Inflammation of the appendages is a problem with serious consequences. Inflammation of the appendages treatment

Pain in the appendages indicates the beginning of the inflammatory process, most often we are talking about adnexitis. Initially, inflammation covers the surface fallopian tubes and then spread to the ovaries. If left untreated, the disease becomes chronic, adhesions form in the ovaries, which is fraught with the onset of infertility and an abscess may occur.

According to available statistics, pain and inflammation of the appendages occurs in more than half of women, most often at the age of 25-30 years.

Why pain in the appendages occurs

This is due to the onset of the inflammatory process caused by the disease salpingoophoritis (adnexitis). As a result of the penetration into the body of such pathogenic elements as streptococcus, gonococcus, staphylococcus, as well as ureaplasmas, chlamydia and Trichomonas, inflammation of the ovaries and fallopian tubes occurs.

Other causes of inflammation of the appendages are:

• Prolonged hypothermia
• Weakened immunity
• Regular overwork

Pain in the appendages can be a symptom of diseases such as:

• Salpingitis (inflammation of the fallopian tubes)
• Oophoritis (inflammatory process in the ovaries)
• Cervicitis (inflammation of the cervix due to its prolapse, trauma, erosion, STIs, etc.)

If the appendages hurt depending on menstrual cycle, the reason for this may be underproduction the hormone progesterone during ovulation (ovulatory syndrome).

Symptoms of inflammation of the appendages

Pain depends on the form of the disease:

• Chronic inflammation of the appendages - dull and aching pain
• Sharp - piercing and cutting

Pain can make itself felt during intercourse, become stronger during physical activity, under stress, accompany the menstrual cycle.

Signs of acute adnexitis:

• A rapid increase in body temperature (up to 38-39 degrees)
• Weakness
• Painful tension in the lower abdomen
• Increased sweating
• Headache and muscle pain
• Spreading
• Difficulty urinating
• Possible vaginal discharge
• Enlarged, painful and swollen appendages

Signs of chronic adnexitis:

• Aching pain in the lower abdomen
• You may feel pain in the vagina, groin
• Changing the monthly cycle

With chronic adnexitis during menstruation, there can be both copious discharge with blood clots, accompanied by pain, and meager discharge against the background of a reduction in the duration of menstruation, the appearance of pain during intercourse and a decrease in libido.

Pain in the appendages during pregnancy

The reasons for this can be very different, both pathological in nature and in connection with the restructuring and adaptation of the body.

Pathological include inflammation of the ovaries, fallopian tubes as a result of:

• Surge
• hypothermia
• Overwork
• Failures in immunity

The pain may be constant or paroxysmal. Inflammation of the ovaries can cause sleep disorders, decreased ability to work, weakness and irritability.

Pain in the appendages during pregnancy is often not associated with inflammatory processes. The reason lies in the adaptation of the body of a pregnant woman to an unusual period for him. The uterus is growing and the pain may be related to the ligaments that support it.

But if pain in the appendages appeared before the onset of pregnancy, which means that the cause is a chronic form of the disease that needs to be cured in the shortest time to prevent negative consequences.

Diagnostics

To diagnose the causes of pain, the following measures are taken:

• Ultrasound of the uterus and appendages
• General blood analysis
• PCR diagnostics (vaginal swab), which allows to establish genital infections
• Colposcopy (examination of the vagina and its walls)
• Bakposev
• Tomography
• Laparoscopy

Treatment of inflammation of the appendages

First you need to establish the cause, and then eliminate the infection and the inflammatory process. The antibiotics used for inflammation of the appendages belong to the group of penicillins, cephalosporins, the course of treatment is 10-14 days.

It is also possible to use:

• Antiviral drugs
• Immunostimulants
• Antibacterial agents
• Physiotherapy treatment (therapeutic mud, ultrasound, diathermy)

Treatment of appendages with folk remedies

Traditional medicine can only be used as an addition to the treatment prescribed by the doctor.

Infusions and decoctions:

• Sweet clover with coltsfoot. One spoonful of herbs is poured into 0.4 liters of boiling water and incubated for 1 hour. Reception 4 spoons up to 5 times a day. A two to three week course is enough to eliminate inflammation of the appendages of a chronic nature.
• Yasnotka. Pour 0.15 l of boiling water into a thermos, add a spoonful of yasnitka and infuse for about 15-20 minutes, then add one spoonful of honey and drink 50 ml 4 times a day
• crushed leaves walnut(1 spoon) pour 0.2 liters of boiling water, then leave for 4 hours and drink during the day.
• Small-leaved linden flowers (3 tablespoons) pour 0.45 liters of boiling water and insist 20-25 minutes, take ½ cup before meals.

douching

• Collection of chamomile and linden. Flowers in a ratio of 3:2 in the amount of 4 tablespoons pour 0.2 liters of boiling water, leave for 30-40 minutes, cool.
• Rose hips (3 parts), strawberry and oak bark leaves (2 parts each), bird cherry flowers, lavender and wormwood (1 part each) pour boiling water (1 l) and leave for 2 hours. It is recommended to douche with the resulting infusion before going to bed.
• Mix in the same proportion flowers of mallow and black elderberry, immortelle, oak bark, then pour 5 tablespoons of the resulting mixture with boiling water (1l), insist for 30-40 minutes, then strain and cool. Douching is carried out 2 times a day, best in the morning and shortly before bedtime.

A woman's health is the key to her family and maternal happiness. Therefore, the main task of modern gynecology is the prevention and treatment various pathologies in the female genital area. the symptoms of which every woman must have experienced at least once in her life is a disease that requires immediate treatment.

What is the danger

With any inflammatory gynecological manifestations, first of all, there is always a risk for reproductive health. Therefore, if any symptoms of such ailments are detected, a specialist consultation is necessary. After all, on how timely and adequately treatment will be carried out, the outcome of the disease depends.

Causes of inflammation

Most often, various pathogens and infections can provoke the development of inflammation of the appendages in women (the symptoms are very similar to an attack of appendicitis or renal colic). Most often, such provocateurs are transmitted sexually. These are primarily chlamydia, trichomonas, mycoplasmas, herpes viruses and other pathogens. However, these may be inhabitants of conditionally pathogenic microflora, which is normally present on the mucous membranes of our body - streptococci, candida, staphylococci and other microbes.

Inflammation can be caused various bacteria, which "fall from above". Rare, but still possible culprits of the inflammatory process can be pathogenic pathogens that penetrate the sex glands through the blood and lymph. They enter the pelvic organs of a woman from the kidneys, lungs and, surprisingly, oral cavity for a sore throat or dental diseases. Such infections provoke and then capture the ovaries.

It is also possible that the cause of inflammation of the appendages in women (both the symptoms and the course of the disease are pronounced, accompanied by periodic or constant sharp pains, fever) are hypothermia, abortion, uterine surgery, ectopic pregnancy, childbirth, use intrauterine devices And so on. The result of the manifestation of an undesirable pathology may be an incorrect diagnosis of the disease or inadequate treatment.

Therefore, the symptoms of inflammation of the appendages in themselves are only a consequence of the spread of an infection that has already settled in the genitourinary system of a woman.

Development of pathology

When harmful microorganisms enter the uterus, they successfully develop in its cavity, covering more and more extensive areas, gradually capturing the fallopian tubes. As a result, the organ begins to thicken: pus accumulates, adhesions appear. If ignored or improper treatment disease at this stage, the process spreads further and already captures the ovaries.

With symptoms of inflammation of the ovaries and appendages in women, pathological changes- soldering of the fallopian tubes and ovaries. As a result of such formations, obstruction of the tubes occurs, which entails the appearance of ectopic pregnancies and the inability to complete. It happens that during inflammation, pathological changes begin to spread to the surrounding peritoneum, so there is always a risk of dangerous septic phenomena.

Exist different types inflammations, and each of them has stages and characteristics of the course.

Salpingitis: symptoms, signs, consequences

Inflammatory pathology of the fallopian tubes, resulting from an infectious effect, is called salpingitis. In the acute course of this disease, patients complain:

• on the severe pain lower abdomen;
• regular temperature rises and feverish conditions;
• chills and general weakness.

Symptoms of inflammation of the appendages in subacute and chronic form have an erased clinic, therefore, for accurate diagnosis, certain laboratory and ultrasound studies are required.

The implications of this inflammatory pathology- obstruction of one or both fallopian tubes, the appearance of purulent tubo-ovarian formations. Requires drug treatment with the use of antibacterial drugs.

Salpingitis itself is quite rare. Usually occurs with involvement in the inflammatory process of the ovaries (salpingoophoritis, or adnexitis) or together with inflammation of the uterus (endometritis).

Adnexitis

Salpingoophoritis (adnexitis) is an inflammatory process that simultaneously occurs in fallopian tubes, and in the ovaries. It is characterized by severe pain and pain in the lower abdomen, temperature, cycle disorders, general weakness and other symptoms. Treatment of inflammation of the appendages in women and this pathology, and other similar diseases, requires an immediate visit to a specialist.

Adnexitis is dangerous because with prolonged acute course provokes the occurrence of adhesive processes in the fallopian tubes. This is the main cause of female infertility.

From the pipe, pus can penetrate into abdominal cavity, which is likely to provoke peritonitis - a life-threatening phenomenon. Physiological changes in the ovaries, signaling themselves with symptoms of inflammation of the appendages, entail the appearance uterine bleeding and cycle disturbances. Since the ovaries are an integral part of the hormonal system, malfunctions in their functioning do not go unnoticed for the whole body. There is a risk of various forms mammological pathologies and disorders in the thyroid gland.

Symptoms and signs of oophoritis

Inflammatory pathology of the ovaries is oophoritis. Modern gynecology distinguishes between acute, subacute and chronic form.

In acute inflammation, patients complain:

• to continuous pain in the lower abdomen, extending to the lumbar region or sacrum;
• frequent urination, accompanied by severe pain and cuts;
• an increase in body temperature, accompanied by fever and malaise;
• purulent discharge;
• sharp pain during intercourse.

On examination, the gynecologist determines the enlargement of the ovaries. When the diagnosis is confirmed, the patient needs urgent hospitalization with treatment in a hospital.

Subacute course is a rather rare form of the disease. Most often occurs in conjunction with tuberculosis or mycosis.

Late diagnosis symptoms and treatment of inflammation of the appendages, as well as its incompleteness, lead to a chronic form of the disease. In this case, the disease acquires a protracted course with periodic exacerbations. Chronic inflammation of the ovaries is characterized by dull, aching pain in the groin area. Unpleasant sensations may intensify with the onset of the cycle. In this case, slight discharge, pain during sexual intercourse and the impossibility of pregnancy are observed.

What is dangerous endometritis

Symptoms of inflammation of the uterus and appendages are characterized by inflammation of the mucous layer of the endometrium in combination with inflammation of the muscular layer. reproductive organ and may have a pronounced pattern. Physiological feature mucous membrane of the uterine cavity - to be updated with the arrival of each new cycle, preparing for the attachment of a fertilized egg, and rejected if fertilization has not occurred.

Very often, due to some inflammatory processes caused by various surgical interventions, childbirth and infectious pathogens, particles of the fetal egg and placenta remain in the uterine cavity. Gradually, a favorable environment is created for the development of pathogenic flora, and adverse changes in the endometrium occur.

Manifestations of endometritis are menstrual irregularities, the occurrence of uterine bleeding, the appearance spotting between periods, purulent serous discharge With bad smell, constant sensation discomfort and pain during intercourse.

Endometritis in all its manifestations is treated in a hospital with the use of antibacterial and hormonal treatment regimens.

Diagnostics

Identification of any form of inflammation of the appendages in women (the symptoms can often be similar to signs of an exacerbation of the appendix, cystitis, renal colic or other pathologies of the pelvic organs) should be carried out only by a specialist. Diagnosis is carried out on the basis of the patient's complaints, the collection of anamnesis of the course of the disease, gynecological examination, ultrasound and laboratory research blood tests and smears.

Traditional medicine: treatment of inflammation of the appendages

Patients diagnosed with inflammation of the appendages are treated in a hospital, as there remains a potential threat of dangerous septic complications(development of parametritis, pelvioperitonitis or peritonitis).

Depending on the type of disease and the form of its course, an individual treatment regimen is selected. The patient is usually prescribed antibacterial drugs, absorbable therapy and physiotherapy. In critical situations, surgical intervention is possible.

Folk remedies

There are many folk methods, which can be used to prevent gynecological inflammation. Many women sometimes quite successfully eliminate the symptoms. Treatment in this case consists in the complex effect of traditional medicine and medications.

However, it is important to remember that in acute and chronic forms of these gynecological diseases the use of certain non-traditional methods may differ significantly. So, for example, in the acute course of the inflammatory process, it is not recommended to warm up in hot baths, while in chronic forms of the disease, warming up and various douching can give a good result.

Do not forget that any inflammatory processes in the pelvic area of ​​a woman are most often a pathology of an infectious origin. Therefore, the treatment of symptoms of inflammation of the appendages with folk remedies can only be an additional measure to the antibacterial effect.

Prevention of gynecological inflammation

To prevent the development of inflammatory processes of the ovaries and appendages, one should adhere to simple, but very important rules. First of all, genital infections, hypothermia and stress should be avoided. At the first symptoms of the inflammatory process, it is not necessary to postpone the visit to the antenatal clinic for “later”. Diagnosis of the disease early stages development largely determines its outcome. Moreover, a visit to the gynecologist every six months is one of best practices prevention of not only inflammation of the appendages, but also other serious female pathologies.

The consequences of neglected and chronic forms of such diseases are infertility, lifelong medication and hormonal drugs or a potential threat to lose the female gonads altogether. Therefore, with any symptoms of inflammation of the appendages, even if you feel quite tolerable, you cannot ignore the signals of the body - it directly depends women Health in future. Take care of yourself and be healthy!

What is meant by the term "inflammation of the appendages"? The uterine appendages include the fallopian tubes, ovaries, and ligaments. Doctors classify inflammation of the appendages as or, which can occur in an acute or chronic form. Inflammation of the appendages can be unilateral and bilateral, in some cases this pathological process leads to the development of severe complications.

Inflammation of the uterine appendages occupies the "first place" among all gynecological diseases. If this pathological process was not diagnosed in a timely manner and fully treated, then there is a high probability of development - according to statistics, 20% of infertile women have a history of chronic adnexitis.

Table of contents:

Causes of inflammation of the appendages

Pathogenic and opportunistic microorganisms can give a "push" to the progression of the inflammatory process. Doctors distinguish between specific adnexitis, which is caused by gonococci, bacillus and, as well as nonspecific salpingo-oophoritis, which is caused by fungi and viruses.

Infection in the uterine appendages can get in different ways:

• descending path - from other inflamed organs (for example, the appendix or sigmoid colon);
• lymphogenous - the infection penetrates the lymphatic vessels;
• ascending - from the vagina and cervix;
• hematogenous - through the blood vessels.

Can contribute to the development of inflammation of the appendages the following factors:

• , transferred infectious diseases and any chronic foci of infection in the body - all this leads to a decrease / weakening of the defenses;
• promiscuous sex life;
• appendectomy;
• complicated childbirth in history;
• non-compliance / violation of the rules of intimate hygiene;
• abortions, hysteroscopy, insertion / removal of the spiral and any intrauterine procedures.

Symptoms of inflammation of the appendages

Acute adnexitis

The clinical picture in the development of acute adnexitis is very characteristic, so the diagnosis does not present any difficulties for the doctor. The disease always begins acutely with an increase in body temperature to 39 degrees, if there is purulent inflammation, then the woman will be disturbed by severe chills. In the lower abdomen there are sharp, cutting nature, they can be present on one side with unilateral inflammation of the appendages, or spread throughout the abdomen with bilateral adnexitis. For acute form of the disease under consideration will be characteristic irradiation of pain in the rectum, sacral region or in the lower extremities.

If, at the very beginning of the disease, palpation of the anterior abdominal wall is performed, then its tension, intense pain and symptoms of peritoneal irritation will be determined. In some cases, there are problems with urination - it becomes painful and difficult. Without fail, the woman's general state of health also worsens - appetite is present and completely absent, obsessive headaches are disturbing.

Examination of the patient on the gynecological chair leads to the detection of serous-purulent (or purulent) discharge from the cervical canal. The doctor cannot clearly determine the size and contours of the appendages, their mobility is limited, and the woman will characterize the examination itself as painful. Laboratory blood tests will determine (ESR), an increased number of leukocytes and high content C-reactive protein.

Chronic adnexitis

Inflammation of the appendages can develop from an acute form into a chronic one, this is observed with poor-quality treatment of an acute inflammatory process. Symptoms of chronic adnexitis include dull / aching pain in the lower abdomen with irradiation to the lower back and vagina. Palpation of the abdomen will be moderately painful, and the whole clinical picture will be somewhat blurred.

In the chronic form of inflammation of the appendages, patients complain of a lack of sexual desire, pain during intercourse. When examining a woman on a gynecological chair, the doctor will note the presence purulent discharge from cervical canal, the area of ​​​​the appendages on palpation will be painful, their mobility will be limited.

Treatment of inflammation of the appendages

Immediately make a reservation that the disease in question should be treated only in a hospital setting.. It all starts with the appointment of a woman diet with a restriction of pepper, salt and carbohydrates and bed rest at least for the first days of the disease. In acute adnexitis and exacerbation of the chronic form of inflammation, cold is placed on the lower abdomen for patients - this will reduce the intensity of pain and stop the progression of the inflammatory process.

Medical treatment

The main drugs in the treatment of inflammation of the appendages are. They select such antibacterial drugs that have a wide spectrum of action, and due to the presence of "communities" in the body of a sick woman pathogenic microorganisms, antibiotics are used immediately for 2 or more. The main purposes include:

• Klaforan (0.5 g 2 times a day intramuscularly) and Gentamicin (80 mg 3 times a day intramuscularly);
• Cefobid (1 g 2 times a day intramuscularly) in combination with Gentamicin;
• Clindamycin (2 g twice a day intramuscularly) and Gentamycin;
• Cefazolin (1 g twice a day intramuscularly) and Ciprofloxacin (100 ml twice a day intravenously);
• Lincomycin 0.6 g three times a day intramuscularly.

Be sure to every woman in the treatment of inflammation of the appendages is prescribed Metronidazole 500 mg three times a day orally (by mouth) or Metrogyl 100 ml twice a day intravenously. In addition, the following appointments can be made as part of therapy:

1. Intravenous infusions of saline solutions, hemodez, glucose, rheopolyglucin in the amount of 2-3 liters - this will be a detoxification therapy that will quickly restore and stabilize the general condition of a woman.
2. Non-steroidal anti-inflammatory drugs in tablet form or in the form of injections - Ibuprofen, Diclofenac, Ketarol, Faspik, Ketanov, Ibuklin. Often a woman is prescribed and rectal suppositories with paracetamol, indomethacin. These medications relieve inflammation and reduce the intensity of pain.
3. Patients must be prescribed vitamin therapy, which will help to quickly restore the body's defenses. Most often, drugs with and are used for this.
4. - Suprastin, Tsetrin, Pipolfen.

To relieve an acute inflammatory process, or to introduce chronic adnexitis into remission, doctors use physiotherapy - for example, electrophoresis with lidase or iodine, ultrasound, high-frequency pulsed currents can be prescribed.

Chronic inflammation of the appendages implies regular spa treatment, mud therapy, therapeutic douching, and paraffin therapy help prevent frequent exacerbations of the pathological process.

Traditional medicine in the treatment of inflammation of the appendages

Of course, with acute adnexitis, qualified medical care will be needed, no folk remedies will not help a woman to recover quickly and fully. But here as maintenance therapy and prevention of exacerbations chronic inflammation appendages some recipes from the category " ethnoscience' will be really effective.

Steam treatments with wormwood

You need to put 2 liters of water on the fire and bring to a boil. Then a full handful of dry wormwood is added there, the water is immediately removed from the fire. A woman should sit down over water with wormwood for 20 minutes, no more - this will be a steam procedure.

Pay attention to several important points:

• under no circumstances should such warm-ups be carried out with elevated temperature body and purulent inflammation of the appendages;
• be sure to consult with your doctor before the procedure;
• pain and all discomfort will disappear only after 6 such warm-ups;
• the procedure is performed once a day;
• immediately after warming up, you need to go to bed, so it is better to do it before bedtime.

Borova uterus - decoction and alcohol tincture

The grass needs to be crushed, then one tablespoon of the finished raw material is poured into a glass of boiling water. This is how a decoction is prepared, which is infused for two hours, then filtered and taken 1/3 cup three times a day 30 minutes before meals.

For cooking alcohol tincture you need 500 ml of vodka to pour 50 grams of boron uterus grass. The remedy is infused in a dark place for two weeks. Tincture is taken 3 times a day, 35 drops at a time one hour before meals.

hippo

This herb is harvested directly during flowering. Find it medicinal plant available in drugstores. To prepare the medicine, you need to take one tablespoon of herb femur, pour a liter of water and boil over medium heat for 10 minutes. Next, the finished broth is cooled and filtered. You need to take the thigh with honey, the remedy is used as a tea.

With the same decoction, only without the addition of honey, you can douche in the morning for 3 weeks. If you drink and douche with a decoction of herb femoral, then the improvement in health will come as early as 3-5 days, but you should not interrupt the course of treatment - traditional medicine recommends using this herb for 3 weeks.

Note:the use of any remedy from the category of "traditional medicine" must be agreed with the attending physician. Uncontrolled use can lead to a significant deterioration in health and the development of an allergic reaction.

Inflammation of the appendages is a rather serious disease; if left untreated, a woman develops complications, up to irreversible. Therefore, at the first symptoms of acute adnexitis, you need to seek qualified medical care. Especially since clinical picture the disease in question cannot be confused with anything.

Tsygankova Yana Alexandrovna, medical observer, therapist of the highest qualification category

In female representatives, inflammatory processes affecting the appendages and ovaries are most often provoked by infectious pathogens and, for the most part, require the use of antimicrobials as a treatment. Inflammation usually begins to develop due to the decreased resistance of the body under the influence of hypothermia or due to the penetration of bacteria, fungi and viruses into the ovaries.

With inflammation of the appendages in women, after establishing an accurate diagnosis, antibiotics should be immediately administered into drug regimen. Even if at this point there are studies that determine the type of pathogen, the initial stages of therapy can be carried out without clarification. However, it must be remembered that antibacterial pharmaceuticals will have a positive effect only in the case of an acute form of ongoing inflammation. In some cases antimicrobials can be used in the exacerbated course of the chronic form of the disease.

Nuances of pathology and principles of antimicrobial treatment

Inflammatory processes occurring in the appendages are primarily dangerous with possible subsequent complications:

• inability to get pregnant;
• suppurative processes that form in the ovary and affect the peritoneum;
• against the background of suppuration, pelvioperitonitis is formed, which can be eliminated only through a surgical operation.

It is possible to assume the presence of an acute form of adnexitis or oophoritis when pain occurs in the lumbar region or lower divisions belly. Soreness can occur when going to the toilet, accompanied by discomfort general weakness and increased temperature. A woman who has similar symptoms needs an immediate examination, a vaginal smear for the purpose of bacterial culture and determination of the nature of the microflora. This approach will allow you to most accurately select tablets and other forms of drugs for therapy.

At the initial stages, while the results of studies are unknown, injections of drugs can be used to relieve the inflammatory process of the ovaries. a wide range impact. Their advantage lies in the ability to destroy not one, but simultaneously many types of bacteria that provoke pathologies. genitourinary system. The main rule in this case is that the selected drugs should be active against chlamydia, mycoplasmas, ureaplasma - it is these organisms that most often cause the development of diseases.

Important point. The next step after receiving the results of laboratory tests is a possible adjustment of the therapeutic regimen, if it is found that in order to eliminate the pathogen the best option there will be another drug.

When choosing antibiotics for inflammation of the appendages, you need to follow some rules. There are certain principles of treatment using antimicrobials:

• In order to avoid negative side effects and polypharmacy as much as possible, the established diagnosis is verified by PCR and ELISA.
• When determining the dose of drugs for inflammation of the ovaries and appendages, the patient's body weight is taken into account.
• When selecting antibiotics, preference should be given to antimicrobial substances that can be in the blood for a long period. If the drug is removed from the plasma too quickly, the required concentration cannot be reached. active substance, which gives pathogens a certain head start.
• The developed therapeutic regimens should not be detrimental to the health of the patient, respectively, before treating inflammation of the ovaries and determining how to do it, bacteriological studies are carried out.
• In case of complications, it is recommended to combine antibiotics, selecting agents with a different mechanism of action on the causative agent of the pathology and different period removing the infection from the body.
• After stopping the pathological process, prevention aimed at preventing the formation of adhesions and restoring intestinal motility cannot be ignored. You should also check the integrity of the endocrine system after the treatment.
• The course of treatment is monitored through tests, which helps to prevent a malfunction in the functionality of the liver.
• If the inflammation of the appendages is running, it is advisable to prescribe injections and take drugs with a more powerful effect. These include the group of Cephalosporins, Lincomycin or Fluoroquinolone.

In the event that within several days of treatment the condition of the victim does not change for the better, there is no progress in both the symptoms and the results of the tests, it is necessary either to change medicine or increase the dosage.

Antibiotic drugs prescribed for inflammation

Preparations for the treatment of inflammatory processes in the appendages must meet a number of requirements. They are expected to be highly effective against the pathogens that caused the pathology, easy penetration into the focus of the disease, as little toxicity as possible and a good level of interaction with prescribed anti-inflammatory substances. Treatment is usually complex, carried out with a combination of antibiotics and NSAIDs - non-steroidal anti-inflammatory drugs. The appointment of NSAIDs is necessary to prevent damage from emerging inflammation.

As for antibiotics, the following medications are commonly prescribed:

• Tetracyclines, despite the fact that most of the pathogens present in inflammatory processes in the appendages, have become quite resistant to this group of drugs over time. It should also be noted that tetracyclines have a considerable list side effects. At the same time, tetracyclines well eliminate the possibility of the pathogen to actively reproduce and are effective against gonococci, streptococci and staphylococci, mycoplasmas, spirochetes, chlamydia and others. Specialists prefer to use Doxycycline, which is highly effective with a small number of negative manifestations. It quickly leaves the body and is effective not only for adnexitis, but also for chlamydia.
• If you list the most effective drugs with adnexitis, macrolides will be next on the list. This group of antibiotics is not susceptible to cleavage in gastrointestinal tract, drugs have a long half-life, which ensures their accumulation in the body and accelerates recovery. The most popular funds are Sumamed with Klacid.
• In gynecology, the group of fluoroquinolones is good in that the resistance of pathogens to such drugs is formed very slowly, so that even with prolonged treatment frequent shift antibiotic is not required. If the patient does not have comorbidities in which the use of fluoroquinolones is prohibited, such drugs for adnexitis are best used. Pefloxacin, Norfloxacin, or Ofloxacin may be prescribed.
• Other synthetic antibacterial agents that have a wide spectrum of action and are good at destroying aerobes include Metronidazole and Tinidazole from the group of nitroimidazoles.
• In addition to the additional uterine preparations with inflammation of the uterus and ovaries, Erythromycin is used, which well destroys mycoplasmas and chlamydia.
• In severe complicated inflammation of the appendages, specialists prescribe a group of aminoglycosides, which are also relevant in the event of a transition of the pathology to other organs. There are four generations of such antibiotics. The first includes Streptomycin and Neomycin, the second - Gentamicin. The third generation is represented by Amikacin, Sizomycin, Tobramycin, and the fourth is Isepamycin.
• The substitute for all the above names of antibiotics against inflammatory processes in the appendages is the group of Cephalosporins. Depending on the activity, drugs are divided into four generations. The first generation of the narrow spectrum includes Cefalexin and Cefazolin, the second generation includes Cefaclor or Cefuroxime. The third generation are broad-spectrum drugs Cefixime, Ceftibuten, Ceftazidime. The fourth generation includes Cefpirome and Cefepime.

Important nuance. With inflammation of the appendages, drugs will help better if they are injected - intravenously or intramuscularly. When therapy begins to show a positive result, the specialist prescribes tablets or suspensions to drink, vaginal suppositories can also be used.

Candles used in inflammatory processes in the ovaries

Antibiotics for inflammation of the ovaries can be in the form vaginal suppositories, and this practice is widespread in the field of gynecology. Conventionally, candles are divided into two groups - those that inhibit the activity of bacteria, viruses and fungi, and those that act anti-inflammatory and soothing. Consider which antibiotic suppositories of the first group are used most often and summarize the names in a table:

Name of suppositories	Active substance	a brief description of	Peculiarities
Hexicon	Chlorhexedine	Candles are used to treat inflammation of the ovaries in women, their use is contraindicated at the age of less than 12 years, when carrying a child, strict control is required and appointment only when absolutely necessary	Candles are administered in the morning and evening, the duration of treatment is seven days. Possible side effects include itching and allergic reactions
Depantol	Chlorhexedine	It is prescribed if the ovaries become inflamed, it is permissible to use women in position. Suppositories are contraindicated in childhood	One suppository inserted into the vagina twice a day. The duration of treatment is 10 days, allergic manifestations are possible
Klion-D	Metronidazole	It is forbidden to use in the first trimester, with breastfeeding, in diseases circulatory system	It is administered at night, the treatment period is 10 days. Side effect - headache, burning sensation and itching
Polygynax	Neomycin, Nystatin, Polymyxin B	Antibacterial, not used in the first three months of bearing a child, while breastfeeding and in case of intolerance to the components	It is recommended to use the drug at night in the amount of one capsule. Duration of therapy - 12 days
Clindamycin	Clindamycin	High performance antibiotic	One suppository at night, duration of treatment 3-5 days
Terzhinan	Ternidazole, Nystatin, Prednisolone, Neomycin Sulfate	Complex drug, contraindications are almost completely absent. Do not use in case of individual intolerance to the components, when carrying and breastfeeding a child, use it when absolutely necessary	The duration of treatment is 10 days
Betadine	Iodine	Assign for fungal or viral inflammation, not indicated in the first three months of pregnancy	Application - once every 24 hours, the duration of treatment is individual, depending on the condition of the victim

The considered drugs have a detrimental effect on pathological microorganisms, reduce the symptoms of inflammatory processes. If we consider than in women, based on the second group, the most popular Diclofenac and Indomethacin should be noted. They are anti-inflammatory nonsteroidal drugs and cannot be used when carrying a child. Contraindications for use include allergic reactions, problems with liver function, gastric ulcers and diseases of the circulatory system. Candles for inflammatory pathology are not prescribed if the patient's age does not exceed 14 years. Suppositories are used rectally, once for 24 hours, after the act of defecation. The duration of treatment is determined by the treating specialist depending on the patient's condition.

Treatment during childbearing and possible contraindications

Separately, it should be considered which antibiotics to treat in women who are carrying a child. In general, antimicrobials are not indicated during pregnancy, as they can adversely affect both the fetus and the health of the mother. When breastfeeding, there is also a risk of penetration of the active ingredient into milk. The risk of negative consequences is especially high when using antimicrobial agents during the first three months of pregnancy. If symptoms of inflammation of the appendages occur medical preparations may be based on the following factors:

• Tetracyclines during pregnancy are not accepted, since they are able to overcome the placental barrier, then accumulating in the tissues of the fetus. The perceived risk for the child is the pathology of the formation of his skeleton.
• Pregnant women are contraindicated and certain macrolides. Clinical Research the negative effects of Clarithromycin have been proven. The least harm will be done if the diseases are eliminated in a feminine way with Erythromycin, Josamycin or Spiramycin prescribed by the attending physician. With a particularly severe course of inflammation, a pregnant patient may be prescribed Azithromycin.
• Fluoroquinolones are not prescribed at all when carrying a child.

Only the attending physician can determine whether antibiotics are appropriate, determine the dose and duration of their administration. But in any case, when using antibiotics, a number of side effects and contraindications are possible. So, with an overdose of Macrolides and Fluoroquinolones, problems with stools are possible, nausea appears, changes heartbeat. Tetracyclines should not be used for kidney failure and leukopenia.

Drug interactions should also be taken into account. If the patient drinks Fluoroquinolones, she is prohibited from drugs that include calcium, bismuth, aluminum and magnesium. Simultaneous reception NSAIDs can cause seizures and problems with the central nervous system. Tetracyclines should not be mixed with barbiturates, as their toxicity increases markedly. Tetracyclines also inhibit the effects of oral contraceptives. Macrolides and aminoglycosides are not combined. The attending specialist informs the patient about other features of the interaction of antibiotics and other substances.

In the structure of gynecological morbidity, acute inflammation of the uterine appendages takes the first place. Isolated inflammation of the fallopian tubes in clinical practice is rare. Most often, women have inflammation of the fallopian tubes and ovaries. It can be combined with inflammation of the uterus. Less commonly, according to statistics, there are suppurative processes of both the uterus and appendages with a possible generalization of the infection.

SALPINGOPHORITIS

Salpingoophoritis- an infectious-inflammatory process of nonspecific or specific etiology with localization in the fallopian tubes and ovaries. This is the most common inflammatory disease of the pelvic organs.

SYNONYMS

Adnexitis, salpingitis.

ICD-10 CODE
N70.0 Acute salpingitis and oophoritis.
N70.1 Chronic salpingitis and oophoritis.
N70.9 Salpingitis and oophoritis, unspecified.

EPIDEMIOLOGY

isolated inflammation various departments pelvis is rare, as anatomically and physiologically they are closely related. In this regard, it is difficult to obtain accurate statistics on the spread of salpingo-oophoritis (as well as on the pathologies of other parts of the small pelvis). Nevertheless, about 40% of patients are hospitalized for acute processes or exacerbations of chronic diseases of the genital organs. About 60% of patients go to the antenatal clinic for inflammation. Complications after transferred salpingo-oophoritis are known.

• Every fifth woman who has undergone salpingoophoritis suffers from infertility.
• Ectopic pregnancy occurs 5-10 times more often.
• 5-6% of patients develop purulent complications requiring inpatient treatment and surgical intervention(often with the removal of the fallopian tubes).

adhesive process(consequence of chronic inflammatory diseases) leads to anatomical disorders and pelvic pain, which can affect the scope of sexual relations.

PREVENTION OF SALpingitis, adnexitis, salpingo-oophoritis

PID is caused by STD pathogens (N.gonorrhoeae, C.trachomatis), aerobic and anaerobic opportunistic microorganisms, fungi, viruses, pyogenic microflora, therefore, the prevention of these infections involves periodic and mandatory examinations(pregnant and planning pregnancy, inpatients, dispensary groups and risk groups - adolescents, employees of children's institutions, children's hospitals, etc.). There is a need to promote contraceptive methods and safer sex.

SCREENING

Survey on hidden infections adolescent girls, kindergarten workers, nurseries, orphanages, boarding schools, dispensary groups with infertility and recurrent inflammatory processes are subject to. All patients undergo bacterioscopic, bacteriological studies and PCR.

CLASSIFICATION OF INFLAMMATORY DISEASES OF THE UTERINE ADDITIONS

• Acute nonspecific (or specific) salpingoophoritis.
• Exacerbation of nonspecific salpingo-oophoritis.
• Chronic nonspecific salpingo-oophoritis.

ETIOLOGY (CAUSES) OF SALpingitis, adnexitis, salpingoophoritis

Nonspecific (non-gonorheal) salpingo-oophoritis are caused by pathogenic and opportunistic pathogens. Among them: Staphylococcus aureus and epidermal staphylococcus aureus, group B streptococci, enterococci, coli, Staphylococcus epidermidis, chlamydia, bacteroids, peptococci, peptostreptococci. Most often, a mixed infection is observed.

PATHOGENESIS OF SALpingitis, adnexitis, salpingoophoritis

In inflammatory processes of the fallopian tubes and ovaries general pathogenesis. Initially, all signs of inflammation appear on the mucous membrane of the fallopian tubes (endosalpinx): hyperemia, microcirculation disorders, exudation, edema, cell infiltration. Then the inflammation spreads to the muscular membrane of the fallopian tube, its edema occurs.

The tube thickens and lengthens, its palpation becomes painful. Microbes, together with the contents of the tube, enter the abdominal cavity, affect the serous cover of the tube and the surrounding peritoneum. There is perisalpingitis and pelvioperitonitis. After the rupture of the ovarian follicle, pathogens get inside, infect the granulosa membrane of the follicle, and an inflammatory process occurs in the ovary (salpingoophoritis). With suppuration, a tubo-ovarian tumor is formed (see below).

In the fallopian tube, the adhesive process in the ampullary section proceeds very quickly due to the thickening of the fimbriae and exudation. The adhesive process also occurs at the mouth of the pipe. The secret accumulates in the tube with the formation of a hydrosalpinx (it can exist for a long time as chronic pathology). The adhesive process occurs as a result of gluing of inflammatory changes in the fallopian tubes (especially their fimbrial section) with the Douglas peritoneum, adjacent intestinal loops, and the appendicular process (secondary appendicitis often occurs).

CLINICAL PICTURE (SYMPTOMS) OF SALPINGITIS, ADNEXITIS, SALPINGOO-OPHORITIS

The first symptom of acute salpingo-oophoritis is severe pain in the lower abdomen, accompanied by fever up to 38 ° C (sometimes with chills), worsening general condition, there may be dysuric phenomena, sometimes bloating. When examining with mirrors, inflammatory endocervicitis and serous-pustular discharge can be detected. With a bimanual examination, it is impossible to clearly determine the appendages, but the area of ​​their study is sharply painful, swelling and pasty consistency are not uncommon. In the blood picture - a shift leukocyte formula to the left, an increase in ESR.

In the proteinogram - dysproteinemia with a predominance of globulin fractions, an increase in the level of C reactive protein. There are phenomena of intoxication - a state moderate, weakness, headache, loss of appetite, sometimes dyspeptic disorders. An acute inflammatory process can result in a complete recovery with timely and adequate treatment.

Acute salpingo-oophoritis can acquire the character of a subacute or chronic process with frequent exacerbations and last for years. Clinical manifestations then not so bright. The temperature reaction can be subfebrile or normal, the pains are in the nature of dull, aching with localization in the lower abdomen and in the lower back. Frequent complaints of dyspareunia and infertility. Bimanual examination is less painful, but the uterus and adnexa are less mobile, and advancement past the cervix is ​​painful. In the blood at chronic process, as a rule, slightly increased ESR. Changes come with an exacerbation of the process.

DIAGNOSIS OF SALPINGITIS, ADNEXITIS, SALPINGOO-OPHORITIS

Based on the following history data:

• complicated childbirth, abortion;
• intrauterine invasive manipulations;
• scraping;
• hysteroscopy;
• insertion and removal of the IUD;
• casual sex, etc.

HISTORY AND PHYSICAL EXAMINATION

In acute inflammation, a bimanual examination is always painful (especially the area of ​​​​the appendages), since the pelvic peritoneum is involved in the process (sometimes with symptoms of irritation). In a chronic process, on the contrary, sclerosis and fibrosis of the fallopian tubes with the formation of an adhesive process in the small pelvis make the appendages inactive. Often determine their soreness.

LABORATORY RESEARCH

In an acute process, there are no specific changes in the analyzes (moderate leukocytosis with a shift to the left, an increase in ESR), and in a chronic process, only an increase in ESR is often found. The main importance is attached to bacterioscopic and bacteriological research material from the cervical canal, vagina and urethra. The goal is to identify pathogens and determine their sensitivity to antibiotics.

INSTRUMENTAL STUDIES

The echographic method does not provide clear information about acute salpingo-oophoritis. It is possible to diagnose only thickening of the fallopian tubes, adhesive process in the small pelvis. With pelvioperitonitis, an accumulation of a small amount of fluid in the Douglas pocket is found. You can also determine the tumor-like form with hydrosalpinx or pyosalpinx.

It is better to use an ultrasound with a vaginal probe. CT or MRI can be used, especially when differential diagnosis with ovarian tumors.

DIFFERENTIAL DIAGNOSIS

Acute salpingo-oophoritis often needs to be differentiated from acute surgical pathologies ( acute appendicitis, surgical peritonitis, intestinal tumors, intestinal or renal colic). At the same time, the use of laparoscopy allows for early topical diagnosis and the choice of the correct treatment tactics.

Often, consultations with a surgeon and a urologist are urgently needed, especially in urgent cases of differential diagnosis.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Exacerbation of chronic bilateral salpingo-oophoritis with the formation of a right-sided hydrosalpinx and adhesive process in the small pelvis.

TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOO-OPHORITIS

GOALS OF TREATMENT

• Relief of acute salpingo-oophoritis or exacerbation of chronic.
• Clinical laboratory examination.

INDICATIONS FOR HOSPITALIZATION

There is always an acute process or an exacerbation of a chronic one.

NON-DRUG TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOO-OPHORITIS

They practice in a chronic process or in the period of post-hospital rehabilitation in an acute process. Physiotherapeutic methods are mainly used: UHF, magnetotherapy, electrophoresis with zinc, magnesium, hyaluronidase, etc., diadynamic currents, spa treatment (radon baths and irrigation, thalassotherapy).

MEDICAL TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOO-OPHORITIS

Fundamental in the treatment is antibiotic therapy, which is prescribed empirically, taking into account the most likely pathogens. Modes antibiotic therapy PID should ensure the elimination of a wide range of pathogens (see section "Etiology of PID"). The first-line regimens include a combination of third-generation cephalosporins (cefotaxime, ceftriacone) with metronidazole, the appointment of inhibitor-protected aminopenicillins (amoxicillin / clavulanic acid, etc.), as alternative regimens, lincosamides in combination with aminoglycosides of the IIIII generation, fluoroquinolones (ciprofloxacin, ofloxacin) can be used with metronidazole, carbapenems. Given the high risk of chlamydial infection, patients are simultaneously shown the appointment of doxycycline or macrolides.

Antibacterial therapy for PID usually begins with intravenous administration drugs with subsequent transition to their oral administration (step therapy). In mild forms of PID, patients are treated in outpatient settings, in which case it is preferable to take oral medications with high bioavailability Antibiotics are combined with detoxification therapy: saline solutions, 5% glucose solution ©, reopoliglyukin ©, gemodez ©, polydez ©, mafusol ©, vitamins, protein preparations, etc. are administered intravenously.

According to indications, analgesics, local anti-inflammatory drugs in the form of suppositories, ice on the stomach are prescribed. When the general condition stabilizes and the acute process subsides, phonophoresis is performed with calcium, copper or magnesium (according to the cycle).

SURGICAL TREATMENT OF SALpingitis, adnexitis, salpingoophoritis

At the initial stage, they use diagnostic laparoscopy. In an acute inflammatory process, it is advisable to introduce an antibiotic solution into the abdominal cavity (ampicillin 1 g per 20 ml of saline). In the future, surgical treatment is resorted to in the absence of the effect of conservative drug therapy and the formation of purulent tubo-ovarian formations.

Schemes for the diagnosis and treatment of salpingo-oophoritis in detail.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of specialists (surgeon, urologist) is indicated:

• at the first stage - for differential diagnosis;
• in the course of treatment - in the absence of the effect of treatment or the appearance of combined symptoms associated with the pathology of other organs.

APPROXIMATE TIMES OF INABILITY TO WORK

With salpingo-oophoritis, the period of inpatient treatment is 7-10 days.

FURTHER MANAGEMENT

Post-hospital rehabilitation (outpatient follow-up care using absorbable, restorative physiotherapy and spa treatment) for the purpose of recovery reproductive function and anatomical and physiological relationships of the pelvic organs.

INFORMATION FOR THE PATIENT

The patient must complete the full course of anti-inflammatory treatment of an acute process or an exacerbation of a chronic one. It is necessary to conduct courses of anti-relapse treatment, use sanatorium balneotherapy, use contraceptive methods. If an STI is found in a partner, treat him and conduct a follow-up examination of the couple.

FORECAST

For life - favorable. Problems, as a rule, are associated with menstrual, sexual and reproductive functions.