Inflammatory diseases of the pelvic organs. Pelvic inflammatory disease: When is surgery necessary?

WHO minimum criteria To establish a diagnosis of “pelvic inflammatory disease” are:

  • pain on palpation of the lower abdomen,
  • pain in the area of ​​the uterine appendages,
  • painful traction of the cervix.

To increase the specificity of diagnosis, there are additional criteria:

  • body temperature above 38.3 °C,
  • pathological discharge from the cervix and vagina
  • increase in ESR,
  • increased levels of C-reactive protein,
  • laboratory confirmation of cervical infection caused by gonococci, trichomonas, chlamydia.

Evidence-based criteria inflammatory diseases of the pelvic organs are:

  • histopathological detection of endometritis on endometrial biopsy,
  • Ultrasound findings using transvaginal scanning demonstrating thickened, fluid-filled fallopian tubes with or without free fluid in the peritoneal cavity; presence of tubo-ovarian formation,
  • abnormalities detected during laparoscopy corresponding to inflammatory diseases of the pelvic organs.

The most dangerous complication of inflammatory diseases of the pelvic organs is infertility. Its frequency is directly dependent on the duration and frequency of exacerbations of pelvic inflammatory diseases. The main complaints in this case are: infertility (primary or secondary), in 12% of cases - pain in the lower abdomen with intensification before menstruation, the presence of odorless liquid discharge usually 4-5 days before it, 3-4 times a year with an interval of 3 -4 months, in 70% - psycho-emotional disorders (sleep disturbance, irritability, headache).

Other equally severe and significant complications of PID are ectopic pregnancy and adhesive bowel disease.

Currently, a number of techniques are used to diagnose urogenital infections, which differ in sensitivity, specificity, ease of use, availability and price. The main and most common diagnostic method is PCR, which makes it possible to identify many infectious agents in body fluids and tissues, including chlamydia, urea, mycoplasma, gardnerella, cytomegalovirus, herpes viruses 1 and 2, gonococci, trichomonas, HIV, pathogens of tuberculosis and syphilis. In addition, immunofluorescence analysis, which detects fluorescently labeled monoclonal antibodies, is widely used. The sensitivity of this method is 98%, specificity is 90%. It can also be used to diagnose chlamydia and mycoplasmosis.

Trichomonas vaginalis can be detected in a native preparation of contents from the vaginal vault, urethra, cervical canal, as well as when stained with an indicator - methylene blue. Gonococcus is detected in the discharge of the urethra, cervical canal, and excretory ducts of the large vestibular glands when stained with Gram.

The culture method is the standard for detecting all types of infection, but its widespread use is limited by the duration, complexity and inconvenience of storing and transporting the material.

Abroad, so-called amplification diagnostic methods are most often used in clinical practice. In addition to PCR, this group includes: ligase chain reaction and ribosomal RNA amplification (TMA - transcription-mediated amplification). Based on amplification techniques, urinary tests have been developed that are quite convenient for use in outpatient settings, but they have not yet become widespread in domestic practice.

It should be especially noted that negative results of examination of material from the urethra, vaginal vaults and cervical canal cannot be considered reliable to exclude damage to the endometrium, myometrium and fallopian tubes. In this regard, it is necessary to emphasize the diagnostic significance of hysteroscopy and laparoscopy, in which it is possible to collect material from the uterus, fallopian tubes and peritoneal fluid. In addition, during an endoscopic examination, the condition of the uterus, endometrium and fallopian tubes is assessed. It is known that in patients with chlamydia in 71% of cases the fallopian tubes are obstructed in the interstitial section, while in patients with “banal” inflammation in 53% of cases the fallopian tubes are impassable in the ampullary sections.

However, routine microbiological examination of material obtained even during laparoscopy is characterized by low sensitivity. When studying laparoscopic data in patients with visual signs of inflammation, microflora is not detected in 63% of cases. It is localized in the thickness of the inflamed tissue, which is confirmed by the study of the appendages and uterus removed according to indications using laparotomy.

Thus, it should be recognized that in reality, therapy for inflammatory diseases of the pelvic organs is predominantly empirical, and the results of incorrect microbiological studies are often misleading and can lead to castration rather than ensure the effectiveness of treatment.

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Modern algorithm for the treatment of inflammatory diseases of the reproductive system.

Tikhomirov A. L., Yudaev V. N., Lubnin D. M. MGMSU im. N. A. Semashko.
Published: "Medical Panorama" No. 9, November 2003.

Poor sex education culture 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 alarming symptoms to appear.

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

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

You can avoid complications only by carefully monitoring your condition, regularly visiting and undergoing all necessary examinations on his recommendation. At MedikCity, patients have the opportunity to be seen by the best specialists in Moscow and Russia. Our gynecological department is equipped with unique equipment, for example, which allows us 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 microorganisms (staphylococci, streptococci, gardnerella,). Often the cause of PID is mixed communities of pathogens.

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


Diagnosis of diseases of the pelvic organs


Laboratory diagnostics

Medical statistics indicate 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. Diagnostic and surgical manipulations on the pelvic organs can also cause infection.

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

  • lack of a permanent sexual partner;
  • sex without using barrier methods;
  • failure to comply with personal hygiene rules;
  • intrauterine interventions, including the use of intrauterine devices;
  • hypothermia of the body, etc.


Ultrasound of the pelvic organs


Ultrasound of the pelvic organs


Diagnosis of diseases of the pelvic organs

Complications of PID

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

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

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


For quotation: Serov V.N., Dubnitskaya L.V., Tyutyunnik V.L. Inflammatory diseases of the pelvic organs: diagnostic criteria and principles of treatment // Breast cancer. Mother and child. 2011. No. 1. P. 46

Pelvic inflammatory disease (PID) usually results from an ascending infection from the endocervix, which can lead to the development of endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscesses and pelvioperitonitis. The causes of PID are pathogens of sexually transmitted infections (STIs), such as Chlamydia trachomatis, Neisseria gonorrhoeae, as well as Mycoplasma genitalium, anaerobes and other microorganisms. PID is a common cause of morbidity in women. They are detected in one patient out of 60 under the age of 45 when examined by a general practitioner. Treatment started just a few days late significantly increases the risk of complications (infertility, ectopic pregnancy and chronic pelvic pain), which lead to significant treatment costs. PID can be represented by one nosological form (endometritis, salpingitis, oophoritis, tubo-ovarian abscess, pelvioperitonitis), or any combination thereof.

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2. Rational pharmacotherapy in obstetrics and gynecology // Guide for practitioners, edited by V.I. Kulakova, V.N. Serova, M., “Litterra”, 2005, pp. 724-727.
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4. Handbook of obstetrics, gynecology and perinatology, edited by G.M. Savelyeva // M., "MIA", 2006, P.487-501
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9. Banikarim C., Chacko M.R. Pelvic inflammatory disease in adolescents. Semin Pediatr Infect Dis 2005 Jul; 16(3): 175-80.
10. Beigi R.H., Wiesenfeld H.C. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am 2003 Dec; 30(4): 777-93.
11. Blondeau J.M. The evolution and role of macrolides in infectious diseases. Expert. Opin. Pharmacother.2002,3:1131-51.
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13. Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. MMWR 2002;51(RR-6):48-52.
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Inflammatory diseases of the pelvic organs are a group of pathologies associated with infection of the genital organs, which can subsequently lead to infertility. It is inflammatory diseases of the pelvic organs that cause ectopic pregnancy.

Diseases of the pelvic organs are most often diagnosed in adolescence during puberty.

Causes of pelvic inflammatory diseases

Most often, inflammatory diseases of the pelvic organs occur due to infection. Normally, the cervix has a protective function and does not allow infection to enter the uterine cavity. As a result of any violations, for example with gonorrhea, the cervix loses its abilities, and the pathogen penetrates into deeply located organs.

In addition, inflammatory diseases of the pelvic organs can occur as a result of surgery, instrumental examinations, as complications after childbirth or abortion, and so on.

Symptoms of pelvic inflammatory diseases

Depending on which organ is affected, certain symptoms may occur. But it is still possible to identify those that patients most often present during a visit to a specialist. This is primarily pain. It can be pulling, sharp or sharp. In addition, discharge of various types is characteristic. The menstrual cycle is most often disrupted, and urination is painful. As the disease progresses, the temperature rises, nausea and vomiting appear.

It should be especially noted that women with chronic infections, an active sexual life, as well as those who already have a history of inflammatory diseases of the pelvic organs are susceptible to pathology.

Diagnosis of inflammatory diseases of the pelvic organs

To make a diagnosis, you should visit a gynecologist and undergo a full examination. First of all, an inspection is carried out. Based on this, the course of further actions is determined. During the examination, tests for infections are taken.

Next, an ultrasound examination or sonogram is prescribed. In some cases, a tissue biopsy may be required to confirm the diagnosis. Laparoscopy is especially indicative, allowing one to assess the condition of internal organs using a visual examination.

Treatment of inflammatory diseases of the pelvic organs

When treating inflammatory diseases of the pelvic organs, antibiotics are first prescribed. In this case, it is very important to determine the nature of the infection and its causative agent, which allows you to select the most effective drug. It should also be noted that treatment is often carried out for both partners, since the cause of the disease may be a sexually transmitted infection.

In some cases, surgery may be required. Most often, this situation occurs in the presence of abscess formation. In this case, the operation can be performed either open or endoscopic. Of course, the second one is more profitable, since it allows manipulation with a minimum of blood loss. In addition, the rehabilitation period is significantly reduced.

If left untreated, the risk of developing conditions that cause infertility, such as adhesions in the fallopian tubes, increases.

Prevention of inflammatory diseases of the pelvic organs

In order to avoid inflammatory diseases, you should maintain genital hygiene. The use of personal protective equipment, treatment of sexually transmitted diseases, and pathologies of neighboring organs will eliminate the risk of complications.

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 a social and psychological problem in modern society.

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

STI infections

Sexually transmitted infections can be asymptomatic or with mild symptoms, and they can cause serious complications, such as infertility, ectopic pregnancy, chronic diseases and even premature death. In unborn and newborn children, chlamydia infections, gonorrhea, and syphilis can cause severe and often life-threatening consequences, including congenital diseases, neonatal pneumonia, and low birth weight. Infection with human papillomavirus increases the likelihood of developing cervical cancer, which is the second leading cause of cancer death in women worldwide, killing 240,000 women each year. The risk of contracting or transmitting HIV increases significantly.

Sexually transmitted infections include:

  1. Human papillomavirus infection.
  2. Urogenital chlamydia.
  3. Urogenital trichomoniasis
  4. Genital herpes
  5. Mycoplasma infection
  6. Cytomegalovirus infection

STI symptoms

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

Symptoms caused by these pathogens may be as follows:

  • discharge from the genital tract (from milky, cheesy to yellow-green foamy discharge)
  • itching, burning
  • swelling of the tissues of the vagina and vulva (external genitalia)
  • rashes on the external genitalia in the form of vesicles, which subsequently open to form erosions
  • finger-shaped or warty growths, single, multiple and confluent (cauliflower-like) formations
  • dyspareunia (discomfort or pain in the external genitalia 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 modern course of trichomoniasis is distinguished by erased signs of the inflammatory process, which are revealed only after a thorough examination of the patient by a doctor. Periodic exacerbations may occur, which are most often caused by sexual intercourse, alcohol consumption, decreased body resistance, and impaired ovarian function.

Urogenital chlamydia(Chlamydial Genitourinary Infections)

A highly contagious infectious disease that primarily affects 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 pose a particular epidemiological danger with these infections. The disease is the cause of the formation of pronounced pelvic adhesions and tubo-peritoneal infertility.

Urogenital mycoplasmas

Urogenital mycoplasmas (ureaplasma urealytica, ureaplasma parvum, mycoplasma genitalium, mycoplasma hominis) are opportunistic microorganisms, but under certain conditions are capable of causing diseases such as urethritis, prostatitis, pyelonephritis, arthritis, postpartum endometritis, pathology of pregnancy, fetus and newborn, sepsis etc. These microorganisms have been identified as possible etiological agents of non-specific non-gonococcal urethritis, pelvic inflammatory diseases and bacterial vaginosis.

Genital herpes

A chronic, relapsing, viral disease, predominantly sexually transmitted. The main causative agent of genital herpes in most cases (70-80%) is herpes simplex virus type 2 (HSV-2). Herpes simplex virus type 1 (HSV-1) usually causes lesions on the lips, face, arms, and torso, but in recent years the frequency of genital herpes caused by this type of virus has increased (20-30% of cases), which is apparently due to changes 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 CMV 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 suffered an infection during pregnancy. The source of infection can be a virus carrier, a patient with an acute form (in the case of primary infection) or a patient during an exacerbation of the infection. The main routes of transmission of infection are airborne, sexual, contact, oral, parenteral, enteral and vertical, while transmission of viruses can occur through all biological fluids and body secretions (saliva, urine, etc.). Once the virus enters the body, after initial infection, it can remain in the body for life. The infection can be asymptomatic (virus carriage) due to the fact that the virus is protected by lymphocytes from the action of specific antibodies and interferon.

Human papillomavirus infection

Human papillomavirus infection (HPV) Human papillomavirus infection (HPV) - initiates a number of genital diseases associated with the human papillomavirus (HPV). Human papillomavirus infection (PVI) is one of the most common in the modern world. The virus is not limited to the traditional risk group and diseases associated with HPV are common in all segments of society. Almost all people who are sexually active can be considered at risk of infection with the human papillomavirus. Around the world, about 630 million people are infected with HPV. Already 2 years after the start 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 changes of sexual partners, other sexually transmitted infections, and smoking.

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

Vulvovaginal candidiasis

Vulvovaginal candidiasis (thrush) is not a sexually transmitted disease; it is caused by infection of the vulva and vagina by yeast-like fungi of the genus Candida and 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 during their lifetime, and 25% of women suffer from vulvovaginal candidiasis for many years.

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

Bacterial vaginosis

Does not apply to STIs, but is one of the most common form of 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 (lactobacteria) in the vagina by a large number of conditional pathogens (anaerobic bacteria) and is accompanied by copious vaginal discharge.

The problem of bacterial vaginosis is currently very relevant, since its causes have not been fully elucidated, treatment methods 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 has a relapsing nature and requires careful diagnosis.

Diagnosis of STIs

Diagnostics is based on laboratory and functional research methods.

Modern research methods necessary to determine the patient’s treatment tactics:

  • methods of nucleic acid amplification (NAAT - PCR, PCR-real time)
  • cultural research method - seeding (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 blood and urine analysis;
  • biochemical blood test and general urine test;
  • Ultrasound of the pelvic organs;
  • determination of 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.

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