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Purulent gynecologic diseases
Medical expert of the article
Last reviewed: 04.07.2025
Inflammatory diseases of the genital organs, which account for 60-65% of outpatients and up to 30% of inpatients, are one of the main medical problems and have a significant impact on the health of millions of women of childbearing age.
In recent years, all countries of the world have seen an increase in inflammatory diseases of the genitals by 13% in the general population of women of reproductive age and by 25% in women with IUD, with the frequency of tubo-ovarian formations of inflammatory etiology increasing threefold. According to research, their share in the structure of all forms of genital inflammation was 27%.
Unfortunately, it should be noted that in the domestic literature there are practically no statistical data on the frequency of purulent diseases both in the regions and in Ukraine as a whole.
According to some data, in the structure of gynecological hospitals providing emergency care, inflammation of the internal genital organs accounts for 17.8 to 28%.
According to doctors, pelvic inflammatory disease affects 1 million American women each year.
The incidence of pelvic inflammatory diseases is 49.3 per 10,000 women. Inflammatory diseases not only occupy a leading position in the structure of gynecological morbidity, but are the most common cause of hospitalization of women of reproductive age and create major medical, social and economic problems worldwide.
The inflammatory process and its consequences often irreversibly damage not only the reproductive system, but also the nervous system, significantly affecting the psycho-emotional status of patients.
Even the consequences of banal salpingitis remain quite serious: infertility and ectopic pregnancy.
Research data shows that 15% of patients with pelvic inflammatory disease do not respond to treatment, 20% will have at least one recurrence, and 18% will become infertile.
It was found that 15% of patients with inflammatory diseases of the pelvic organs require hospitalization, more than 20% may subsequently become infertile, and at least 3% are at risk of ectopic pregnancy.
Scientists retrospectively studied the three-year consequences of acute inflammation of the uterine appendages: 24% of patients suffered from pelvic pain syndrome for 6 months or more after treatment, 43% had exacerbations of the inflammatory process and 40% were infertile.
Chronic anovulation as a result of the inflammatory process can subsequently lead to the development of tumor growth.
According to observations, patients with inflammatory disease of the pelvic organs are 10 times more likely than healthy patients to have chronic pain syndrome, 6 times more likely to have endometriosis, they are 10 times more likely to undergo surgery for ectopic pregnancy, and they are 8 times more likely than the general population to have their uterus removed.
Inflammatory purulent tubo-ovarian formations pose a danger to the patient's life, especially if they are complicated by sepsis. The mortality rate of patients with purulent diseases of the internal genital organs, according to foreign authors, is 5-15%.
An important factor is the economic costs associated with the disease itself and its consequences.
According to G. Newkirk (1996), every tenth woman in the USA suffers from pelvic inflammatory disease during her reproductive years, and every fourth of them experiences some serious complications. Medical costs for the treatment of the disease and its consequences, including infertility, ectopic pregnancy or chronic pain syndrome, amount to more than 5 billion dollars annually.
Acute inflammatory diseases of the pelvic organs are the main gynecological health problem of women of childbearing age in the USA: estimating the direct and indirect costs of more than one million patients who are forced to visit gynecologists annually, M. Quan (1994) cites a figure exceeding 4.2 billion dollars.
Due to the increasing incidence of the disease, the costs associated with the treatment of inflammatory diseases in the United States are expected to reach approximately $10 billion by 2010.
However, in recent years, positive trends have emerged in a number of countries in reducing the severity of this problem.
Preventive measures aimed at combating gonorrheal and chlamydial infections, together with improved diagnostics and treatment, have reduced the incidence of inflammatory diseases of the pelvic organs of specific etiology and their serious complications.
There have been remarkable advances in the treatment of tubo-ovarian abscesses over the past 20 years, including a significant reduction in mortality. Although surgery is still required in 25% of cases, the combined use of conservative and surgical techniques (eg, unilateral adnexectomy and broad-spectrum antibiotics) has reduced the need for hysterectomy.
However, the frequency and severity of purulent inflammatory diseases and their complications, including infertility, numerous intrauterine infections and, possibly, deaths from ectopic pregnancy, perforation of tubo-ovarian abscesses, as well as the risk of combined infection with the human immunodeficiency virus and hepatitis B virus, make it necessary to look for new effective methods of their treatment.
Causes of purulent gynecological diseases
The development and formation of inflammatory diseases is based on many interconnected processes, ranging from acute inflammation to complex destructive tissue changes.
The main trigger for the development of inflammation is, of course, microbial invasion (microbial factor).
On the other hand, in the etiology of the purulent process, the so-called provoking factors play a significant and sometimes decisive role. This concept includes physiological (menstruation, childbirth) or iatrogenic (abortions, IUD, hysteroscopy, hysterosalpingography, operations, IVF) weakening or damage to barrier mechanisms, which contributes to the formation of entry gates for pathogenic microflora and its further spread.
In addition, it is necessary to emphasize the role of background diseases and other risk factors (extragenital diseases, some bad habits, certain sexual inclinations, socially conditioned conditions).
An analysis of the results of numerous bacteriological studies in gynecology conducted over the past 50 years has revealed a change in the microbes that cause such diseases over these years.
Causes of purulent gynecological diseases
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Pathogenesis of purulent gynecological diseases
Currently, inflammatory diseases of the pelvic organs have a multimicrobial origin, and are based on a complex interaction between synergistic infectious agents.
The female body, unlike the male, has an open abdominal cavity, which communicates with the external environment through the vagina, cervical canal, uterine cavity and fallopian tubes, and under certain conditions, infection can penetrate into the abdominal cavity.
Two variants of pathogenesis are described: the first is ascending infection with flora from the lower parts of the genital tract, the second is the spread of microorganisms from extragenital foci, including from the intestines.
Currently, the prevailing theory is about the ascending (intracanalicular) route of infection.
Damaged tissues (micro- and macrodamage during invasive interventions, operations, childbirth, etc.) are the entry points for infection. Anaerobes penetrate from adjacent ecological niches of the mucous membranes of the vagina and cervical canal, and also partly from the large intestine, external genitalia, skin; they multiply, spread and cause the pathological process. The ascending route of infection is also characteristic of other forms of microorganisms.
Pathogenesis of purulent gynecological diseases
Diagnostics of purulent gynecological diseases
Peripheral blood indices reflect the stage of acuteness of the inflammatory process and the depth of intoxication. Thus, if at the stage of acute inflammation the characteristic changes are leukocytosis (mainly due to band and young forms of neutrophils) and an increase in ESR, then during remission of the inflammatory process the first thing that attracts attention is a decrease in the number of erythrocytes and hemoglobin, lymphopenia with normal neutrophil formula indices and an increase in ESR.
Objective laboratory criteria for the severity of intoxication are considered to be a combination of such laboratory indicators as leukocytosis, ESR, the amount of protein in the blood, and the level of medium molecules.
Mild intoxication is typical for patients with a short-term process and uncomplicated forms, and severe and moderate intoxication is typical for patients with so-called conglomerate tumors that have a remitting course and require long-term conservative treatment.
The clinical course of the purulent process is largely determined by the state of the immune system.
Diagnostics of purulent gynecological diseases
Treatment of purulent gynecological diseases
The tactics of managing patients with purulent inflammatory diseases of the pelvic organs are largely determined by the timeliness and accuracy of diagnosis of the nature of the process, the extent of its spread and the assessment of the real risk of developing purulent complications, while the clinical approach and the ultimate goal are fundamentally important - timely and complete elimination of this process, as well as the prevention of complications and relapses.
That is why the importance of a correct, and most importantly, timely diagnosis in these patients is difficult to overestimate. The concept of diagnosing purulent lesions (clinically clearly thought out and instrumentally proven definition of the stages of localization of the process and the stage of suppuration) should be the foundation of successful treatment.
What do need to examine?