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Chronic adnexitis
Medical expert of the article
Last reviewed: 05.07.2025
A frequently occurring or not fully cured inflammatory disease of the uterine appendages can eventually develop into a more protracted form – chronic adnexitis.
This disease is characterized by a sluggish course and, unlike the acute process, is much more difficult to treat.
According to the world medical classification, the pathology code for chronic adnexitis ICD-10 is:
N70.1 Manifestations of chronic salpingitis and oophoritis.
Causes of chronic adnexitis
Chronic adnexitis is a consequence of acute or subacute adnexitis that was not cured completely or was not treated at all.
The inflammatory reaction in adnexitis begins with the tubal mucosa: this process is accompanied by all the symptoms of inflammation, which spreads to the muscular tissue of the tubes, causing their swelling.
The thickened and elongated tube becomes palpable. The infectious agent with the tubal fluid can penetrate into the serous tissues and peritoneal tissues. As a consequence, there is a possibility of developing suppuration, peritonitis, and the formation of a tubo-ovarian neoplasm.
In the appendages, further inflammation occurs, the walls of the tubes stick together, exudation and fimbrial thickening occur, and hydrosalpinx may develop. All this leads to tubal obstruction and the risk of developing an ectopic pregnancy.
Adhesion of the walls is the initial stage of the adhesion process, one of the characteristics of chronic inflammatory pathology. Adhesions can also affect some areas of the peritoneum, intestines, and appendix.
The presence of a constant, sluggish source of infection provokes the appearance of vague and relatively hidden symptoms. Clear signs of the disease are visible only during relapses.
Symptoms of chronic adnexitis
A relapse of chronic adnexitis may begin with pain in the lower abdomen, chills, and urinary disorders. A mirror examination reveals signs of endocervicitis and the presence of serous or purulent discharge.
A two-handed examination does not allow one to clearly feel the appendages, but a sharp pain is felt in the area where they are located.
Blood tests show an increase in the number of leukocytes and ESR.
The chronic form of the disease can last for more than one year, periodically worsening and manifesting itself. Clinical symptoms of the "dormant" course of the disease can manifest themselves hidden, in the form of a constant temperature of about 37 C, dull or pulsating pain to the right or left below the navel, especially during PMS or ovulation. Pain is also noted on the affected side during sexual intercourse: often this pain becomes the reason for a woman's refusal to have sex. Often, patients complain of the inability to conceive a child, and during the examination, they are found to have a chronic form of adnexitis.
Pain in chronic adnexitis is of a “dull” nature; it tends to intensify after significant physical exertion, before the onset of menstruation, during sexual contact, after a stressful situation or hypothermia.
Chronic adnexitis can exist in several variants of the course of the disease:
- bilateral chronic adnexitis - the inflammatory reaction is present in both the left and right tubes and ovaries;
- chronic left-sided adnexitis - the inflammatory process affects only the left fallopian tube and left ovary;
- Chronic right-sided adnexitis is an inflammatory lesion of the right tube and ovary.
Chronic adnexitis in the remission stage (in a "dormant" state) may not be accompanied by pain, but there may be menstrual dysfunction, changes in the amount and duration of discharge, pronounced PMS. A woman may experience weakness and headaches associated with constant intoxication of the body. Blood tests only confirm the presence of latent inflammation in the body.
An exacerbation of chronic adnexitis resembles an acute inflammatory process in its symptoms. Signs of inflammation are pronounced: pain in the lower abdomen, general weakness, irritability, temperature of 37-37.5 C, and the possible appearance of vaginal purulent-serous discharge.
Chronic adnexitis and pregnancy
Since chronic adnexitis is often the cause of tubal obstruction and ectopic pregnancy, it is necessary to cure this disease before planning a child. After a course of therapeutic procedures and prescriptions, it is also necessary to make sure that the left and right tubes are patency in order to assess the chances of pregnancy and prevent ectopic pregnancy. If everything is in order, you can safely try to conceive a baby.
If you find out about pregnancy when the course of chronic adnexitis is in full swing, consult a specialist, perhaps he will prescribe you supportive and gentle treatment. Antibiotic therapy during pregnancy is not recommended, since antibacterial drugs can negatively affect the development of the embryo. However, the presence of a source of infection in the reproductive organs can also provoke very serious complications, including fetal death and spontaneous abortion. Therefore, bearing a child against the background of chronic adnexitis should be carried out under the mandatory supervision of a specialist.
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Consequences of chronic adnexitis
The most serious consequence of chronic adnexitis can be tubal obstruction, and, as a result, infertility. The walls of the tubes stick together and do not allow the sperm to penetrate and fertilize the egg.
Inflammation also affects the condition and functionality of the ciliated epithelium. Cilia are located in the tubes. Their function is to push the fertilized egg to the uterus. If this ability is impaired, the egg can stop somewhere along the tube and begin its development not in the uterus, but inside the tube. This is how an ectopic pregnancy develops - the next possible consequence of adnexitis.
Sometimes a chronic inflammatory process can provoke a disruption of the ovarian function. In this case, the egg loses its ability to mature and fertilize, which also causes problems with conception. Menstrual dysfunction may also occur.
Constant pain in the affected ovary during sexual intercourse can contribute to a decrease in libido; irritability, weakness, dissatisfaction, and frequent mood swings may appear.
If a woman with chronic adnexitis still manages to become pregnant, the disease can affect the ability to bear a child: with this pathology, fetal infections, spontaneous abortions or premature labor often occur.
Diagnosis of chronic adnexitis
Diagnosis of inflammation of the appendages is made on the basis of the anamnesis of the disease. Previous abortions, complicated labor, various intrauterine procedures, salpingography, and insertion of a uterine IUD are taken into account.
Bimanual examination almost always reveals pain and limited mobility of the appendages on one or both sides.
A chronic process may not reveal itself in a general blood test: sometimes it only reveals an elevated ESR. That is why a blood test is not an informative diagnostic method: much more information can be obtained from bacterioscopic and bacteriological tests of smears from the cervical, urethral canal and vaginal walls. The detected infectious agents are tested for susceptibility to antibiotic therapy.
Among the instrumental examination methods, we can highlight echography (shows thickening of the tubes, adhesions in the pelvic area), hysterosalpingography (shows the degree of patency of the fallopian tubes), vaginal ultrasound, computed tomography or magnetic resonance imaging.
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Treatment of chronic adnexitis
Is it possible to cure chronic adnexitis? It is difficult, but possible: the chronic form may require long-term treatment, however, if you are patient and strictly follow all the doctor's instructions, the result will definitely be there.
The treatment regimen for chronic adnexitis is determined by the attending physician individually, based primarily on the sensitivity of the detected microorganisms to antibiotics. Antibiotics for chronic adnexitis are prescribed almost always: the only exception is, perhaps, the period of pregnancy.
The disease is best treated during periods of exacerbation: it is much easier to attack active bacteria than dormant ones.
Treatment of exacerbation of chronic adnexitis can be carried out using a comprehensive approach, simultaneously combining medication, physiotherapy and other additional measures.
Treatment of chronic adnexitis with drugs
Treatment of the disease with antibiotics is carried out taking into account the possible type of pathogens. Most often, drugs with a wide range of effects are used in therapy, which have a detrimental effect on the maximum number of bacterial variants.
The main treatment regimen includes a combination of cephalosporin drugs (ceftriaxone, cefotaxime) and metronidazole; a group of aminopenicillin antibiotics (amoxicillin, amoxiclav) is often used.
Recently, fluoroquinolone series of drugs (ofloxacin, ciprofloxacin) have been actively used in the treatment of the disease. If chlamydia is detected in the tests, doxycycline or macrolide antibiotics (erythromycin, leucomycin, oleandomycin) can be prescribed.
Treatment is carried out in a hospital setting. Antibacterial agents are first administered intravenously, gradually moving to internal medication. Antimicrobial drugs are combined with detoxification therapy: isotonic solution, glucose solution, vitamin and protein agents.
Symptomatic therapy includes analgesic and anti-inflammatory drugs, which can be prescribed according to individual indications.
Treatment of chronic adnexitis with suppositories
Suppositories are very effective for this disease and are used in complex therapy to relieve inflammation and neutralize bacteria. Vaginal or rectal use of drugs allows for a therapeutic effect as close as possible to the source of infection. Considering this dosage form, we will focus on the following drugs that have proven themselves:
- Voltaren. It has a detrimental effect on bacteria and produces an anesthetic effect. The maximum daily dose of the drug is up to 150 mg, used 2 times a day;
- Movalis. A good analgesic, used for 5-7 days as indicated;
- Hexicon. An antimicrobial and anti-inflammatory drug used even during pregnancy;
- Fluomizin. An antibacterial drug, used once a day before bedtime;
- Indomethacin. Anti-inflammatory and antipyretic rectal agent;
- Polygynax. It is used for 10-14 days, 1 suppository per day as an anti-inflammatory agent;
- Belladonna extract in suppositories. Has a good analgesic effect.
Self-administration of suppositories without a doctor's prescription is not allowed. Any drug has its own contraindications, and only a specialist can decide whether this treatment is right for you.
Treatment of chronic adnexitis with folk remedies
Traditional medicine recipes can only be used in combination with traditional therapy prescribed by a specialist. Self-medication is not recommended: it is risky, and you alone are responsible for the consequences of such treatment. However, the complex use of drug and traditional therapy can complement each other, accelerating the onset of recovery:
- mumiyo. This drug is sold in regular pharmacies. Take 1 tablet in the morning and at night on an empty stomach, washed down with milk or juice;
- tea from St. John's wort, chamomile, yarrow, sage and succession. Brew a full teaspoon of each ingredient in 1 liter of boiling water. Infuse and drink a glass three times a day;
- sitz baths with oak bark, oregano and marshmallow root. Brew 6 teaspoons of oak bark, 4 teaspoons of oregano, 1 teaspoon of marshmallow in a liter of boiling water, leave for half an hour. Pour into a basin (the infusion should be 40-45 C) and take a sitz bath for 15 minutes twice a day;
- raw potato juice. Drink freshly squeezed juice one third of a glass in the morning, for up to six months in a row;
- chamomile tea. This tea should be drunk throughout the day without measure, you can add honey;
- Borovaya uterus and red brush. Well-known female herbs, brew 1 teaspoon per glass of boiling water. Drink before each meal (half an hour).
Treatment with folk remedies should be agreed with your doctor so as not to harm the body. The use of herbs is not recommended during menstruation.
More information of the treatment
Prevention of chronic adnexitis
The main measure for the prevention of chronic adnexitis is timely treatment of the acute form of the disease. The course of therapy must be completed in full, using all dosages and doctor's recommendations.
Subsequently, you can periodically take courses aimed at preventing exacerbations, use spa treatment, mud therapy, and improve your sex life with a regular partner.
You should avoid situations that provoke the development of the inflammatory process: stress, hypothermia, genital infections.
It is essential to adhere to the rules of intimate hygiene: take a shower daily, wash with warm water, and change tampons and pads in a timely manner.
It is unacceptable to sit on cold surfaces or swim in cold water. In winter, you should wear warm underwear.
Use condoms during casual sex; avoid promiscuous sex.
If you experience any pain associated with the reproductive organs, or if you experience unusual vaginal discharge, you should see a doctor without waiting for the disease to progress.
Prognosis of chronic adnexitis
The prognosis for the chronic form of the disease can be favorable if timely and qualified treatment is provided, with subsequent adherence to all preventive recommendations. The disease does not pose a threat to life. Untreated adnexitis increases the risk of infertility and ectopic pregnancy, and disrupts the menstrual cycle.
Chronic adnexitis is a serious disease, but it can be dealt with by contacting a doctor and strictly following all recommendations.