From the Guidelines
Tubo-ovarian abscess is most commonly caused by pelvic inflammatory disease (PID), which is typically the result of sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae, as well as other bacteria including anaerobes, Escherichia coli, and streptococci. The infection process begins with bacteria ascending from the vagina or cervix through the uterus to the fallopian tubes, causing inflammation that can lead to scarring, tissue damage, and eventually abscess formation when the infection becomes walled off 1.
Key Points to Consider
- The most common cause of tubo-ovarian abscess is pelvic inflammatory disease (PID) 1.
- Sexually transmitted infections like Chlamydia trachomatis and Neisseria gonorrhoeae are the primary causes of PID, but other bacteria can also be involved 1.
- Risk factors for developing tubo-ovarian abscess include multiple sexual partners, intrauterine device use, previous episodes of PID, and procedures that breach the cervical barrier.
- Treatment typically requires broad-spectrum antibiotics for 14 days, and may necessitate drainage or surgical intervention in severe or unresponsive cases 1.
Evidence-Based Recommendation
Based on the most recent and highest quality study, patients with tubo-ovarian abscess that does not respond to antibiotics should undergo surgical drainage 1. This approach prioritizes minimizing morbidity, mortality, and improving quality of life for patients with tubo-ovarian abscess.
Considerations for Clinical Practice
In clinical practice, it is essential to consider the potential causes of tubo-ovarian abscess and to provide empiric, broad-spectrum coverage of likely pathogens, including N. gonorrhoeae, C. trachomatis, anaerobes, Gram-negative facultative bacteria, and streptococci 1. A diagnostic evaluation that includes some of the more extensive studies, such as endometrial biopsy or transvaginal sonography, may be warranted in certain cases to confirm the diagnosis and guide treatment 1.
From the FDA Drug Label
GYNECOLOGIC INFECTIONS, including endometritis, endomyometritis, tubo‑ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusniger, and Peptostreptococcus species.
The possible cause of a tubo-ovarian abscess is a bacterial infection caused by susceptible anaerobic bacteria, including:
- Bacteroides species (such as B. fragilis)
- Clostridium species
- Peptococcus niger
- Peptostreptococcus species 2
From the Research
Possible Causes of Tubo-Ovarian Abscess
The possible causes of a tubo-ovarian abscess include:
- Pelvic inflammatory disease (PID), which is a polymicrobial infection of the upper genital tract 3
- Sexually transmitted microorganisms, such as Neisseria gonorrhoeae and Chlamydia trachomatis, either alone or associated with endogenous flora of the lower genital tract 4, 5, 6
- Mixed anaerobic and aerobic bacteria 4, 5, 6
Risk Factors
The risk factors for developing a tubo-ovarian abscess include:
- Being a young, sexually active woman 3
- Having a history of pelvic inflammatory disease or sexually transmitted infections 3
- Not responding to oral medication or being severely ill, which may require hospitalization and parenteral treatment 3
Microorganisms Involved
The microorganisms involved in the development of a tubo-ovarian abscess include: