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Inflammation of the ovaries (oophoritis) is one of the forms of the pelvic inflammatory disease (pelvic inflammatori disease – PID). The infection occurs with climbing of the microorganisms from the lower parts of the female reproductive system and it is one of the major causes of ectopic pregnancy, infertility and chronic pelvic pains. Inflammation of the ovaries should be differentiated from other pains in the abdomen.
Occurence
Infection is climbing after the bacteriae colonize the cervix, then they go to the uterus, Fallopian tubes and ovaries. Bacteriae Neisseria gonorrhoeae (cause of gonorrhea) and Chlamidia trachomatis tipically cause pelvic inflammatory disease. These causers rarely get isolated from the ovarian tissue; more often they encourage the infection with other bacteriae. If the inflammation of the ovaries is not treated, around the ovaries and the Fallopian tubes a constrained purulent cluster may be formed and that is called tubo-ovarian abscess.
Age
Inflammation of the ovaries is most common with women under the age of 25.
Symptoms
- pain in the abdomen
- pain in the pelvis
- discharge from the vagina
- painful vaginal sexual intercourse
- fever
- chills
- nausea
- vomitting
A doctor will find during the examination:
- body temperature higher than 38 ° C
- lower abdominal quadrant sensitivity when touching
- purulent discharge
- painful sensitivity of the cervix when moved
- pain in the ovaries
- a mass in the ovarian area (if tubo-ovarian abscess has appeared)
Causes
Main causes of the pelvic inflammatory diseases are sexually transmitted diseases that are most common with the younger, sexually active population, and with more sexual partners. Sexually transmitted diseases are, unfortunately, mostly without symptoms or with such mild symptoms that the person does not consider them to be of greater importance, so they are hard to detect.
Risk factors can be summed up like this:
- unprotected sexual intercourse
- multiple sexual partners
- highly risky sexual behaviour
- immunosuppression (immune system disorder)
- instrumental checkups of the genital tract (endometric biopsy)
- intrauterine contraceptive insert (coil)
Differential diagnosis
With occurrence of these symptoms, besides the inflammation of the ovaries, you should suspect some of the following diseases:
- ovarian tumors
- inflammation of the appendix
- non-bacterial inflammation of the bladder
- diverticulitis
- ectopic pregnancy
- inflammatory diseases of the digestive system - gastroenteritis
- inflammation of the intestinal lymphatic vessels – mesenteric lymphadenitis
Diagnosis
Diagnosis of the inflammation of the ovaries is made by talking to the patient, checkup, lab techniques, histological evaluation and various scanning techniques and imaging of the ovaries and the abdomen. Lab findings that are needed: complete blood analysis, differential blood analysis, urine analysis (to eliminate bladder inflammation), pregnancy test (to eliminate ectopic pregnancy), wet preparation of the vaginal discharge, bacterial cultures of the cervix for gonococcus (Neisseria gonorrhoeae) and chlamydia (Chlamidia trachomatis) to eliminate or confirm infection of these bacteriae. Of scanning devices, the least expensive and widely accessible is ultrasound that will eliminate the presence of the tubo-ovarian abscess.
Other methods include diagnostic laparoscopy which are usually run when the diagnosis is unclear. Serological tests for the virus hepatitis B, the hepatitis C virus, syphilis and HIV are needed because the listed causes can be found in persons that are into highly risky sexual behaviour. Histological evaluation is done if the cases are evaluated with a surgical procedures.
Treatment
Hospitalization is not needed if the patient is:
- 1. hemodynamically stable (no bleeding)
- 2. responsible enough to endure the treatment and go to regular
- 3. immunocompetent (the immune system is working properly)
- 4. not pregnant
- 5. tubo-ovarian abscess free
Hospital treatment is needed if the patient is:
- 1. already treated out of the hospital, but it was not successful
- 2. pregnant
- 3. HIV positive
- 4. if tubo-ovarian abscess has occured
- 5. if there is no possibility for oral treatment with tablets because of severe nausea and vomitting
Treatment with medication has the purpose of reducing morbidity, to prevent the occurrence of complications and to eradicate the infection. Antibiotics are not used for treatment. Antomocrobial therapy should cover all possible disease causers. For gonococcal infection the best solution is the third generation of cephalosporins, such as ceftriaxone, cefuroxime and cefixime, then the medication such as ciprofloxacin and ofloxacin. For chlamydian infection the best are azithromycin, doxycycline, ofloxacin and erythromycin. For mycoplasma the best are tetracyclines. Anaerobic bacteriae are treated with clindamycin, metronidazole, imipenem, some third generation cephalosporins, and amoxicilin of clavulanic acid.
Outpatient cases can have a treatment that has a combination of ofloxacin and metronidazole at the beginning and after the main symptoms are gone, continue the treatment with doxycycline for two more weeks. It is of utmost importance to treat well a chlamydian infection because for the lack of symptoms and a belief that they are cured, the patients often do not carry on with the therapy. That is when the infection is only suppressed and it is still destroying female reproductive system which can lead to infertility and ectopic pregnancy.
Surgical treatment cannot be done unless the other forms of treatments have lessened the symptoms after 48-72 hours. Surgical procedure can include laparoscopy with abscess drainage, ovary removal or uterus removal with removal of both ovaries. Factors that determine the extent of the procedure are abscess size, immune disorder degree and conservation of fertility for childbirth in the future. Interventional radiology is sometimes used when the patients are not surgical candidates for some reason. I
Complications
- tubo-ovarian abscess burst is an indication for surgical procedure because it can be life threatening
- infertility can occur in 12-15% cases after one episode of pelvic inflammatory disease
- ectopic pregnancy is more often after this disease has taken place. If a woman gets pregnant shortly after inflammation of the ovaries, she should consult a doctor immediately.
- long lasting pain in the pelvis is a possible consequence after a cured pelvic inflammatory disease
Prognosis
If tubo-ovarian abscess doesn’t occur, 90% of the patients will respond well to an antibiotic treatment.
Special care
Increased concern is needed if the inflammation of the ovaries occurs during:
- pregnancy – even though it is rare, it is possible and a gynecologist should be consulted immediately
- childhood – children rarely have inflammation of the ovaries, but if there is a suspicion for it, there is a possibility that sexual abuse has taken place
- older age – in this period of life inflammation of the ovaries is often related to malignant changes like ovarian carcinoma or endometriosis.
Prevention
With education of women, it is unusually important to get early diagnosis and treat lower parts of female reproductive system, so it doesn’t spread. Women who got through inflammation of the ovaries should be educated and counseled about condom use to prevent future infections. Sexual partners should also be tested for sexually transmitted diseases and they should be treated as well.
Diet
There is no need for diet alterations. Before surgical procedures, food shouldn’t be taken orally.
Physical activity
It can be carried out as much as the woman can endure.