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Adnexitis – Causes, Symptoms and Treatment

Adnexitis is an inflammation of the female adnexa, including the fallopian tubes and ovaries. It is usually caused by bacteria and requires prompt medical treatment.

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Things worth knowing about "Adnexitis"

Adnexitis is an inflammation of the female adnexa, including the fallopian tubes and ovaries. It is usually caused by bacteria and requires prompt medical treatment.

What is Adnexitis?

Adnexitis refers to an inflammation of the female adnexa, which includes the fallopian tubes and the ovaries. Medically, it is also known as salpingo-oophoritis. The condition can affect one or both sides and is one of the most common gynecological infectious diseases. Without timely treatment, it can lead to serious complications, including chronic pelvic pain or infertility.

Causes

Adnexitis is most commonly caused by ascending bacterial infections. Pathogens travel from the vagina and cervix into the upper reproductive organs.

Sexually transmitted pathogens: Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent causative agents.
Mixed infections: Multiple bacterial species are often involved, including anaerobes and enterobacteria.
Contributing factors: Multiple sexual partners, unprotected intercourse, recent uterine procedures (e.g., IUD insertion), or a previous episode of adnexitis.

Symptoms

Symptoms can vary depending on the severity of the inflammation. Common signs include:

Lower abdominal or pelvic pain, often on both sides
Fever and general malaise
Increased or altered vaginal discharge
Pain during sexual intercourse (dyspareunia)
Pain during urination or bowel movements
Irregular menstrual bleeding

In severe cases, a tubo-ovarian abscess may develop, a pus-filled abscess involving the fallopian tube and ovary that requires urgent treatment.

Diagnosis

The diagnosis of adnexitis is based on a combination of clinical examination, laboratory tests, and imaging:

Gynecological examination: Tenderness in the lower abdomen and cervical motion tenderness are typical findings.
Laboratory values: Elevated inflammatory markers such as CRP and white blood cell count, along with pathogen detection via swab cultures.
Ultrasound: Transvaginal ultrasound is used to evaluate the adnexa and rule out an abscess.
Laparoscopy: In unclear or severe cases, direct visualization via laparoscopy may be performed.

Treatment

Treatment depends on the severity of the condition and usually involves antibiotic therapy:

Outpatient Treatment

For mild to moderate cases, oral antibiotic therapy is possible. Combination regimens are typically used to cover the broad spectrum of potential pathogens (e.g., a cephalosporin combined with doxycycline and metronidazole). The treatment duration is usually 14 days.

Inpatient Treatment

Hospitalization is required in severe cases, suspected abscess, pregnancy, or when outpatient therapy fails to produce improvement. Intravenous antibiotics are administered in hospital. Surgical intervention may be necessary in the case of a tubo-ovarian abscess.

General Measures

Physical rest and reduced activity
Treatment of the sexual partner if a sexually transmitted pathogen is confirmed
Abstinence from sexual intercourse during treatment

Complications

If adnexitis is left untreated or treated too late, the following complications may occur:

Chronic adnexitis with persistent pelvic pain
Adhesions (scar tissue) within the abdominal cavity
Ectopic pregnancy due to scarring of the fallopian tubes
Infertility
Spread of infection to the peritoneum (peritonitis)

Prevention

The risk of adnexitis can be reduced through the following measures:

Using condoms to prevent sexually transmitted infections
Regular gynecological check-ups
Early treatment of pelvic infections

References

Deutsche Gesellschaft fur Gynakologie und Geburtshilfe (DGGG) - Guideline on the Diagnosis and Treatment of Adnexitis (2019).
Workowski KA, Bachmann LH et al. - Sexually Transmitted Infections Treatment Guidelines. MMWR Recomm Rep. 2021;70(4):1-187.
Berek JS (ed.) - Berek and Novak's Gynecology. 16th edition. Wolters Kluwer, 2020.

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