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MEMF ยป Pelvic inflammatory disease and infertility – what’s the connection?

Pelvic inflammatory disease and infertility – what’s the connection?

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Pelvic inflammatory disease is a serious condition that should not be underestimated due to the complications it can lead to if left untreated. About 10-15% of women of reproductive age suffer from the pelvic inflammatory disease at least once in their lives, and the disease occurs mainly in women aged 15 to 24 years.

Pelvic inflammatory disease is an ascending infection in which there is inflammation of the fallopian tubes, uterus, and ovaries. The infection is ascending since the pathogen is disseminated from the organs of the lower genital tract and spreads upward. The main cause of inflammatory diseases of the pelvic organs is the presence of a complicated sexually transmitted infection. About 85% of cases occur in patients with gonorrhea and chlamydial infection.

In addition to the bacteria Neisseriae gonorrhea and Chlamydia trachomatis, pelvic inflammatory diseases can also develop from pathogens of bacterial vaginosis – Gardnerella vaginalis, Peptostreptococcus, etc. Infection of the upper genital tract can also be caused by respiratory pathogens (Haemophilus influenzae, Streptococcus pneumonia, Staphylococcus aureus) or intestinal – eg. Escherichia coli.

Factors that increase the risk of developing the pelvic inflammatory disease include early age at onset of sexual activity, lack of contraception during intercourse, frequent changes in sexual partners, or having sexual relations with a partner with a large number of past sexual partners. The use of a vaginal douche may also increase the risk of pelvic inflammatory disease. According to a recent study, intrauterine devices are not associated with the development of this condition. A risk factor is also a recent gynecological intervention, in which pathogens have penetrated from the vagina through the cervix into the uterus. Smoking can also increase your risk because it weakens the immune system and makes the body susceptible to infections.

 Very often, inflammatory diseases of the pelvic organs are asymptomatic, which is quite dangerous and can lead to the development of serious complications. To prevent this, an annual preventive gynecological examination and seeking medical attention for any change from the normal state of the genital tract is recommended. Symptomsthat can tell you about the presence of an inflammatory process of the uterus, fallopian tubes and ovaries:

  • Pelvic pain or pain in the lower abdomen of varying intensity;
  • Fever, nausea, vomiting, and general malaise;
  • Change in color, consistency and smell of vaginal discharge, which becomes thick, has a changed color and has an unpleasant fishy smell;
  • abnormal bleeding outside the menstrual cycle or after intercourse;
  • Pain and burning during urination, as well as the presence of pain during intercourse;
  • Presence of stomach complaints.

The diagnosis of inflammatory diseases of the pelvic organs is made after taking an anamnesis, gynecological examination, microbiological examination of vaginal discharge, if necessary, an ultrasound or laparoscopic examination can be performed. Symptoms are very important for the diagnosis, the leading of which is persistent pelvic pain. The presence of pain during a gynecological examination and the identification of an inflammatory process, atypical vaginal discharge, adhesions, etc. are also important for making a diagnosis.

During a gynecological examination, material is taken for microbiological examination, with the help of which the presence of an infectious agent can be detected. A complete blood count can also confirm the development of an inflammatory process, the main signs of which are leukocytosis, an acceleration of the erythrocyte sedimentation rate, and an increase in the level of C-reactive protein. A very important test proving the presence of N. gonorrheae or C. trachomatis is the nucleic acid amplification test (NAAT test), which mainly examines vaginal discharge and identifies small sections of DNA or RNA of the pathogen using special techniques. .

If pelvic inflammatory disease is suspected, it is important to do a pregnancy test, as this condition often occurs with ectopic pregnancy as a complication. With the described symptoms, a differential diagnosis is made with appendicitis, diverticulitis, ovarian torsion, endometriosis, ruptured tubo-ovarian abscess.

If left untreated, inflammatory diseases of the pelvic organs can be complicated by the development of chronic pelvic pain – it develops on average in about 18% of patients. Other complications are the development of an ectopic pregnancy due to the presence of adhesions in the fallopian tubes that prevent the implantation of the embryo into the uterus. Due to the development of fibrous tissue in the reproductive organs, pelvic inflammatory disease is a common cause of infertility. infertility It is treated in about 50% of cases of untreated pelvic inflammatory disease. Another complication that may arisepi, tubo-ovarian abscess.

 Pelvic inflammatory disease is treated with antibiotics. Therapy is started empirically until the results of the prescribed tests with broad-spectrum antibiotics are obtained, and when the pathogen is established, treatment is carried out according to the results of the antibiogram. First-line therapy for pelvic inflammatory disease includes a combination of oral doxycycline and parenteral third-generation cephalosporin. The inclusion of metronidazole is recommended for suspected Trichomonas or as a result of gynecological intervention. Treatment is prescribed to both sexual partners and takes place with complete abstinence from sexual intercourse.

 Pelvic inflammatory disease is a serious disease that occurs in women at a young age and is one of the main causes of infertility.

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