Salpingitis

Case report:

A 28-year-old female will appear in the practice and complained of acute pain in the left lower abdomen for 24 hours. Here there are no discomfort during urination and no chair abnormalities; the last menstruation was a week ago. Along with the pain abruptly occurring had been measured to 39 � C fever.

Diagnosis:

The physical examination initially confirms the increased body temperature of 38.5 � C. In addition, there is a distinct pressure pain in the left lower abdomen with a painful, little sliding resistance in the area of pain spontaneously given. The rectal examination is unremarkable, likewise also the sediment analysis of the urine. The gynecological examination gives the same palpation with a pressure painful resistance in the left ovary and a moderate purulent cervical secretions. This secretion is obtained for microbiological analysis for chlamydia and gonorrhea. Microscopic examination on gonococcal was negative, likewise the PCR, or LCR on chlamydia. The differential diagnosis must be excluded Ectopic pregnancy, which is why a pregnancy test should be necessarily performed.

Pathogenesis:

The salpingitis commonly arises through an ascending bacterial infection, which usually reaches from the lower genital tract through the cervix and the endometrium adnexa. Menstruation is considered as a potential risk factor for salpingitis because the cervical defenses during menstruation are not effective. Although the exact mechanisms of these defense factors are not known, however, produce cervical tissue secretory immunoglobulins, and the cervical mucus contains a variety of antimicrobial factors such as lactoferrin, peroxidases and complement components.

Therapy:

In the rather moderately severe clinical picture of the patient will be omitted hospital treatment then also possible laparoscopic and sonographic diagnosis. Oral therapy should be used with ofloxacin (Cipro others) 500 mg twice daily plus clindamycin (SOBELIN etc.) take place (Tarivid others) 400 mg every 12 hours or ciprofloxacin three times 600 mg daily or metronidazole (Clont others) 500 mg twice daily for 14 days; Alternatives are in severe cases Ceftriaxone (Rocephin) 250 mg in the or i.v. plus doxycycline (VIBRAMYCIN others) 100 mg twice daily also for 14 days. Despite early antibiotic therapy can be expected with a post infectious Infertilit�tsrate of 10-30%.