The upper part of the female genital system refers to infections from the cervix to the intrauterine tissue, tubes, ovaries, and surrounding tissue.
These infections often begin in the cervix and often end in the cervix. Immune mechanisms and hormonal support play an important role here. However, infections can reach the intrauterine tissue called endometrium (endometritis) from the cervix and from there to the tubes (salpingitis). It can also reach the ovaries (oopharitis) from the tubes. At this point, infections involving the tubes and ovaries can lead to intraabdominal abscesses called tuboovarian abscesses.
Causes of Pelvic Infections
The biggest cause of infections are microbiological agents transmitted by sexual intercourse. The two main factors are gonorrhea and chlamydia. Ueoplasma, mycoplasma, B streptococci, anaerobic bacteria, actinomyces and tuberculosis bacillus can be considered after these two main factors.
Wearing an intrauterine device with active infection in the vagina or cervix will increase the risk of infection and should be avoided. Although abortion, births, and operations involving the pelvic region may also occur, abortion for abortion or pregnancy termination may occur, but its frequency is much lower.
Risk factors for Pelvic Infections
If the woman or her partner is polygamous
Having had a pelvic infection before
Low sociocultural level
Not getting effective healthcare or late application to doctor
Use of intrauterine device
Problem presence in general health
Frequent vaginal shower
It is the presence of Trichomonas infection.
The risk of pelvic infection is very low in those who use condoms. In the use of birth control pills, it is thought that the progesterone hormone in its content decreases the risk by preventing infection from the cervix to the upper genital system.
The decrease in mucus in the cervix during sexual intercourse during menstrual bleeding brings with it a decrease in infection protection. Meanwhile, blood; creates a very suitable medium for the reproduction of infectious agents. For this reason, it will be appropriate to avoid sexual intercourse or use condoms during menstruation.
Complaints in Pelvic Infections
Complaints in the presence of pelvic infection in women may not always be very specific, as they can be confused with many other diseases. The most common complaint is abdominal pain or groin pain. If this is accompanied by foul-smelling and colourful discharge, the complaint will become even more meaningful. Complaints of fever and vagina over 38 degrees, temperature increase, menstrual irregularities, intermediate bleeding, altered bowel habits (diarrhoea in general) and burning while urinating may also be a complaint.
Painful intermediate bleeding frequently occurs in the infection of the intrauterine tissue and is mostly caused by chlamydia.
All these complaints are not only specific to pelvic infection and gynecological examination, ultrasonography and laboratory examinations must be performed in differential diagnosis.
Pelvic Infections Diagnosis and Differential Diagnosis
First of all, gynecological examination is very helpful. First of all, pulse, blood pressure and fever should be measured. In the examination, the properties of the discharge in the vagina and cervix are the next step. Then, in the cervical movements, in the groin area where the ovaries and tubes are located, and in the uterus, tenderness is sought for manual examination. Pelvic infection cannot be diagnosed by ultrasonography. Although ultrasonography is very helpful in the diagnosis of Tuboovarian abscess, it will mainly help us in the differential diagnosis of other diseases that may be confused in the diagnosis.
Laboratory findings are the best support for diagnosis and differential diagnosis. Looking at infection markers such as leukocyte sedimentation and C reactive protein in the blood and cultures of samples taken from vaginal fluid and cervix will support diagnosis and treatment.
Appendicitis and ectopic pregnancy will often be encountered in differential diagnosis. A general surgery consultation may be performed in case of appendicitis. Ectopic pregnancy can be distinguished by looking at B HCG in the blood.
In the advanced stages of pelvic infection, severe abdominal pain, nausea, vomiting and diarrhea may occur due to abdominal membrane inflammation. It can be confused with other causes of acute abdomen in abdominal examination. If an abscess has formed, it can be perceived as a mass on manual examination or ultrasonography. Adhesions due to infection can also give signs in the form of mass.
A special case here is that the inflammation of the abdominal membranes reaches the liver capsule, causing infection. This infection around the liver capsule, which can present with right upper abdominal pain and right shoulder pain, is called Fitz Hugh Curtis Syndrome and USG and CT and laparoscopy can be used for diagnosis. Its treatment is the same as for pelvic infection.
Complications of Pelvic Infections
The most important complication in pelvic infection is adhesions and tube damage that can prevent having a child. Increasing the number of infections also increases the risk. Tube obstructions are reported as the most common reason for not having children in the United States. Therefore, the risk of ectopic pregnancy also increases. In a woman who has had a pelvic infection once, the probability of an ectopic pregnancy increases 6-10 times.
The probability of chronic pain due to adhesions for the post-infection period is reported to be 15%. The number of infections and the likelihood of pain and the severity of pain also increase. The pain is usually in the groin, but abdominal and low back pain can be seen.
As the severity and prevalence of the infection increases, abdominal lining inflammation and intra-abdominal abscesses can occur and a life-threatening picture may appear.
Treatment of Pelvic Infections
Planning of infection treatment is all about the severity of the disease.
If the woman does not have a fever or pain below 38 and there are no signs of abdominal infection, it can be treated with outpatient antibiotics. Here it may be necessary to add painkillers to antibiotics, and bed rest can also facilitate the treatment response.
If the patient does not respond to treatment within 48-72 hours, it can be treated by hospitalization. However, if the woman’s fever is above 38, her pain is very severe, if there are signs of inflammation of the abdominal membrane, tuboovarian abscess is suspected or diagnosed, she should be hospitalized and treated. Here, antibiotics are applied in the form of double or triple combined protocols, taking into account the microbiological agent, in which the suspicion of infection is intense. Pain relief and edema relief preparations are absolutely added and fluid treatment is also performed. In cases where the diagnosis is not certain, it is appropriate to be hospitalized and followed up.
Surgery can be planned if the woman does not respond to medical treatment in the hospital or if there is a tuboovarian abscess. Emptying the abscess will speed up healing very much. The path chosen here should be laparoscopic surgery.
If there is a pelvic infection in the pregnant woman, it is more appropriate to be hospitalized and treated.
Considering that the age of onset of sexuality is early now, it should be taken into consideration that adolescence, that is, in the very young age group, may not be compatible with treatment and hospitalization should be considered with social indication.
If the woman has an intrauterine device, it must be withdrawn. Although there are schools that think that intrauterine device should be withdrawn 48 hours after the start of antibiotics, there are also schools that find it appropriate to withdraw immediately.
One of the most important points in the treatment is that the partner treatment must be applied simultaneously.