Chronic oophoritis is a long–term inflammatory process affecting the ovaries. The exacerbation of the disease is characterized by dull or aching pains in the lower abdomen and inguinal region, mucous and mucopurulent whites. In the remission phase, there is a disorder of the ovarian-menstrual cycle, dishormonal disorders, infertility. To diagnose the disease, bimanual examination, ultrasound of the pelvic organs, laparoscopy, laboratory diagnostic methods are used. The treatment regimen includes etiotropic antibacterial drugs, anti-inflammatory, immunocorrective and enzyme agents.
ICD 10
N70.1 Chronic salpingitis and oophoritis
General information
The chronic form of oophoritis as an independent pathology is extremely rare. Usually, inflammation of the ovaries is combined with a lesion of the fallopian tubes, called chronic salpingoophoritis (adnexitis). In the vast majority of cases, oophoritis is secondary and develops as a result of the spread of the infectious process from other organs. Both ovaries and one of them can be involved in inflammation. The disease occurs more often in women aged 18-28 years who are sexually active. The importance of timely detection and treatment of oophoritis is due to the high frequency of secondary infertility. According to various studies in the field of clinical gynecology, reproductive dysfunction is observed in 60-70% of cases of the disease.
Causes
An inflammatory reaction in the ovarian tissues usually occurs in response to exposure to infectious agents. The direct causative agents of the process can be:
- Sexually transmitted infections. The most common cause of chronic oophoritis are gonococci, chlamydia, trichomonas, mycoplasmas. In this case, the disease is usually bilateral.
- Conditionally pathogenic microorganisms. Inflammation can be caused by streptococci, staphylococci, E. coli, anaerobes, etc. In the case of activation of non-specific flora, the process can be bilateral or unilateral.
- Mycobacterium tuberculosis. One- or two-sided specific oophoritis in the form of tuberculous tubercles or caseomas is observed in 1/3 of patients with a phthisiological profile.
Due to the peculiarities of the anatomical location and the presence of a dense outer capsule, the ovaries are well protected from the ingress of microorganisms. For the occurrence of a chronic inflammatory process in them, a combination of several predisposing factors is required, the main of which are:
- Female inflammatory diseases. Most often, inflammation is detected in women with vaginitis, cervicitis, endometritis and salpingitis.
- Inflammatory processes in the pelvis. Acute appendicitis and other pathological conditions involving the peritoneum can lead to the development of chronic oophoritis.
- Invasive interventions. The spread of pathogens is facilitated by abortions, complicated childbirth, curettage and other medical and diagnostic procedures.
- Promiscuous sex life. Frequent change of partners and unprotected sex increase the likelihood of infection with STIs, pathways to ovarian tissue.
- Concomitant pathology and decreased immunity. The risk of symptoms of the disease is increased in patients who suffer from obesity, diabetes, chronic diseases, experience stress or take immunosuppressive drugs.
Extremely rarely, inflammation develops as a result of organ injury during accidents and abdominal operations. In some cases, the secondary inflammatory process occurs with benign and malignant neoplasms of the ovaries.
Pathogenesis
Chronic inflammation can develop gradually (for example, with gonorrhea or an asymptomatic course of chlamydia) or be the result of an untreated acute oophoritis. There are four main ways for pathogens to enter the ovarian tissues: ascending (from the vagina, cervical canal, uterus, fallopian tubes), descending (along the peritoneum), lifmogenic (from nearby organs) and hematogenic (in tuberculosis). Often, inflammation spreads from the outer membranes of the organ to the cortical and cerebral substance. With lymphogenic and hematogenic infection, the stroma and follicular tissue are the first to be involved in the process. Usually the inflammation is serous or serous-fibrinous, much less often purulent.
The chronic course of the disease is promoted by increasing endogenous intoxication, decreased immune reactivity, local microcirculation disorders and changes in blood rheology. As the cortical substance is involved in the process, the endocrine function is disrupted, which is manifested by signs of hypo- or hyperestrogenemia. Chronization of oophoritis is accompanied by the inclusion of autoimmune mechanisms, as a result of which antibodies to ovarian tissues are produced. The combination of these disorders with the action of specific infections, especially chlamydia, depletes the ovarian reserve, which increases the risk of infertility and worsens the prospects for in vitro fertilization.
The disease proceeds cyclically: the period of exacerbation with clinical symptoms, expressed to varying degrees, is replaced by remission. The exacerbation of the process is usually facilitated by hypothermia, stress, hormonal changes during pregnancy or before menstruation, colds, decreased immunity.
Symptoms of chronic oophoritis
The clinic of the disease depends on its phase. During the period of exacerbation, the patient is concerned about dull or aching pain in the lower abdomen and in the groin area. Possible irradiation into the sacrum, increased pain during physical exertion and sexual intercourse. If other genitals are involved in the inflammation, the number of vaginal secretions increases, usually mucous, less often mucopurulent. The general symptoms, as a rule, are expressed slightly, in rare cases it is manifested by an increase in temperature to subfebrile figures, nausea, sometimes vomiting.
In remission, pain is usually absent. A woman’s sleep may worsen, her working capacity may decrease, fatigue and irritability may occur, the menstrual cycle, sexual and reproductive functions may be disrupted. With chronic oophoritis, menstruation becomes irregular, while the menstrual cycle usually lengthens, intermenstrual bleeding, soreness and copious menstrual discharge may occur. Some patients note pronounced PMS. In 50-70% of women, sexual desire decreases, which is often associated with dyspareunia (painful sensations during sex). In some cases, the only sign of chronic inflammation is the inability to get pregnant with regular sexual activity.
Complications
Since the chronic course of oophoritis is usually combined with salpingitis, the most serious complication of the disease is adhesive disease. It is plastic pelvioperitonitis and violation of the endocrine function of the ovaries that usually lead to tubal-peritoneal infertility. In addition, such patients significantly increase the risk of ectopic pregnancy and miscarriage of the fetus. With exacerbation, oophoritis can be complicated by purulent-inflammatory processes, from purulent melting of the ovaries (pioovar) to the formation of tuboovarian abscess and the development of peritonitis.
Diagnostics
When making a diagnosis, it should be taken into account that the symptoms characteristic of chronic oophoritis are quite nonspecific and may indicate other gynecological diseases. Therefore, the examination plan includes methods that reliably confirm the localization of inflammation and identify the causative agent.:
- Examination on the chair. During bimanual examination, the appendages are pasty, compacted or heavy. During palpation, soreness and limited mobility are noted.
- Transvaginal ultrasound. The ovaries are enlarged, their surface is smoothed. The echogenic structure is enhanced due to the presence of fibrosis sites. There may be echo signs of inflammation of the fallopian tubes and endometrium.
- Laparoscopy. The endoscopic method is considered the gold standard for the diagnosis of inflammation in the ovaries. During the procedure, it is possible not only to confirm the inflammatory process, but also, if necessary, to take a biomaterial for histological examination.
- Laboratory diagnostics. Microscopy, seeding of vaginal secretions, PCR, RIF, ELISA and other analyses allow to determine the causative agent of oophoritis.
- Tuberculin test. It is indicated in the presence of an extensive inflammatory process in the pelvic region with scant clinical symptoms.
Differential diagnosis is performed with other inflammatory gynecological diseases and volumetric processes in the pelvic cavity. According to the indications, the patient is referred for consultation to a gynecologist-reproductologist, oncogynecologist, phthisiologist.
Treatment of chronic oophoritis
- The choice of therapeutic scheme depends on the phase of the process. In case of exacerbation and the identified pathogen of inflammation, the following are indicated:
- Etiotropic antibacterial therapy. Medicines are selected taking into account the sensitivity of pathogenic flora. If necessary, broad-spectrum antibiotics are prescribed until the results of sowing are obtained.
- Anti-inflammatory drugs. Nonsteroidal drugs can reduce pain and the severity of inflammatory changes.
- Enzyme therapy. The use of enzyme preparations is aimed at preventing adhesive disease and resorption of existing adhesions.
- Immunocorrection. To strengthen the body’s own defenses, immunostimulants, interferogens, vitamin and mineral complexes are recommended.
During remission, the leading role is played by therapy aimed at strengthening immunity, restoring reproductive and endocrine functions. At this stage, immunoregulators, enzymes, eubiotics, biogenic stimulants, hormonal drugs are prescribed. The combination of medical treatment with physiotherapy and balneotherapy is effective. Surgical techniques are used in the presence of complications. Operations are indicated for the detection of severe purulent-inflammatory diseases (pyoovar, tuboovarian abscess, peritonitis, etc.) and adhesive disease leading to tubal-peritoneal infertility.
Prognosis and prevention
With uncomplicated course and proper treatment, the prognosis is favorable. To prevent chronic oophoritis, it is recommended to visit a gynecologist every 6 months, reasonably carry out invasive procedures, refuse abortions, treat infectious and inflammatory diseases of the reproductive sphere in a timely and sufficient manner. It is important to exclude casual sexual relations, use barrier contraceptives, observe personal hygiene, lead a healthy lifestyle with sufficient motor activity, quitting smoking and alcohol abuse. It is necessary to avoid hypothermia, significant psycho-emotional and physical exertion.