Medical treatment: hitting on all fronts
The basis of conservative management is potent antibacterial therapy. Given the frequent combination of chlamydial and gonococcal infections, drugs are always combined.
- Spectrum: 3rd generation cephalosporins, fluoroquinolones, macrolides, and aminoglycosides are used. To cover anaerobic flora, nitroimidazole derivatives (metronidazole) are necessarily included in the regimen. For complicated forms, carbapenems serve as reserve drugs.
- Tactics: With pronounced inflammation, treatment starts with parenteral administration. As soon as clinical improvement occurs, in 24–48 hours the patient is switched to oral forms (step-down therapy).
- Comprehensive approach: Antimycotics for fungal infection prophylaxis, NSAIDs for pain and edema relief, and infusion therapy are included in the regimen. Saline and rheopolyglucin drips not only relieve intoxication, but also improve antibiotic delivery directly to the focus by reducing blood viscosity.
Severe forms of inflammation require pathogenetic support: normalization of gastrointestinal function, antihistamines (to reduce sensitization to tissue breakdown products), and immunomodulators (interferon preparations, thymalin).
Surgical tactics: when waiting is not an option
If conservative therapy for pelvioperitonitis yields no effect within 12–24 hours, symptoms escalate, or rupture of a purulent tubo-ovarian mass is suspected, emergency surgery is indicated.
- Laparoscopy: The gold standard of adnexal surgery. It allows adhesiolysis, opening of abscesses, washing the abdominal cavity with antiseptics, and placing drains. Second-look laparoscopy is critically important to prevent adhesion formation and preserve reproductive function.
- Puncture: In isolated abscesses (piosalpinx, pyovarium), aspiration of pus through the posterior vaginal fornix under ultrasound guidance with subsequent washing of the cavity with antibiotics is possible.
- Hysteroscopy: The method of choice for endometritis. The uterine cavity is washed, removing residual gestational tissue or intrauterine devices if necessary.
- Laparotomy: Lower midline celiotomy is used for generalized peritonitis, intra-abdominal abscesses, or ineffectiveness of laparoscopic drainage.
- Radical measures: Hysterectomy with adnexectomy is performed if the uterus itself has become the source of infection, as well as in multiple abscesses. In women of reproductive age, surgeons always strive to preserve ovarian tissue as much as possible.
Chronic inflammation and infertility
Outside the acute stage (in remission), management focuses on relief of residual pain, restoration of a normal menstrual cycle, and fertility.
- Physiotherapy: The leading treatment method in remission. Electrophoresis with potassium iodide, zinc, or magnesium, phonophoresis with hydrocortisone, alternating magnetic fields, and laser therapy are used.
- Surgical restoration: Patients under 35 years of age undergo laparoscopic surgery (fimbrioplasty, salpingostomy, adhesiolysis) to restore fallopian tube patency.
- IVF: If tubal-peritoneal infertility does not respond to surgical correction, in vitro fertilization becomes the method of choice.
Gonorrhea as a frequent cause of inflammation
Gonococcus (Neisseria gonorrhoeae) is a gram-negative intracellular diplococcus that affects mucous membranes lined exclusively with columnar epithelium (cervical canal, fallopian tubes, urethra).
The pathogen is extremely ingenious in its defense mechanisms:
- Forms L-forms, losing antigenic properties and becoming invisible to immunity and antibodies.
- Produces the enzyme β-lactamase, which destroys penicillin antibiotics.
- Capable of surviving directly inside leukocytes (the phenomenon of incomplete phagocytosis).
Interesting fact: The stratified squamous epithelium of the vagina is normally resistant to gonococcus. Gonococcal vaginitis occurs only when the mucosa is thinned or loosened—in girls, pregnant women, or postmenopausal women.
To memorize the survival factors of gonococcus, use the acronym PILKA: Pili (for fixation), Immune evasion (incomplete phagocytosis), L-forms (loss of antigens), Kapsule-like substance, Antibiotic resistance (production of the β-lactamase enzyme).
Class and exam questions
When to switch from intravenous antibiotics to pills?
Step-down therapy involves switching to oral intake 24–48 hours after clear clinical improvement occurs.
In what cases is the uterus removed during adnexal inflammation?
Hysterectomy is indicated if the uterus itself is the source of infection (e.g., against the background of an IUD or after abortion), as well as in generalized peritonitis and multiple abscesses.
Why does gonorrhea often become latent or chronic?
The pathogen is capable of forming L-forms, producing the β-lactamase enzyme to destroy antibiotics, and surviving inside leukocytes, making standard therapy less effective.
What else to study on this topic
- Extracorporeal detoxification methods (plasmapheresis, UV blood irradiation)
- Management tactics for patients with ectopic pregnancy
- Use of cytostatics (Methotrexate) in gynecology
- Apparatus autologous blood reinfusion (Cell saver) in intra-abdominal bleeding
- Prevention of Rh-sensitization after gynecological surgeries
- Second-look laparoscopy to assess reproductive function
Master the entire topic in the "Obstetrics and Gynecology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Pelvic inflammatory disease" and 973 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 21 video lessons on the subject
Other topics in the "Gynecology" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.