseases, cervical samples and pregnancy tests are conducted. However, infection of the upper urinary tract is possible even if the cervical samples are negative. Excreta from the cervical canal is important to examine for pus content.
If the patient cannot be adequately examined due to severe pain, an ultrasound scan should be used as soon as possible.
If the pregnancy test is positive, ectopic pregnancy with similar symptoms should be considered.

Other frequent causes of pelvic pain include endometriosis, twisted appendages, ruptured ovarian cysts and appendicitis. Differential diagnosis of these conditions is discussed in other sections.

Fitz-Hugh Curtis syndrome may be masked as acute cholecystitis, but it can be differentiated from the latter if there are signs of salpingitis in gynecological examination or, if necessary, in the ultrasound. If the diagnosis is unclear after the ultrasound, you should resort to laparoscopy; the purulent peritoneal material obtained by laparoscopy is the gold standard of diagnosis.


Inflammatory diseases of the pelvic organs. Diagnostics and treatment

They use antibiotics to treat diseases.
The spectrum of antibiotics administered empirically should be effective against diseases caused by N. gonorrhoeae and C. trachomatis and adjusted based on the results of laboratory tests. Empirical treatment should be applied if the diagnosis is controversial for several reasons:

  • The results of the tests (in particular, tests at the place of treatment) are not unequivocal.
  • A diagnosis based on clinical criteria may be inaccurate.

Untreated minimally symptomatic inflammatory pelvic diseases may lead to serious complications.

Patients with cervicitis or mild to moderate pelvic inflammatory diseases do not need hospitalization. Outpatient treatment regimens are also usually aimed at eradicating bacterial vaginosis, which is often found together.

Sexual partners of patients with infections caused by N. gonorrhoeae or C. trachomatis should be treated.
If patient health does not improve after treatment covering common pathogens, pelvic inflammatory diseases caused by M. genitalium should be considered.
Women with pelvic inflammatory diseases are usually hospitalized. Schemes to treat pelvic inflammatory diseases begin immediately after sowing and continue until the patient stops fevering within 24 hours.

Tubo-ovarian abscesses may require longer intravenous administration of antibiotics. If antibiotic therapy is ineffective, treatment should be resorted to by percutaneous or transvaginal drainage under ultrasound or CT control. Sometimes, laparoscopy or laparotomy may be necessary. Suspicion of rupture of the abscess is an indication of immediate laparotomy. In women of reproductive age, surgery should be aimed at preserving pelvic organs (with the hope of preserving reproductive function).

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