Organ Inflammatory Pathway: Ovaries
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Introduction
The ovaries are one of the vital organs that make up the female reproductive system. If
the ovaries become inflamed, it is referred to as ovaritis or oophoritis due to a bacterial
infection.4 This also becomes known as a pelvic inflammatory disease (PID) due to being one of
the upper organs of the female reproductive system becoming inflamed.
Epidemiology
According to a study by Mohseni et al., it was found that females with tubo-ovarian
abscess, hydrosalpinx, pyosalpinx, oophoritis (THPO) were made up of 0.3% of patient
encounters seen in a study of 17,905 females. There were 50% of women with THPO admitted to
the hospital.6 The women who were diagnosed with THPO were significantly older, and it was
suggested they were more likely to be infected with gonorrhea, sepsis, and PID.6
Before the use antibiotics and modern surgical practice, the mortality rate with tubo-
ovarian abscesses (TOA) were 50%. Currently, this mortality rate is at 0% for abscesses that
have not ruptured.1
Etiology
Ovarian inflammation can be caused by several factors. They can be caused by a
common cold, miscarriage, sexually transmitted infections (STI), cancer, puerperium problems,
and allergic reactions to medications administered vaginally.4,5
Types/Classification
Organ Inflammatory Pathway: Ovaries
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The infections that can cause ovarian inflammation are the associated pathogens
Streptococcus, Staphylococcus, E. coli and gonococci.4 This may occur due to unprotected sex. It
is also possible for bacteria to enter the reproductive tract during menstruation, childbirth,
miscarriage, or abortion. It may occur in the rare case of an insertion of an intrauterine device
(IUD) or medical procedure involving the insertion of instruments in the uterus.4
Signs/Symptoms
The signs of ovaritis can vary with the severity of pain. Common symptoms to look for
are headaches, excess flow, belly and ovarian pain, nervousness or palpitations, menstrual cycle
changes, diarrhea, nausea, or urination discomfort.5 It is suggest if any of these symptoms occur,
then a visit with the gynecologist be scheduled to determine the source of inflammation.
Pathologic Features/Genetic Basis of Disease
PID is caused by bacterial infections typically from the pathogens gonorrhea and
chlamydia. This can lead to damage in the genital tracts leading to scarring, adhesions, or some
or complete obstruction to the fallopian tubes.2 A loss of ciliated epithelial cells can occur around
the fallopian tube lining which can lead to impaired ovum transport.2
Laboratory Features
To determine in an individual has PID, the gynecologist may administer a pelvic exam,
blood or urine tests, or an ultrasound test. For additional confirmation, a laparoscopy or
endometrial biopsy may also be performed. In the pelvic exam, the doctor will check the pelvic
region for any possible tenderness or swelling. Samples may also be taken to test for possible
bacterial infections or organisms.4 If a blood or urine test needs to be done, it may help
Organ Inflammatory Pathway: Ovaries
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determine if there are any STI’s or measure the white blood cell count or other markers to
diagnose infection or inflammation. In the ultrasound, the test will use sound waves to visually
see the organs.4 In the laparoscopy, a thin instrument is inserted through a small incision in the
abdomen to see the pelvic organs. In the endometrial biopsy, a thin tube in place in the uterus to
obtain a sample of endometrial tissue to test for any possible signs of infection or inflammation.4
Differential Diagnosis
Potential differential diagnoses may be appendicitis, cervicitis, urinary tract infection,
endometriosis, ovarian torsion, or adnexal tumors.2 Symptoms of ectopic pregnancy can be
easily mistaken as PID. This is typically mistaken in this diagnosis. For further confirmation, a
pregnancy test is required who individuals that experience lower abdominal pain.2 It is also
possible for PID to produce TOA, which can further lead to peritonitis and Hugh-Curtis
Syndrome.2
Management/Treatment
To manage PID, suggested treatment is antibiotics, treatment for significant other, or
temporary abstinence.4 In more serious causes, intravenous antibiotics can be given or surgery if
needed. Treatment for a partner is suggested to avoid reinfection of a STI so they do not have
symptoms either.4 Having temporary abstinence will also help avoid reinfection. Although
antibiotics can help get rid of the infection, the scarring or damage to the reproductive tract
cannot be reversed.
Complications
Organ Inflammatory Pathway: Ovaries
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Complications that may occur due to PID may be ectopic pregnancy, infertility, chronic
pelvic pain, or tubo-ovarian abscesses. Ectopic pregnancy can occur when untreated PID has left
scar tissue to develop in the fallopian tubes. This will prevent the egg from moving towards the
uterus and remain in the fallopian tubes.4 Infertility may occur when untreated PID has been
prolonged.4 Chronic pelvic pain may also occur due to PID that can leave scarring in the
fallopian tubes and neighboring pelvic organs.4 PID can also cause a tubo-ovarian abscess to
occur in the reproductive tract. This can affect the fallopian tubes and ovaries, but can also
develop in the uterus and nearby organs. If this is left untreated, this can cause very bad
infection.4
Prognosis
Statistically, chronic pelvic pain occurs in approximately 25% of patients with a history
of PID.3 Approximately 125,000 to150,000 hospitalizations occur yearly in the United States due
of PID.3 Women in countries with lack of resources can experience an increased rate of
complications with PID. This can be due to lack of access to care and inability to afford optimal
care.3 It is essential for women to be educated about PID and risk factors that are associated with
this.
Current/Future Research (Including Clinical Trials)
In a study conducted by Wiesenfeld, there were two antibiotic treatments to help treat
acute PID. Their main goal with this study was to compare the eradication of anaerobic
organisms from the upper genital tract between women who receive standard outpatient
antibiotic treatment to those who receive standard outpatient treatment.7 The results suggested
the addition of metronidazole improved treatment for PID.7.1
Organ Inflammatory Pathway: Ovaries
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References
1. Beigi, R. H., Sharp, H. T., & Marrazzo, J. (n.d.). Epidemiology, clinical manifestations,
and diagnosis of tubo-ovarian abscess. UpToDate. Retrieved from
https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-
of-tubo-ovarian-abscess
2. Jennings, L. K., & Krywo, D. M. (n.d.). Pelvic Inflammatory Disease. National Library
of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499959/
3. Kristi A Tough DeSapri, M. D. (2021, September 13). Pelvic inflammatory disease.
Practice Essentials, Background, Pathophysiology. Retrieved from
https://emedicine.medscape.com/article/256448-overview#a6
4. Mayo Foundation for Medical Education and Research. (2022, April 30). Pelvic
inflammatory disease (PID). Mayo Clinic. Retrieved from
https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-
causes/syc-20352594
5. Michelle Lorraine Embleton (Biochemist) 08/03/2022 at 11:43 am. (2022, August
3). Ovarian inflammation: Main causes and symptoms. inviTRA. Retrieved from
https://www.invitra.com/en/how-to-treat-ovarian-enlargement/#causes-of-ovarian-
inflammation https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-
disease/symptoms-causes/syc-20352594
6. Mohseni, M., Simon, L. V., & Sheele, J. M. (2020, November 23). Epidemiologic and
clinical characteristics of tubo-ovarian abscess, Hydrosalpinx, pyosalpinx, and
oophoritis in emergency department patients. Cureus. Retrieved from
https://www.cureus.com/articles/42836-epidemiologic-and-clinical-characteristics-of-
tubo-ovarian-abscess-hydrosalpinx-pyosalpinx-and-oophoritis-in-emergency-department-
patients#!/
