Adnexitis - what it is, causes, symptoms and treatment of adnexitis in women. In gynecology, chronic adnexitis, chronic salpingoophoritis, urticaria

Are you here: Respiratory

The uterine appendages are often subject to chronic inflammation: fallopian tubes, ovaries, ligaments. The disease is sluggish in nature and is called: chronic adnexitis, as well as salpingoophoritis.

The pathology may weaken, progress, pose a threat to health, and the woman may not be aware of it. As a rule, they do not pay attention to mild pain that goes away voluntarily.

How dangerous is the chronic form of the pathology?

The danger of a sluggish process lies in its unpredictability. One day, sharp pain may begin, and, as a result, the transition from the chronic stage to acute. Such an attack ends in hospital, since this pathology is treated in a hospital.

However, more often chronic adnexitis lasts for years. A woman may be planning a pregnancy and not understand why there is no conception. The disease can disappear arbitrarily if certain factors contribute to this:

- healthy lifestyle

- careful personal hygiene

- no hypothermia

- light sports activities

- absence of disordered relationships

- absence of bronchitis, pneumonia

- sexual relations with a clean partner.

Development of the chronic stage

First, the infection enters the lower genital organs, but in the presence of provoking factors - into the uterus and appendages. Bacteria also penetrate from the upper respiratory tract, intestines, and gallbladder if there is inflammation in them. That is why it is necessary to treat chronic adnexitis before complications develop.

It is easier to control the uterine appendages when the sluggish stage occurs after an untreated acute form, since the woman already knows about her diagnosis. In this case, it is better to undergo diagnostics at will, rather than wait for a referral from a doctor. It should also be remembered that the chronic stage often develops independently.

With this disease, conception can occur, but there is a high probability of ectopic pregnancy. The egg cannot pass through the “corridor” of the fallopian tube into the uterus. Along its path there are scars and adhesions that form after treatment of the acute stage or during complications of the chronic stage.

How does a sluggish process develop?

Chronic adnexitis develops after microbial damage to the appendages or nearby organs. The disease can appear after pregnancy, childbirth, if an infection enters the uterus. In this case, endometriosis is possible, and then, as a consequence, salpingoophoritis. Signs of sluggish adnexitis are almost invisible. In this case, a bilateral process exhibits more pronounced symptoms, because the pathology develops on 2 sides of the uterus:

1. Aching pain in the lower abdomen, from weak to throbbing, noticeable. They almost always go away on their own.

2. Pain appears in the middle of the cycle. This distinguishes chronic inflammation of the appendages from many uterine pathologies. This symptom has an explanation: adhesions prevent the egg from leaving the fallopian tube in the middle of the cycle.

3. Cycle failure: periods come profusely, with a significant delay.

4. Pain during sexual intercourse. It does not appear at the site of inflammation, but in the entire pelvic area.

Classification of the disease according to ICD

According to the international classification of diseases ICD 10, chronic adnexitis has statistical code N70.1. The disease is listed in a document entitled: Chronic salpingitis and oophoritis. It explains the essence of the chronic form of the uterine appendages, which combines inflammation of the tubes (salpingitis) and ovaries (oophoritis).

In ICD 10, the disease is included in the subsection “Salpingitis and oophoritis”, which has code N70. This subsection in ICD 10 is divided into 3 parts according to the forms of this pathology:

— acute N70.0

- unspecified N70.9

— chronic N70.1

Due to the fact that the characteristics of the development of pathology differ, ICD 10 classifies them as separate diseases in their group. Section N70 is included in the category "Inflammatory diseases of the female pelvic organs", which includes codes N70-N77. The entire section devoted to these pathologies is included in the heading “Diseases of the genitourinary system,” which includes codes N00-N99.

ICD code N70.1 includes all types of chronic salpingoophoritis:

- double-sided

- one-sided (left or right)

This classification allows you to use ICD 10 code to find out about the diagnosis: chronic salpingoophoritis, if it is noted in the medical record. It should be noted that the ICD only provides analysis, classification, and interpretation of diseases, but does not include treatment instructions.

How is the chronic stage treated?

Chronic 1st and 2nd side adnexitis, like other stages of this disease, is treated with antibiotics. They are prescribed according to the cause of infection. This is an important factor, since the doctor prescribes certain antibiotics for a specific type of microbe.

When making appointments, the following data is taken into account:

- degree of neglect of the inflammation process

— age, weight of the patient

— place of treatment (outpatient, inpatient).

Antibiotics for the chronic stage

Most often, chronic inflammation of the appendages is a consequence of the penetration of bacteria transmitted from a sexual partner. Then appropriate antibiotics are prescribed. For example:

- one- or two-sided form is caused by chlamydia, mycoplasma, then erythromycin is prescribed

- the cause of inflammation is gonococci, the antibiotic ceftibuten (Cedex) is prescribed.

More modern drugs: ciprofloxacin, zanocin. These antibiotics make it possible to achieve good results by reducing the dose and duration of the course. The drugs are quite effective in stopping the exacerbation of chronic adnexitis and preventing the disease from moving into the acute stage. These drugs are also used for other forms of adnexitis.

Is pregnancy possible?

If a woman is planning a pregnancy, antibiotics should be taken according to the regimen prescribed by the doctor. Do not exceed doses or stop treatment prematurely. It should be noted that the chronic stage reduces the chances of getting pregnant, since the process is permanent. Adhesions and scars are characteristic of the sluggish stage, even when symptoms do not appear. However, this only aggravates the situation, because treatment is not carried out, and infertility develops.

One day, as a consequence of a long, sluggish process, an exacerbation of chronic salpingoophoritis may begin, due to which the pathology will spread to other organs of the pelvic peritoneum. That is why pregnancy planning should be carried out with simultaneous diagnosis of the uterine appendages using modern equipment.

Sometimes laparoscopic surgery is performed to restore lumen in the tubes. However, the chances of getting pregnant do not increase 100% even after such intervention. At the same time, medicine knows cases when a woman managed to get pregnant after treatment of this pathology. It is important to complete the entire course of recovery.

Chances and dangers of possible conception

If a form of bilateral adnexitis is diagnosed, the chances are less than those of 1 side. In this case, much depends on the patency of the pipe, but with an exacerbation of chronic adnexitis, the chances drop many times over. However, if the egg can pass between the scars, it will enter the uterus and be fertilized by a sperm. The sperm itself can also enter the fallopian tube and fertilize the egg there.

This moment is dangerous due to ectopic pregnancy, which leads to urgent hospitalization and, often, to the loss of the fallopian tube. However, if paired uterine appendages remain, the chances of getting pregnant are very high. Here it is important to monitor the condition of the appendages and undergo treatment for chronic 1-sided salpingoophoritis.

So far the question is: is it possible to cure chronic adnexitis? — there is no clear answer. Modern drugs can cope with inflammation, but the consequences largely depend on the woman. The sooner attention is paid to even mild symptoms, the greater the chance of living with healthy uterine appendages.

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

SALPINGOOPHORITIS

Salpingo-oophoritis- 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 of various parts of the pelvis is rare, since they are closely related anatomically and physiologically. In this regard, it is difficult to obtain accurate statistical data on the spread of salpingoophoritis (as well as on pathologies of other parts of the pelvis). Nevertheless, about 40% of patients are hospitalized in hospitals due to acute processes or exacerbations of chronic diseases of the genital organs. About 60% of patients visit antenatal clinics for inflammation. Complications after suffering salpingo-oophoritis are known.

Every fifth woman who has had salpingo-oophoritis, suffers from infertility.
Ectopic pregnancy is 5–10 times more likely.
In 5–6% of patients, purulent complications arise that require hospital treatment and surgical intervention (often with removal of the fallopian tubes).

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

PREVENTION OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

PID is caused by STI pathogens (N.gonorrhoeae, C.trachomatis), aerobic and anaerobic opportunistic microorganisms, fungi, viruses, pyogenic microflora, therefore the prevention of these infections requires periodic and mandatory examinations (pregnant women and those planning pregnancy, inpatients, dispensary groups and risk groups - teenagers, employees of child care institutions, children's hospitals, etc.). Promotion of contraceptive methods and safe sex is necessary.

SCREENING

Adolescent girls, workers in kindergartens, nurseries, orphanages, boarding schools, and dispensary groups with infertility and recurrent inflammatory processes are subject to examination for hidden infections. All patients undergo bacterioscopic, bacteriological examinations and PCR.

CLASSIFICATION OF INFLAMMATORY DISEASES OF THE UTERINE APPENDIXES

Acute nonspecific (or specific) salpingoophoritis.
Exacerbation of nonspecific salpingoophoritis.
Chronic nonspecific salpingoophoritis.

ETIOLOGY (CAUSES) OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

Nonspecific (nongonorrheal) salpingo-oophoritis is caused by pathogenic and opportunistic pathogens. Among them: Staphylococcus aureus and Staphylococcus epidermidis, group B streptococci, enterococci, Escherichia coli, Staphylococcus epidermidis, chlamydia, bacteroides, peptococci, peptostreptococci. Most often, a mixed infection is observed.

PATHOGENESIS OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

Inflammatory processes of the fallopian tubes and ovaries have a common pathogenesis. Initially, all signs of inflammation appear on the mucous membrane of the fallopian tubes (endosalpinx): hyperemia, microcirculation disorders, exudation, edema, cellular infiltration. Then the inflammation spreads to the muscular lining of the fallopian tube, causing swelling.

The tube thickens and lengthens, palpation becomes painful. Microbes, along with the contents of the tube, enter the abdominal cavity, affecting the serous cover of the tube and the surrounding peritoneum. Perisalpingitis and pelvioperitonitis occur. After the ovarian follicle ruptures, pathogens enter, infect the granulosa membrane of the follicle, and an inflammatory process occurs in the ovary (salpingoophoritis). When suppuration occurs, a tubo-ovarian tumor forms (see below).

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

CLINICAL PICTURE (SYMPTOMS) OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

The first symptom of acute salpingoophoritis is severe pain in the lower abdomen, accompanied by an increase in temperature to 38 ° C (sometimes with chills), deterioration of the general condition, there may be dysuric phenomena, and sometimes bloating. When examined with the help of speculum, inflammatory endocervicitis and serous-purulent discharge can be detected. During a bimanual examination, it is impossible to clearly identify the appendages, but the area of their examination is sharply painful, swelling and a pasty consistency are not uncommon. The blood picture shows a shift in the leukocyte formula to the left, an increase in ESR.

The proteinogram shows dysproteinemia with a predominance of globulin fractions, an increase in the level of Reactive protein. Intoxication phenomena occur - a state of moderate severity, weakness, headache, loss of appetite, and sometimes dyspeptic disorders. An acute inflammatory process can result in complete recovery with timely and adequate treatment.

Acute salpingoophoritis can become a subacute or chronic process with frequent exacerbations and last for years. Clinical manifestations are not so bright then. The temperature reaction can be low-grade or normal, the pain is dull, aching, localized in the lower abdomen and lower back. Complaints of dyspareunia and infertility are common. Bimanual examination is less painful, but the uterus and appendages are less mobile, and advancement beyond the cervix is painful. In the blood during a chronic process, as a rule, the ESR is slightly increased. Changes occur when the process intensifies.

DIAGNOSTICS OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

Based on the following anamnesis data:

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

HISTORY AND PHYSICAL EXAMINATION

In acute inflammation, 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 the chronic process, on the contrary, sclerosis and fibrosis of the fallopian tubes with the formation of adhesions in the pelvis make the appendages inactive. Their pain is often determined.

LABORATORY RESEARCH

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

INSTRUMENTAL RESEARCH

The echographic method does not provide clear information about acute salpingoophoritis. Only thickening of the fallopian tubes and adhesions in the pelvis can be diagnosed. With pelvioperitonitis, a small amount of fluid accumulates in the pouch of Douglas. You can also determine the tumor-like form of hydrosalpinx or pyosalpinx.

It is better to use an ultrasound with a vaginal sensor. CT or MRI may be used, especially in the differential diagnosis of ovarian tumors.

DIFFERENTIAL DIAGNOSTICS

Acute salpingoophoritis 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 selection of the correct treatment tactics.

Consultations between a surgeon and a urologist are often extremely necessary, especially in urgent cases of differential diagnosis.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Exacerbation of chronic bilateral salpingoophoritis with the formation of right-sided hydrosalpinx and adhesions in the pelvis.

TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

TREATMENT GOALS

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, SALPINGOOPHORITIS

Practiced during a chronic process or during post-hospital rehabilitation during an acute process. Physiotherapeutic methods are mainly used: UHF, magnetic therapy, electrophoresis with zinc, magnesium, hyaluronidase, etc., diadynamic currents, sanatorium treatment (radon baths and irrigations, thalassotherapy).

DRUG TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

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

Antibacterial therapy for PID, as a rule, begins with intravenous administration of drugs followed by a transition to oral administration (stepped therapy). In mild forms of PID, patients are treated on an outpatient basis, in which case it is preferable to take oral medications with high bioavailability. Antibiotics are combined with detoxification therapy: saline solutions, 5% glucose solution ©, rheopolyglucin ©, hemodez ©, polydez ©, mafusol ©, vitamins are administered intravenously , protein preparations, etc.

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

SURGICAL TREATMENT OF SALPINGITIS, ADNEXITIS, SALPINGOOPHORITIS

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

Diagnostic and treatment schemes for salpingoophoritis in detail.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

Consultation with specialists (surgeon, urologist) is indicated:

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

APPROXIMATE DURATION OF DISABILITY

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

FOLLOW-UP

Post-hospital rehabilitation (outpatient follow-up treatment using absorbable, restorative physiotherapy and sanatorium-resort treatment) in order to restore 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 for an acute process or exacerbation of a chronic one. It is necessary to conduct courses of anti-relapse treatment, use sanatorium balneotherapy, and use contraceptive methods. If an STI is detected in a partner, treat it and conduct a follow-up examination of the couple.

FORECAST

Favorable for life. Problems, as a rule, are associated with menstrual, sexual and reproductive functions.

Treatment of chronic adnexitis (salpingoophoritis) is most effective in the acute stage when pathogenic bacteria are activated. Before drawing up a therapeutic regimen, a number of laboratory and instrumental studies are carried out. The test results help to establish the species of microorganisms, their resistance to antibiotics, and the degree of development of the pathological process. To treat chronic adnexitis, an integrated approach is used, which consists of taking pharmacological drugs, conducting physiotherapeutic procedures, and following a special diet.

Diagnosing the disease at an early stage significantly increases a woman’s chances of a full recovery. In the international classification, chronic salpingoophoritis is listed under ICD 10 code No. 70.1.

What kind of disease is this?

Chronic adnexitis according to ICD 10 code in the International Statistical Classification of Diseases and Related Health Problems is assigned the number 70.1 (manifestations of chronic salpingitis and oophoritis). The disease develops after penetration of pathogenic microorganisms of various origins into the organs of the reproductive system: bacterial, viral, fungal.

As a result of their growth and active reproduction in the ovaries and fallopian tubes, which form the uterine appendages, an acute inflammatory process occurs. In the absence of qualified medical care, it quickly becomes latent.

With hypothermia, frequent stressful situations, or depressive states, a relapse of the pathology occurs due to the reactivation of bacteria or viruses. According to the International Classifier, such exacerbation of chronic adnexitis is assigned ICD 10 code No. 70.0, and with an unspecified diagnosis - No. 70.9. Infection of a woman with tubercle bacilli or gonococci causes bilateral inflammation of the appendages. In this case, the patient is hospitalized for treatment in a hospital setting. And the penetration of E. coli and staphylococci into the reproductive organs provokes the development of the most commonly diagnosed disease. This is a chronic left-sided adnexitis, or an inflammatory process occurring in the left appendage.

Important: The most common pathogens are streptococci, enterococci, mycobacterium tuberculosis, and E. coli. Often the development of chronic adnexitis is provoked by microbial associations, for example, E. coli and staphylococci.”

The beginning of its development is damage to the uterine mucosa by an infectious agent, and then destructive-degenerative changes affect:

serous layer;
smooth muscle muscles;
ovarian epithelium;
peritoneum of the pelvis.

After the release of the egg into the fallopian tube as a result of rupture of a mature follicle, the pathological process rapidly develops in the ovary. Thus, untreated chronic adnexitis in women is an inflammation that leads to the formation of numerous adhesions that reduce the functional activity of the fallopian tubes, including the degree of their patency.

Clinical picture

Symptoms and treatment of chronic adnexitis are closely interrelated. In case of a sluggish process with vague symptoms, conservative methods are used aimed at preventing relapses and destroying infectious pathogens. And exacerbations manifest themselves in a pronounced clinical picture, requiring an integrated approach to treatment. Symptoms of chronic adnexitis include:

frequent occurrence of pain in the lower abdomen of varying degrees of intensity, which spreads to the lumbar and gluteal regions, and sometimes to the hips;
psycho-emotional instability, manifested in excessive irritability, nervousness, insomnia, and depression;
autonomic disorders, most often disorders of the gastrointestinal tract.

The severity of pain increases against the background of hormonal changes, stressful situations and respiratory pathologies. Symptoms and characteristic signs of chronic adnexitis also include menstrual irregularities - menometrorrhagia, hypomenstrual and premenstrual syndromes, which accompany anovulation or insufficiency of the corpus luteum. Tubal-peritoneal factor and ovarian steroidogenosis, which develop due to the inflammatory process, often provoke problems with conception. And adhesions formed in the fallopian tubes significantly increase the likelihood of an ectopic pregnancy. Neurological disorders and autonomic disorders in combination with frequent relapses cause a decrease in libido.

Exacerbation of chronic adnexitis is complicated by symptoms of general intoxication of the body. When exposed to external or internal negative factors, active reproduction and growth of infectious agents occurs, accompanied by releases of their waste products into the systemic bloodstream. Toxic organic compounds provoke the following symptoms:

increased temperature above subfebrile levels (38.5°C);
fever, chills, profuse sweating;
weakness, apathy, fatigue;
headaches, dizziness;
dyspeptic disorders - nausea, vomiting, peristalsis disorders.

Read also on the topic

What suppositories are best to use for inflammation of the appendages?

Against the background of hyperthermia, mucus mixed with pus may be released from the vagina. With an abscess, the likelihood of rupture of the fallopian tubes and the entry of purulent mass into the peritoneal cavity increases.

Note: Chronic adnexitis is often accompanied by a decrease in the body's resistance to infectious agents. Therefore, after a few months, a woman develops vaginal and (or) intestinal dysbiosis, manifested in impaired peristalsis and digestion.

Inflammation of the appendages during pregnancy

In accordance with ICD 10 code No. 70.1, chronic adnexitis is a disease for the treatment of which intensive antibiotic therapy is carried out. Therefore, gynecologists strongly recommend that women, before planning a pregnancy, undergo a full examination to identify pathologies of the reproductive system. This will help avoid a course of taking antibacterial drugs while carrying a child. In addition, the development of a chronic disease often causes infertility as a result of obstruction of the fallopian tubes and ectopic pregnancy.

After therapy, the patient is examined again to determine:

absence of pathogenic microbes and viruses in the appendages;
complete restoration of the functional activity of all organs of the reproductive system.

If an exacerbation of left-sided chronic adnexitis occurred during pregnancy, then antibiotic therapy cannot be avoided. The fact is that this pathology can provoke miscarriage and intrauterine fetal death. Therefore, doctors immediately begin treatment, including broad-spectrum antibacterial drugs in therapeutic regimens. Daily and single dosages, as well as the duration of administration, are adjusted taking into account the general health of the woman, the presence of pathologies in the anamnesis, and the duration of pregnancy. When choosing antibiotics, preference is given to those that do not have a teratogenic effect. In case of chronic adnexitis and pregnancy, constant laboratory monitoring and monitoring of the patient’s well-being are carried out.

Chronic left-sided adnexitis, like right-sided one, does not require hospitalization of a woman provided there are no symptoms of general intoxication of the body. A necessary condition for a quick recovery is the simultaneous use of pharmacological drugs and physiotherapeutic procedures:

electrophoresis;
magnetic therapy;
inductothermy;
ultrasound therapy;
oxygen barotherapy.

In the treatment of all infectious diseases, including chronic adnexitis, in addition to taking medications, patients are prescribed a therapeutic diet. Pathogenic microorganisms grow and multiply faster in an environment favorable to them. It occurs when a woman consumes foods high in fat and sugar - rich and puff pastries, butter or butter cream. The daily menu of a patient with chronic adnexitis should consist of fresh vegetables and fruits, cereal porridges, clear soups, lean meats and fish.

If the pathology is not accompanied by severe pain and inflammation, then gynecologists recommend that women regularly engage in therapeutic exercises or physical exercise. This will help normalize blood circulation in the pelvis. Restoring optimal circulation helps accelerate metabolism and tissue regeneration. Gynecologists recommend that patients with intense pain, to increase the effectiveness of treatment, observe semi-bed rest to prevent the development of complications. The removal of pathogenic bacteria and viruses is facilitated by daily consumption of 2-2.5 liters of liquid. It could be:

pure still water;
chamomile tea;
mineral low-salt waters - Essentuki No. 2 and No. 4, Borjomi, Nagutskaya, Slavyanovskaya, Narzan;
infusion of rose hips;
compotes, fruit drinks, jelly from fruits and berries.

Read also on the topic

Antibiotics used in the treatment of adnexitis

Drinking plenty of fluids helps prevent the appearance of symptoms of general intoxication of the body due to the rapid removal of the final and intermediate products of the inflammatory process from infectious foci.

Warning: Drinking large volumes of liquid is contraindicated if you are prone to edema and have any pathologies of the urinary system.

Drug therapy

Only highly specialized doctors - gynecologists and venereologists (for gonococcal infections) know how to cure chronic adnexitis. Folk remedies are used in therapy only during the rehabilitation period, after a course of antibiotics. Herbs, beekeeping products, and vegetable oils do not have antimicrobial, antiviral and antimycotic activity, so their use in the treatment of adnexitis is not only impractical, but also dangerous. The weak anti-inflammatory effect of folk remedies will distort the clinical picture and will not allow timely diagnosis of the pathology.

Antibiotic therapy

Antibacterial agents become the first choice drugs in the treatment of acute or chronic adnexitis. Since the duration of laboratory tests is several days, patients are prescribed broad-spectrum antibiotics to relieve the inflammatory process.

As a rule, such activity is characteristic of semisynthetic penicillins, the active ingredient of which is Amoxicillin.

When choosing, preference is given to combination drugs with clavulanic acid. This compound does not have any therapeutic efficacy, but is capable of preventing the development of antibiotic resistance in infectious agents. Clavulanic acid is part of Amoxiclav, Panclave, Augmentin, Flemoklav. After establishing the species of the causative agents of chronic right-sided adnexitis (left-sided, bilateral), the therapeutic regimen is adjusted. Most often it includes the following drugs:

tetracyclines (Doxycycline, Tetracycline);
fluoroquinolones (Ofloxacin);
macrolides (Azithromycin, Erythromycin, Clarithromycin);
aminoglycosides (Kanamycin, Gentamicin);
nitroimidazoles (Metronidazole);
lincosamides (Clindamycin).

For mixed infections, antibiotics are combined with antimicrobial agents, antimycotic drugs, and sulfonamides. Before treating chronic adnexitis, the stage of the pathological process is established. In cases of moderate to severe disease, antibacterial agents are immediately used in the form of injection solutions to create maximum therapeutic concentrations in inflammatory foci. After a few days they are replaced with tablets, capsules or dragees.

Recommendation: While taking antibiotics, patients are prescribed eubiotics to prevent dysbiosis. Their use makes it possible to preserve beneficial lacto- and bifidobacteria in the biocenosis of the vagina and intestines.

Additional treatment

Chronic adnexitis is considered a cured pathology if the results of laboratory tests do not reveal infectious pathogens. But pathogenetic and symptomatic therapy is also necessary to eliminate developed complications and improve the patient’s well-being. To stop the inflammatory process and reduce the intensity of signs of the disease, non-steroidal anti-inflammatory drugs are used:

Nimesulide;
Movalis;
Ibuprofen;
Ketoprofen;
Diclofenac.

These drugs are not prescribed to patients with erosive and hyperacid gastritis, as well as ulcerative lesions of the gastrointestinal tract. To prevent ulceration of the mucous membranes of the digestive system, non-steroidal anti-inflammatory drugs are combined with proton pump inhibitors - Omeprazole, Ultop, Pantoprazole.

NSAIDs are used both in tablet form and in rectal suppositories. In the treatment of chronic adnexitis, drugs are used in the form of local remedies - vaginal suppositories, tablets, balls. They have a wide range of clinical activity: antimicrobial, antimycotic, antibacterial. It is advisable to use topical products only as prescribed by a doctor after identifying the type of infectious agent. For example, Pimafucin is usually prescribed for the treatment of fungal infections, and Terzhinan for mixed ones.

It is of no small importance to increase the resistance of the body’s defenses, which helps prevent painful relapses. For this purpose, immunostimulants (Immunal, echinacea tincture) and balanced vitamin complexes with microelements (Supradin, Vitrum, Center) are included in therapeutic regimens. And to eliminate psycho-emotional instability, patients are recommended to take a course of sedatives - Tenoten, Persen, Afobazol.

The most common pathology in gynecology is Adnexitis or Salpingoophoritis. It often occurs in young women, which significantly reduces the quality of life. According to Wikipedia, the story has deep roots. Every fifth patient who has been diagnosed with this continues treatment, but due to infertility or is forced to resort to IVF.

Let's figure out what Adnexitis is in women, and for what reasons it occurs, what the symptoms are, and what effective treatment methods exist.

Adnexitis is a gynecological disease in women

The gynecological disease Adnexitis is an inflammation of the uterine appendages caused by various infections, as shown in the photo.

Often the etiology of the disease is the effect of streptococci, staphylococci or E. coli on the woman’s genitals.

Inflammation of the appendages may also occur if infectious agents enter. This type of infection is transmitted sexually by species such as gonococci, which causes gonorrheal adnexitis. A rare cause of inflammation can be a tuberculous process that spreads through the vessels of a woman’s body.

It is most common in women aged 20-45 years. The female disease Adnexitis is considered dangerous, since if not treated on time, it leads to more serious health consequences and ultimately provokes infertility or ectopic pregnancy. But even when pregnancy occurs, newborn babies in the first half of the year often suffer from Candidiasis.

What is Salpingoophoritis

Inflammation of the appendages is a general term and therefore is often referred to in medicine as salpingoophoritis. The development of the disease is caused by the destruction of the epithelium of the fallopian tubes, as a result of which their walls become saturated with waste products of microorganisms, thereby causing an inflammatory process. What is salpingo-oophoritis in women and where the name of the disease comes from needs to be understood.

The uterine appendages include the fallopian tubes, ovaries and ligaments. Diseases such as Salpingitis and Oophoritis develop. First of all, the pathology affects the mucous tubes and walls, as a result of which characteristic liquid and even pus are formed in them. At this stage of development it is called Salpingitis. When inflammation occurs purely in the ovaries, the disease is usually called Oophoritis. Then, when both organs are affected, they have the common name Salpingoophoritis.

Therefore, when signs of inflammation of the appendages appear in a woman, the female diseases Adnexitis, Salpingitis, Oophoritis, which have a common pathogenesis and are essentially varieties of one disease, are diagnosed.

Depending on the routes of entry of infection into the body, women are distinguished:

ascending path, when the pathogen penetrates through the vagina and cervix;
descending path, that is, the infection penetrates through other affected organs;
lymphogenous route, in which damage occurs through the lymph nodes;
hematogenous route, when the infection spreads through the blood vessels.

Forms: subacute, acute, chronic

Depending on the clinical course, salpingo-oophoritis is divided into acute, subacute and chronic; let’s figure out what this means and what is the difference between them.

The acute form is expressed in a violent and painful course with clearly expressed symptoms with a sharp rise in temperature.
Subacute salpingoophoritis is accompanied by a mild clinical course without obvious symptoms with a low temperature, and is characterized by a small amount of vaginal discharge.
Chronic salpingoophoritis is characterized by a sluggish process with clear periods of remission and exacerbation over a long period of time. At the same time, the woman is constantly bothered by aching pain in the pelvic area.

ICD 10 code

Especially for systematization and analysis of data from all existing diseases, a special reference book ICD 10 (International Classification of Diseases 10-revision) was created, which is a manual for doctors.

It contains information on any pathology and each of them is assigned its own specific code. Inflammation of the appendages is divided into several types and, according to the reference book, is included in the category “Inflammatory diseases of the female pelvic organs” with code numbering N70-N77.

Salpingoophoritis code according to ICD 10 corresponds to N70, while the category is called “Salpingitis and oophoritis” and includes the following subcategories:

acute adnexitis ICD code 10 - N70.0;
chronic adnexitis ICD code 10 - N70.1;
unspecified adnexitis code according to ICD 10 - N70.9.

Under code N70.1 according to ICD 10, all types of chronic forms are included, both 2-sided and unilateral salpingoophoritis. Adnexitis can lead to such a disease as No. 30.0

Types: left-sided, right-sided, two-sided

Depending on the area of the lesion, adnexitis can be of several types, and left-sided inflammation is diagnosed much more often than right-sided inflammation.

The causative agent of the infection enters the right fallopian tube and thereby causes inflammation not only in it, but also in the right ovary, and the disease is diagnosed as right-sided salpingoophoritis. Divided into acute form or advanced chronic form.

If organs on the left side are affected, left-sided Adnexitis is distinguished, which in turn, depending on the form of the course, is divided into categories:

chronic left-sided salpingoophoritis;
acute left-sided salpingoophoritis.

When pathology develops on both sides simultaneously, the disease is classified as bilateral inflammation of the appendages with subcategories:

acute bilateral salpingoophoritis;
chronic bilateral salpingoophoritis.

Causes

Symptoms and causes of Adnexitis in women may vary depending on the infection that caused the inflammatory process, as well as the conditions for the development of pathogenic microflora. In medicine, there are several risk factors that can contribute to the development of pathology:

frequent changes of sexual partner or failure to use contraceptives during sex;
hypothermia of the body. It often develops after swimming in the sea or visiting a pool, regardless of the time of year. Hypothermia can be caused by wearing light clothing in cold weather;
weakened immunity due to regular nervous stress;
hormonal imbalance and menstrual irregularities;
chronic cystitis;
neglect of personal hygiene rules;
using an intrauterine device for a long time;
during various medical procedures (childbirth, cleaning after a miscarriage or abortion, examination by a doctor);
sexual intercourse during menstruation.

All these factors contribute to another common disease in women: thrush, which can occur against the background of Adnexitis. Treatment of thrush is carried out on an outpatient basis; you can choose ones that can cope with the disease even in 1 day.

Often, the development of salpingoophoritis is associated with concomitant problems, such as ARVI, herpes, influenza, or appears as a result of indiscriminate use of hormonal drugs.

Psychosomatics plays an important role, that is, experts believe that internal psychological factors are the cause of the development of the disease. A woman to some extent feels flawed or cannot understand how to behave with a man and thereby realize her feminine qualities. As a result, she invents a disease for herself on a psychological level. Then chronic Adnexitis is treated not only with medications, but also with regular visits to a psychologist.

Symptoms in women

Symptoms and treatment of Adnexitis in women may vary depending on the form and type of infection. Signs of inflammation can be felt both on one side in case of left- or right-sided disease, and on both sides simultaneously if chronic bilateral adnexitis develops.

In the acute form of salpingoophoritis, the following symptoms appear:

bloating;
nausea;
vomit;
there is severe pain in the lower abdomen, which can radiate to the lower back;
frequent urination with a burning sensation when emptying the bladder;
increased body temperature causing chills;
dizziness;
complaints about deterioration of the general condition of the body;
bleeding between menstrual cycles;
brown purulent or mucous discharge, in rare cases bloody.

In the absence of timely and relevant treatment, the acute form becomes chronic, but slightly different symptoms are already observed. In this case, bilateral chronic salpingoophoritis is expressed in the same symptoms as right-sided or left-sided:

constant dull pain in the lower abdomen that radiates to the leg or hip;
thrush;
delayed menstruation or cycle failure;
decreased sexual desire;
frequent manifestations of cystitis;
body temperature fluctuates at 37 - 37.5.

In order to find out what antibiotics to take for chronic adnexitis, you should definitely go to see a doctor at the first sign of exacerbation.

Diagnostics and diagnosis

Establishing a diagnosis of salpingoophoritis in some cases can be a very difficult task, since at an early stage of development, the symptoms are the same as those of colpitis, endometriosis, hydrosalpinx or metroendometritis. Therefore, differential diagnosis is used to help recognize or eliminate concern. A complete blood and urine test is performed, an ultrasound and an MRI are prescribed.

A smear of more than 100 leukocytes indicates that a woman has an inflammatory process in her body. To confirm, the doctor can use an ultrasound scanner to check for echo signs of pathology.
Based on the protocol of the examinations, the doctor makes a conclusion and establishes a diagnosis.

Treatment (antibiotics and suppositories)

If Adnexitis is diagnosed, treatment with antibiotics and suppositories is inpatient with bed rest. First of all, treatment is aimed at reducing pain in a woman, and then therapy is carried out to eliminate the cause of the disease.

The treatment regimen and tactics consists of several stages, which is carried out in accordance with all the doctor’s recommendations. How to treat adnexitis, and which drugs are best to inject and which ones to take in tablet form can only be prescribed by a qualified specialist.

List of drugs used in treatment:

Drug group	Name
Long-acting antibiotics	Sumamed, Amoxiclav, Ceftriaxone, Ciprofloxacin, Azithromycin, Ciprolet, Gentamicin, Doxycycline, Suprax, Avelox, Biseptol, Clarithromycin, Ofloxacin, Penicillin, Amikacin, Cefazolin, Monural, Ampicillin, Cefotaxime, Flemoxin Solutab.
Vaginal and rectal suppositories with anti-inflammatory and analgesic effects	Metronidazole, Ichthyols, Metromicon, Indomethacin, Hexicon, Cervicite, Longidaza, Clindamycin, Levofloxacin, Polygynax, Kipferon, Genferon, Methyluracil, Betadine, Movalis, Polyoxidonium.
Antibacterial and antiviral drugs, immunomodulators	Wobenzym, Diclofenac, Terzhinan, Nolicin, Canephron, Duphaston, Cycloferon, Furamag, Nimesil, Meloxicam, Ibuprofen, Unidox Solutab, Vilprafen, Voltaren, Flemoxin Solutab.
Absorbable drugs to restore blood vessels and stabilize the body's condition	Magnesia, calcium gluconate, Siofor.

Spicy

Depending on the form of Adnexitis, treatment may differ, so the dosage of medications and the rehabilitation period are determined solely by the attending physician.

Therapy of the acute form is carried out only in a hospital, includes bed rest and complete rest, if necessary, nursing care is provided. In the first days of hospitalization, a course of treatment with antibiotics and painkillers is prescribed. A special diet or therapeutic fasting is also prescribed, during which you cannot eat salty and spicy foods, and minimize the consumption of carbohydrates.

If there is no improvement after 5 days, the antibiotics are changed or surgery is prescribed. The operation is called laparoscopy, during which pus is removed from the affected appendages and an antibacterial agent is administered.

Subacute

Treatment of the subacute form of Adnexitis is carried out on an outpatient basis with the help of probiotics, anti-inflammatory and antibacterial drugs. The doctor may prescribe immunocorrection to strengthen the woman’s body as a whole and Remens for follow-up treatment of the pathology.

Often, to quickly relieve pain in the pelvic area, tampons with Levomekol or Vishnevsky ointment are used, which are inserted into the vagina at night, as well as douching with Miramistin.

Chronic

In the chronic form, complex therapy is used, which includes not only drug treatment, but also physical therapy (electrophoresis), in addition, Combilipen vitamins are prescribed to strengthen the body’s immunity as a whole. Physiotherapy can be carried out in the form of acupressure, which will help eliminate adhesions in the fallopian tubes.

There are complications, such as uterine fibroids, then additionally absorbable drugs are prescribed that help reduce its size. In particularly advanced cases, a surgical operation is performed to help improve the patency of the fallopian tubes or remove the ovaries if they are completely damaged.

Adnexitis can be successfully treated with homeopathy without taking antibiotics. To do this, you need to contact a homeopathic doctor to select individual medications.

Treatment at home

As an addition to the main treatment, you can use folk herbal remedies that will help achieve maximum treatment results. If you have chosen a recipe for yourself. Be sure to consult with the doctor who is treating you.

Microenemas made from chamomile and St. John's wort are used as an analgesic and anti-inflammatory agent. To do this, use a decoction of the plant infused for at least 20 minutes, after which it must be strained and cooled to room temperature. Before the procedure, a cleansing enema is first performed, and then a syringe with chamomile and St. John's wort is inserted into the anus. The woman should lie on her side until the infusion is completely absorbed. After this procedure, the pain is significantly reduced. Treatment is carried out every evening for 1 week.

Aloe juice with honey is very effective in reducing the inflammatory process. Take 1 dessert spoon orally in a 1:1 ratio three times a day before meals. The course of treatment is at least 7 days.

Bedstraw infusion can be used as an antifever and hemostatic agent. For this you need 2 tsp. Pour a glass of boiling water over the crushed plant and leave for 3 hours. The product must be taken hot, half a glass at a time, at least 4 times a day, so it must be warmed before each dose. The course of therapy is 20 days.

To relieve inflammation, douching with boron uterus or wormwood is performed. To do this, make an infusion of the herb for 2 hours, after which it is diluted with boiled water 1:1 and the procedure is carried out. Treatment lasts 7 days.

As a gentle therapy, you can use tampons with sea buckthorn oil, which are inserted into the vagina overnight. This helps relieve pain and inflammation. The procedure must be repeated for 1 week. Propolis with honey can also be used in this capacity.

During pregnancy

The most dangerous is Adnexitis or, so at the first sign of it you should consult a doctor.

Treatment in such cases is carried out in a hospital with the help of antibiotics, which are acceptable during this period. Lack of timely treatment can have serious consequences for the newborn.

Prevention

To prevent the recurrence of the disease, you must follow the following rules:
use natural cotton underwear;
protect yourself during sex;
avoid casual connections;
prevent hypothermia of the body;
balance physical activity with periods of rest;
exercise to strengthen the immune system.

Doctor's advice

As a recommendation, after discharge, doctors advise going to a sanatorium and taking an additional course of healing. If mud therapy is not contraindicated, it can strengthen the body and increase periods of remission in the chronic form.

It is also necessary for parents to explain to children, especially girls, how important it is to dress for the weather and avoid hypothermia, since living healthy is much more fun. In addition, you need to give a lecture to the child, which describes all the dangers of Adnexitis for the female body and how much effort it costs to ultimately restore health. If you want to know whether you can get thrush from a man, you should.

Watch a video about the pelvic floor muscles - why it is necessary to train:

Expert opinion. Gynecologist med. centers "City Clinic", "MD Clinic" Lazarevich A. E.

Adnexitis is now considered the most common female disease. The lack of timely treatment very often becomes the cause of the development of more serious health complications and ultimately lead to: worsening of the adhesive process, the formation of uterine fibroids and a further increase in its size, as well as premature onset of postmenopause, endometritis, grade 1, 2, 3 dysplasia, nodular fibroids and infertility. There is no need to suffer or look for a solution to the problem on forums, you need to see a doctor and undergo a high-quality course of treatment that will help you get rid of the pathology forever.

Adnexitis is a disease that requires mandatory treatment, otherwise very serious consequences may occur.

Among the inflammatory ailments of the female reproductive system, the first place firmly belongs to adnexitis. The disease usually affects not only the fallopian tubes, but also the ovaries. Therefore, adnexitis code according to ICD 10 is No. 70, which includes salpingitis and oophoritis at the same time.

Read in this article

What happens when you get sick

Under the influence of factors favorable for infection, inflammation invades the mucous lining of the fallopian tube. Gradually, its walls are involved in the process layer by layer, which is why serous fluid appears in the lumen. This is salpingitis.

Since the fallopian tubes are connected to the ovaries, inflammation quickly spreads to them. The infection is located on the epithelial covering, from which, when the germ cell exits, it enters the gland.

Total inflammation leads to adhesion of the ovary and fallopian tube. And therefore, for adnexitis they put a code according to ICD 10, meaning the general process, since separate infection of these organs is extremely rare due to their close connection.

Routes of infection

The uterine appendages are a very vulnerable area of the reproductive system. You can get the disease in several ways:

Infection through the blood during tuberculosis of the genital organs;
Leakage of agents through the lymphatic system;
Ascending, that is, by the relocation of bacteria from the infected kidneys, lungs, even throat;
Spread from the lower parts of the reproductive system.

Adnexit ICD 10 does not divide according to this principle. However, the cause of the disease is of decisive importance in therapy and in preventing relapse. They are distinguished by the type of infectious agents, dividing salpingo-oophoritis into:

Specific, that is, caused by gonococcus, tuberculosis or diphtheria infections;
Nonspecific, which are provoked by sexually transmitted diseases or opportunistic flora, which are also present in a healthy body.

Reasons for development

Nonspecific cases of the disease are more common. But whatever its origin, appropriate conditions are required under which adnexitis is more likely:

Ailments that do not affect the reproductive organs (pyelonephritis, frequently recurring tonsillitis);
Psychological shocks affecting immunity and vaginal microflora;
Hypothermia;
Improper lifestyle, weakening resistance to infections;
Ignore ;
Surgical operations and other medical manipulations on the uterus (, hysteroscopy,);
Frequent change of sexual partners.

Salpingo-oophoritis ICD 10 is classified as a special subsection if the causes of infection in this area of the reproductive system are unknown. This is N 70.9, describing unspecified types of illness.

The disease can settle on one side of the system, in the right or left appendage. When a process is running, it captures both.

Acute course of the disease

It is equally important what salpingoophoritis code according to ICD 10 has in connection with the duration and symptoms of the disease. These points are reflected in the classification, as they also determine.

When an infection initially enters the body, bacteria develop vigorous activity. The disease has an acute course, that is, obvious signs of trouble that force you to go to a specialist. Moisture collects in the fallopian tube, causing sacs with serous fluid to appear. Sometimes the cavities become filled with pus.

Acute adnexitis, ICD 10 code No. 70.0, lasts up to 7-10 days and has the following manifestations:

in the lower segment of the abdomen, and aggravated by pressure. If inflammation has developed in the right appendage, the sensations are similar to appendiceal colic, as they radiate to the intestines. When the infection has affected the organs on the left, the pain is disturbing on this side, radiating to the lower back;
purulent from the vagina. If they coincide with menstruation, they change color;
Increased body temperature, fever, muscle spasms;
Feeling of nausea, repeated vomiting;
Problems with urination, pain during the process.

If the inflammation has taken a chronic course with periodic exacerbations, the listed symptoms are accompanied by painful sensations during sex and loss of interest in sexual activity.

Chronic salpingoophoritis

Chronic adnexitis received ICD 10 code number 70.1. This course of the disease is caused by incorrect or incomplete treatment, as a result of which the disease subsides but does not go away. Chronic adnexitis also occurs when the circumstances that provoke it intensify.

It is more difficult to identify this form than the acute form, since there may be no obvious symptoms. And yet they can really be detected, these are:

Periodically disturbing pain in the abdomen, which also affects the thigh. They manifest themselves more strongly before, under stress;
Lethargy, general malaise;
Changes in the passage of menstruation. The discharge becomes more intense, and the time intervals between critical days increase noticeably. At the same time, mucus with blood is also noticed outside of menstruation.

Menstrual dysfunction often helps in identifying the diagnosis. Long delays mean that infection therefore makes conception impossible. Infertility is not only one of the signs of salpingoophoritis, but also a serious consequence, which is more difficult to eliminate than to get rid of the acute form of the disease.

Adnexitis received a code according to ICD 10 along with the complications it causes:

Fallopian tube abscess. The serous fluid accumulated during inflammation is transformed into pus, affecting the walls of the organ, causing the formation of adhesions and obstruction in it;
Ovarian abscess. With the unhindered development of the infectious process in the organ, purulent capsules appear, which, connecting with each other, melt the tissue. Next, the sex gland turns into a bag filled with pus;
Tuboovarian inflammatory disease. The purulent infection, remaining in the ovaries and fallopian tubes, also passes into the abdominal cavity, affecting the peritoneum and organs adjacent to the appendages.

Adnexitis is not life-threatening. But this serious disease can worsen its quality.

It has a bad effect on sexual life and reproductive capabilities, which is expressed primarily in. This should prompt the need for examination if there are no other symptoms.