Skip to main content
SpringerLink
Log in

Adnexitis – eine klinische Herausforderung

Adnexitis – a clinical challenge

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Eine Entzündung des inneren weiblichen Genitaltrakts (Adnexitis) ist unter Frauen im gebärfähigen Alter weit verbreitet und geht mit schwerwiegenden gesundheitlichen und reproduktionsmedizinischen Problemen, einschließlich Infertilität (etwa 20%), chronischen pelvinen Schmerzen (etwa 18%) oder extrauteriner Gravidität (etwa 6%) einher. Die Diagnose einer Adnexitis stellt eine große Herausforderung dar. Sie erfolgt durch die Anamnese in Zusammenhang mit der klinischen Untersuchung, bildgebenden Verfahren einschließlich der invasiven Diagnostik sowie der Erhebung klinisch-chemischer und mikrobiologischer Befunde. Die Behandlung sollte vor irgendeiner zusätzlichen Diagnosemaßnahme erfolgen, da eine verzögerte Therapieeinleitung mit einem größeren Risiko einer Sterilität und chronischen Unterbauchbeschwerden einhergeht.

Abstract

Inflammation of the female internal genital tract (pelvic inflammatory disease) is widespread among fertile women and a common cause of problems including infertility (about 20%), chronic pelvic pain (18%), and ectopic pregnancy (6%). Signs and symptoms of this syndrome vary widely, further complicating diagnosis and treatment. Diagnosis is on anamnestic data, clinical presentation, sonographic and invasive diagnostic procedures, elevated clinical and chemical findings, and suspicious microbiologic findings. Treatment should start promptly before any additional diagnostic measures, as delayed treatment onset carries increased risk of sterility and chronic lower abdominal disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Barrett S, Taylor C (2005) A review on pelvic inflammatory disease. Int J STD AIDS 16:715–720; quiz 721

    Article  PubMed  CAS  Google Scholar 

  2. Beckmann KR, Melzer-Lange MD, Gorelick MH (2004) Emergency department management of sexually transmitted infections in US adolescents: results from the National Hospital Ambulatory Medical Care Survey. Ann Emerg Med 43:333–338

    Article  PubMed  Google Scholar 

  3. Beigi RH, Wiesenfeld HC (2003) Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am 30:777–793

    Article  PubMed  Google Scholar 

  4. Boardman LA, Peipert JF, Brody JM et al (1997) Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol 90:54–57

    Article  PubMed  CAS  Google Scholar 

  5. Brunham RC, Binns B, Guijon F et al (1988) Etiology and outcome of acute pelvic inflammatory disease. J Infect Dis 158:510–517

    PubMed  CAS  Google Scholar 

  6. Crombleholme WR, Schachter J, Ohm-Smith M et al (1989) Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin. Am J Med 87:142S–147S

    Article  PubMed  CAS  Google Scholar 

  7. Eckert LO, Thwin SS, Hillier SL et al (2004) The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol 190:305–313

    Article  PubMed  CAS  Google Scholar 

  8. Eschenbach D (2007) Treatment of pelvic inflammatory disease. Clin Infect Dis 44:961–963

    Article  PubMed  Google Scholar 

  9. Eschenbach DA, Buchanan TM, Pollock HM et al (1975) Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med 293:166–171

    PubMed  CAS  Google Scholar 

  10. Eschenbach DA, Holmes KK (1975) Acute pelvic inflammatory disease: current concepts of pathogenesis, etiology, and management. Clin Obstet Gynecol 18:35–56

    Article  PubMed  CAS  Google Scholar 

  11. Eschenbach DA, Wolner-Hanssen P, Hawes SE et al (1997) Acute pelvic inflammatory disease: associations of clinical and laboratory findings with laparoscopic findings. Obstet Gynecol 89:184–192

    Article  PubMed  CAS  Google Scholar 

  12. Fortenberry JD, Zimet GD (1999) Received social support for sexually transmitted disease-related care-seeking among adolescents. J Adolesc Health 25:174–178

    Article  PubMed  CAS  Google Scholar 

  13. Friese K, Schäfer A, Hof H (2003) Infektionskrankheiten in Gynäkologie und Geburtshilfe. Springer, Berlin Heidelberg New York Tokio

  14. Haggerty CL, Hillier SL, Bass DC et al (2004) Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 39:990–995

    Article  PubMed  Google Scholar 

  15. Haggerty CL, Peipert JF, Weitzen S et al (2005) Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sex Transm Dis 32:293–299

    Article  PubMed  Google Scholar 

  16. Haggerty CL, Schulz R, Ness RB (2003) Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Obstet Gynecol 102:934–939

    Article  PubMed  Google Scholar 

  17. Haggerty CL, Totten PA, Astete SG et al (2006) Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol 2006:30184

    PubMed  Google Scholar 

  18. Hillier SL, Kiviat NB, Hawes SE et al (1996) Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol 175:435–441

    Article  PubMed  CAS  Google Scholar 

  19. Hillis SD, Joesoef R, Marchbanks PA et al (1993) Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol 168:1503–1509

    PubMed  CAS  Google Scholar 

  20. Hong S, Xin C, Qianhong Y et al (2002) Pelvic inflammatory disease in the People’s Republic of China: aetiology and management. Int J STD AIDS 13:568–572

    Article  PubMed  Google Scholar 

  21. Joesoef MR, Linnan M, Barakbah Y et al (1997) Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia. Int J STD AIDS 8:576–580

    Article  PubMed  CAS  Google Scholar 

  22. Kane BG, Degutis LC, Sayward HK et al (2004) Compliance with the Centers for Disease Control and Prevention recommendations for the diagnosis and treatment of sexually transmitted diseases. Acad Emerg Med 11:371–377

    PubMed  Google Scholar 

  23. Kane JL, Woodland RM, Forsey T et al (1984) Evidence of chlamydial infection in infertile women with and without fallopian tube obstruction. Fertil Steril 42:843–848

    PubMed  CAS  Google Scholar 

  24. Kildea S, Bowden FJ (2000) Reproductive health, infertility and sexually transmitted infections in indigenous women in a remote community in the Northern Territory. Aust N Z J Public Health 24:382–386

    Article  PubMed  CAS  Google Scholar 

  25. Kiviat NB, Wolner-Hanssen P, Eschenbach DA et al (1990) Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am J Surg Pathol 14:167–175

    PubMed  CAS  Google Scholar 

  26. Korn AP, Hessol N, Padian N et al (1995) Commonly used diagnostic criteria for pelvic inflammatory disease have poor sensitivity for plasma cell endometritis. Sex Transm Dis 22:335–341

    PubMed  CAS  Google Scholar 

  27. Lareau SM, Beigi RH (2008) Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am 22:693–708, vii

    Article  PubMed  Google Scholar 

  28. Manhart LE, Critchlow CW, Holmes KK et al (2003) Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 187:650–657

    Article  PubMed  Google Scholar 

  29. Miettinen A, Heinonen PK, Teisala K et al (1990) Antigen specific serum antibody response to Chlamydia trachomatis in patients with acute pelvic inflammatory disease. J Clin Pathol 43:758–761

    Article  PubMed  CAS  Google Scholar 

  30. Molander P, Finne P, Sjoberg J et al (2003) Observer agreement with laparoscopic diagnosis of pelvic inflammatory disease using photographs. Obstet Gynecol 101:875–880

    Article  PubMed  Google Scholar 

  31. Monif GR, Welkos SL, Baer H et al (1976) Cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis and gonococcal endocervicitis. Am J Obstet Gynecol 126:158–161

    PubMed  CAS  Google Scholar 

  32. Mylonas I, Bolz M, Bredt W et al (2007) Weibliche Geschlechtsorgane. In: Marre, Mertens, Trautmann, Zimmerli (Hrsg) Klinische Infektiologie. Elsevier, München

  33. Mylonas I, Friese I (2008) Infektiologische Erkrankungen in der Gynäkologie. In: Janni, Rack, Friese (Hrsg) Facharzt Gynäkologie. Elsevier, München

  34. Mylonas I, Friese K (2009) Infektionen in der Gynäkologien und Geburtshilfe. Elsevier, München

  35. Ness RB, Hillier SL, Kip KE et al (2005) Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women. Am J Epidemiol 161:186–195

    Article  PubMed  Google Scholar 

  36. Ness RB, Soper DE, Holley RL et al (2002) Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 186:929–937

    Article  PubMed  Google Scholar 

  37. Paavonen J, Aine R, Teisala K et al (1985) Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease. Am J Obstet Gynecol 151:645–650

    PubMed  CAS  Google Scholar 

  38. Paavonen J, Teisala K, Heinonen PK et al (1987) Microbiological and histopathological findings in acute pelvic inflammatory disease. Br J Obstet Gynaecol 94:454–460

    PubMed  CAS  Google Scholar 

  39. Paris M, Gotuzzo E, Goyzueta G et al (1999) Prevalence of gonococcal and chlamydial infections in commercial sex workers in a Peruvian Amazon city. Sex Transm Dis 26:103–107

    Article  PubMed  CAS  Google Scholar 

  40. Peipert JF, Montagno AB, Cooper AS et al (1997) Bacterial vaginosis as a risk factor for upper genital tract infection. Am J Obstet Gynecol 177:1184–1187

    Article  PubMed  CAS  Google Scholar 

  41. Peipert JF, Ness RB, Blume J et al (2001) Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol 184:856–863, discussion 863–854

    Article  PubMed  CAS  Google Scholar 

  42. Petersen E (2003) Infektionen in Gynäkologie und Geburtshilfe. Thieme, Stuttgart New York

  43. Punnonen R, Terho P, Nikkanen V et al (1979) Chlamydial serology in infertile women by immunofluorescence. Fertil Steril 31:656–659

    PubMed  CAS  Google Scholar 

  44. Rein DB, Kassler WJ, Irwin KL et al (2000) Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol 95:397–402

    Article  PubMed  CAS  Google Scholar 

  45. Safrin S, Schachter J, Dahrouge D et al (1992) Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study. Am J Obstet Gynecol 166:1300–1305

    PubMed  CAS  Google Scholar 

  46. Scholes D, Stergachis A, Heidrich FE et al (1996) Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 334:1362–1366

    Article  PubMed  CAS  Google Scholar 

  47. Sellors J, Mahony J, Goldsmith C et al (1991) The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol 164:113–120

    PubMed  CAS  Google Scholar 

  48. Simms I, Stephenson JM, Mallinson H et al (2006) Risk factors associated with pelvic inflammatory disease. Sex Transm Infect 82:452–457

    Article  PubMed  CAS  Google Scholar 

  49. Soper DE (1994) Pelvic inflammatory disease. Infect Dis Clin North Am 8:821–840

    PubMed  CAS  Google Scholar 

  50. Svenstrup HF, Fedder J, Abraham-Peskir J et al (2003) Mycoplasma genitalium attaches to human spermatozoa. Hum Reprod 18:2103–2109

    Article  PubMed  Google Scholar 

  51. Sweet RL (2009) Treatment strategies for pelvic inflammatory disease. Expert Opin Pharmacother 10:823–837

    Article  PubMed  CAS  Google Scholar 

  52. Sweet RL, Draper DL, Schachter J et al (1980) Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: what is the appropriate site to sample? Am J Obstet Gynecol 138:985–989

    PubMed  CAS  Google Scholar 

  53. Sweet RL, Mills J, Hadley KW et al (1979) Use of laparoscopy to determine the microbiologic etiology of acute salpingitis. Am J Obstet Gynecol 134:68–74

    PubMed  CAS  Google Scholar 

  54. Thompson SE 3rd, Hager WD, Wong KH et al (1980) The microbiology and therapy of acute pelvic inflammatory disease in hospitalized patients. Am J Obstet Gynecol 136:179–186

    PubMed  Google Scholar 

  55. Tukeva TA, Aronen HJ, Karjalainen PT et al (1999) MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 210:209–216

    PubMed  CAS  Google Scholar 

  56. Uno M, Deguchi T, Komeda H et al (1997) Mycoplasma genitalium in the cervices of Japanese women. Sex Transm Dis 24:284–286

    Article  PubMed  CAS  Google Scholar 

  57. Washington AE, Katz P (1991) Cost of and payment source for pelvic inflammatory disease. Trends and projections, 1983 through 2000. JAMA 266:2565–2569

    Article  PubMed  CAS  Google Scholar 

  58. Wasserheit JN, Bell TA, Kiviat NB et al (1986) Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin. Ann Intern Med 104:187–193

    PubMed  CAS  Google Scholar 

  59. Westrom L (1988) Decrease in incidence of women treated in hospital for acute salpingitis in Sweden. Genitourin Med 64:59–63

    PubMed  CAS  Google Scholar 

  60. Westrom L (1975) Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol 121:707–713

    PubMed  CAS  Google Scholar 

  61. Westrom L, Joesoef R, Reynolds G et al (1992) Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 19:185–192

    Article  PubMed  CAS  Google Scholar 

  62. Westrom LV (1994) Sexually transmitted diseases and infertility. Sex Transm Dis 21:S32–S37

    PubMed  CAS  Google Scholar 

  63. WHO (2005) Sexually transmitted diseases and other reproductive tract infections: a guide to essential practice.

  64. Wiesenfeld HC, Hillier SL, Krohn MA et al (2002) Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol 100:456–463

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum Innenstadt, Ludwig-Maximilians-Universität, Maistr. 11, 80337, München, Deutschland

    I. Mylonas & K. Friese

Authors
  1. I. Mylonas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Friese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Mylonas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mylonas, I., Friese, K. Adnexitis – eine klinische Herausforderung. Gynäkologe 42, 786–792 (2009). https://doi.org/10.1007/s00129-009-2352-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-009-2352-8

Schlüsselwörter

Keywords

Search

Navigation