WHAT YOU NEED TO KNOW ABOUT OOPHORITIS AS A WOMAN?

Oophoritis (ie, inflammation of the ovary) is an uncommonly used term for pelvic inflammatory disease (PID). This is an ascending infection of the ovaries and a major cause of female infectious morbidity(tisuue damage due to disease), ectopic pregnancy(conception elsewhere than in the uterus), and sterilization. Oophoritis is a clinically diagnosed disease that must be carefully distinguished from other causes of illness.
Infection ascends from bacterial colonization of the cervix and extends to the uterus, fallopian tubes, and ovaries. Gonorrhea and Chlamydia species(A sexually transmitted infection a.k.a cupid's itch) are typically colonized from the cervix in cases of oophoritis, but these pathogens are rarely isolated in ovarian tissue. These organisms instead facilitate infection of the adjoining anatomical parts like the uterus and the fallopian tubes by other bacteria. If left untreated, an abscess may form around the fallopian tubes and ovaries, a condition known as a tubo-ovarian abscess (TOA).

Frequency

United States
One million cases are reported each year.

International
Worldwide incidence and prevalence rates are unknown.

Mortality/Morbidity
In the United States, the Centers for Disease Control and Prevention (CDC) estimate that 150 women die each year and 100,000 women become infertile due to oophoritis. The other major morbidities are an increased risk of ectopic pregnancy and chronic pelvic pain.

Age
Oophoritis most commonly occurs in women younger than 25 years. When oophoritis occurs in postmenopausal women, it is usually associated with an underlying progressive and untreatable condition.

History
• Abdominal pain
• Pelvic pain
• Vaginal discharge
• Dyspareunia (painful intercourse)
• Fever
• Chills
• Nausea/vomiting

Physical
• Temperature greater than 38°C
• Abdominal tenderness in lower quadrants
• Possible rebound tenderness on pelvic examination
• Mucus/pus discharge
• Cervical motion tenderness
• Adnexal tenderness
• Adnexal mass (if a tubo-ovarian abscess is present)

Causes
• Unprotected sexual intercourse
• Multiple sexual partners
• High-risk sexual behavior
• Immunosuppression
• Recent instrumentation of genital tract (endometrial biopsy, intrauterine device [IUD] placement)
• Gynecologic malignancy (in postmenopausal women)

Medical Care
Outpatient treatment is appropriate for patients who are (1) hemodynamically stable(stil able to move around without aid), (2) sufficiently reliable to return for follow-up care, (3) immunocompetent, (4) not pregnant, (5) tolerant of oral medication, and (6) without clinical suspicion of a tubo-ovarian abscess (TOA).
Inpatient treatment is required for patients who (1) have already failed outpatient treatment, (2) are pregnant, (3) are infected with HIV or otherwise immunocompromised, (4) are exhibiting evidence of a TOA, (5) are hemodynamically unstable or appear septic, or (6) are unable to tolerate oral medications.

Surgical Care
Oophoritis may be managed with surgery when medical treatment fails to ameliorate symptoms after 48-72 hours. Surgical options may include laparoscopy(incision of the abdomen) with drainage of the abscess, removal of adnexa(adjoining tissues), and total abdominal hysterectomy(surgical of the uterus) oophorectomy (surgical removal of both ovaries)
Factors that influence the choice of surgery include extent of the abscess, degree of immunocompromise of the patient(damage to the immune system) , and preservation of fertility for future childbearing potential. Interventional radiology can sometimes be used for drainage of abscesses in patients who are not surgical candidates or in patients who prefer a less invasive procedure than surgery.

Consultations
If needed, consultation with obstetricians and gynecologists can be made for follow-up care and surgical expertise.

Diet
No changes are necessary. Nothing is to be taken orally if surgical treatment is anticipated.

Special Concerns
• Pregnancy
• Oophoritis in pregnancy is very uncommon.
• A consultation with an obstetrician/gynecologist is immediately required if this diagnosis is suspected.
• Pediatrics
• Children rarely have this condition.
• The provider must have a high suspicion for sexual abuse if PID is suspected in an adolescent patient.
Geriatrics: Elderly patients with PID are more likely to have an associated genital tract malignancy such as ovarian cancer or endometrial cancer.

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