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Tubo-Ovarian Abscess

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  • Tubo-ovarian abscess refers to an infection in either the ovaries (source of eggs) or the fallopian tubes (which deliver eggs to the uterus).  This results in a collection of pus, causing symptoms of Pelvic Inflammatory Disease or stomach pain.
  • The infection is usually accompanied by fever, and the patient will appear ill.  Treatment is generally with antibiotics.  In some, surgery may be required to remove the pus.

  • The most common symptoms include vaginal discharge along with vaginal pain, itching, or burning.
  • The infection causing the abscess may come from various sources.  The following are most common:
    1. Candidal infections cause itching and burning.  There is a thick, white discharge that usually does not smell bad.  This type of infection occurs more often in women with diabetes, women who are pregnant, and in women taking antibiotics.
    2. Trichomonas causes vaginal itching.  Usually, there is a green colored, frothy discharge that smells bad.  This infection usually spreads through sexual contact.
    3. Bacterial vaginosis usually causes a grayish discharge that often smells bad.  It may cause a fish-like odor.

  • Tubo-ovarian abscesses are usually due to an infection that travels up the woman's genital tract.

  • A physical examination (including a pelvic exam) is the first step in making the diagnosis.  It may show inflammation/irritation of the vagina and the presence of discharge.  The examination of the uterus or ovarian regions may be abnormal.
  • During the pelvic exam, a sample of the discharge is taken and either sent to the lab or examined by the doctor under a microscope.  This is usually enough to make the diagnosis.
  • Ultrasonography shows a multilocular, cystic, complex adnexal mass, often with debris and thick septations.

  • Treatment depends on the type of infection present.
  • For Candida infections (the common yeast infection) there are several options:
    1. Miconazole , clotrimazole , or butoconazole (2% cream) can be used for 3 days.
    2. Clotrimazole or miconazole (2% cream) can be used for 7 days.
    3. A one-time dose of clotrimazole or a one time oral dose of fluconazole may also be used.
    4. If the infection keeps coming back, treat with ketoconazole for 6 months.
  • Trichomonas vaginalis can be treated with metronidazole.  Sexual partners also need to be treated because it is spread by sexual contact.
  • Bacterial vaginosis can be treated in several was:
    1. Metronidazole
    2. Clindamycin vaginal cream once a day for 7 days, or clindamycin by mouth  for 7 days
    3. Metronidazole vaginal gel twice a day for 5 days.





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