eMedicine Specialties > Obstetrics and Gynecology > Infections

Oophoritis: Follow-up

Author: Arthur T Ollendorff, MD, Associate Professor of Clinical Obstetrics and Gynecology, Residency Program Director, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine; Chief of Gynecology, Veterans Affairs Medical Center, Cincinnati
Contributor Information and Disclosures

Updated: Aug 14, 2007

Follow-up

Further Inpatient Care

Continue IV antibiotics until the patient is afebrile for 24 hours. If patients are placed on gentamicin and clindamycin and do not respond to this antibiotic coverage, add ampicillin to provide coverage for enterococci. Metronidazole (Flagyl) may be substituted for clindamycin if a tubo-ovarian abscess (TOA) is present.

Further Outpatient Care

Arrange for a follow-up visit within 48-72 hours of treatment (outpatient) or discharge from hospital to evaluate the treatment's success. Pain may take 7-10 days to abate.

Inpatient & Outpatient Medications

Continue patients on doxycycline for a total of 14 days. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain control.

Transfer

Transfer is typically unnecessary.

Deterrence/Prevention

  • Patients with oophoritis must be counseled about the use of condoms to prevent the future acquisition of sexually transmitted diseases (STDs).
  • Fully evaluate the male sexual partner of a patient with PID for STDs. Initiate appropriate treatment based on test results.

Complications

  • Ruptured TOA is a surgical emergency with a high mortality rate. Aggressive surveillance for the presence of a TOA and prompt inpatient medical management is required. Consider the diagnosis of a ruptured TOA if the patient has increased peritoneal signs and a rigid abdomen.
  • Infertility occurs in 12-15% of women after a single episode of PID.
  • The chances for ectopic pregnancy are increased with PID. Patients should be counseled regarding this fact, and they should seek early prenatal care if they subsequently become pregnant.
  • Chronic pelvic pain is a possible long-term consequence of PID. The mechanism of pain is presumably secondary to adhesive disease.

Prognosis

Ninety percent of patients with PID respond to medical therapy if no TOA is present. Most patients respond to IV antibiotics alone if a TOA is smaller than 7 cm.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose pelvic inflammatory disease (PID) at an early stage may lead to tubo-ovarian abscess (TOA) and added morbidity.
  • Missing a TOA when present or mistakenly treating one on an outpatient basis can lead to a ruptured TOA and the requirement for major abdominal surgery.

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.
 


More on Oophoritis

Overview: Oophoritis
Differential Diagnoses & Workup: Oophoritis
Treatment & Medication: Oophoritis
Follow-up: Oophoritis
References
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References

  1. Beigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am. Dec 2003;30(4):777-93. [Medline].

  2. Centers for Disease Control. 2006 Guidelines for Treatment of Sexually Transmitted Diseases. MMWR. 2006;55(RR11):1-94. [Full Text].

  3. Grimes DA. Deaths due to sexually transmitted diseases. The forgotten component of reproductive mortality. JAMA. Apr 4 1986;255(13):1727-9. [Medline].

  4. Ness RB, Trautmann G, Richter HE, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol. Sep 2005;106(3):573-80. [Medline].

  5. Reed SD, Landers DV, Sweet RL. Antibiotic treatment of tuboovarian abscess: comparison of broad- spectrum beta-lactam agents versus clindamycin-containing regimens. Am J Obstet Gynecol. Jun 1991;164(6 Pt 1):1556-61; discussion 1561-2. [Medline].

  6. Soper DE. Surgical considerations in the diagnosis and treatment of pelvic inflammatory disease. Surg Clin North Am. Oct 1991;71(5):947-62. [Medline].

  7. Stenchever M, Droegemueller W, Herbst A. Comprehensive Gynecology. 4th ed. Mosby Year Book; 2006:708-731.

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Further Reading

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Keywords

oophoritis, pelvic inflammatory disease, PID, tubo-ovarian abscess, TOA, ectopic pregnancy, infertility, chronic pelvic pain, Gonorrhea, Chlamydia, inflammation of the ovary, infection of the ovaries, sterilization

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Contributor Information and Disclosures

Author

Arthur T Ollendorff, MD, Associate Professor of Clinical Obstetrics and Gynecology, Residency Program Director, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine; Chief of Gynecology, Veterans Affairs Medical Center, Cincinnati
Arthur T Ollendorff, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Public Health Association
Disclosure: Nothing to disclose.

Medical Editor

Ronald Levine, MD, Director, Section of Gynecologic Endoscopy, Professor, Department of Obstetrics and Gynecology, University of Louisville School of Medicine
Ronald Levine, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Obstetricians and Gynecologists, American Medical Association, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Antonio V Sison, MD, FACOG, Program Director, Department of Obstetrics and Gynecology, Robert Wood Johnson University Hospital
Antonio V Sison, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

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