Tubo-Ovarian Abscess in Older Women: Is the Woman’s Age a Risk Factor for Failed Response to Conservative Treatment?

Abstract

Objective: To assess retrospectively if there is a trend of change in the epidemiology of tubo-ovarian abscess (TOA) and to define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy. Study Design: The charts of 60 patients, admitted with clinically and sonographically diagnosed TOA between January 1995 and December 2000, were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. Forty-three patients, responding to antibiotic therapy, constituted group A, whereas 17 patients who did not respond and were further treated by sonographically guided drainage or surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings, duration of hospital stay and recovery rate of different pathogens from the endocervix. Results: The mean age of patients responding to medical therapy (group A) was significantly lower (39.6 ± 8.3) than the age of patients who did not respond (group B) (45.3 ± 6.6) (p = 0.02). The gravidity as well as the percentage of menopausal women were significantly increased in group B (p = 0.03 and p = 0.02, respectively). There was a significantly lower incidence of previous pelvic surgery and past history of PID in group B versus group A (p = 0.02 and p = 0.03, respectively), yet the duration of IUD use was significantly prolonged in group B (p = 0.02). The size of TOA, evaluated clinically and sonographically, was significantly increased in group B compared with group A (p = 0.04 and p = 0.009, respectively). Pelvic peritonitis was observed in 40% of group B patients and in none of group A patients (p = 0.0001). The only laboratory finding differentiating between the two groups was the mean sedimentation rate, being significantly higher in group B than in group A (p = 0.0005). The time interval from admission to afebrile condition as well as the duration of hospitalization were significantly shorter in group A (6.1 ± 2.3 days) than in group B (10.7 ± 4.7 days) (p = 0.00003). The incidence of positive culture from the endocervix was significantly higher in group B than in group A (p = 0.007). One hundred percent of patients in group B versus 65.2% of patients in group A were treated with triple agent therapy (p = 0.007). Conclusion: The results of the current study strengthen our previous assumption that there is probably a new trend in the epidemiology of TOA, occurring in older women, who do not present the traditional risk factors for pelvic inflammatory disease and TOA.

The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses

“…In our study, surgical treatment was necessary for 20 patients (26%). Success of medical treatment is associated with the following factors: age, abscess size, bilateral adnexal involvement, laboratory parameters (8).…”

Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT

“…PID is a polymicrobial infection characterized by inflammation of the upper genital tract, including endometritis, salpingitis and pelvic peritonitis [6][7][8][9]. Secondary TOA can rarely arise from inflammatory bowel disease, diverticulitis, appendicitis, pelvic surgery, pelvic malignancy, or ovarian hyperstimulation [10,11].…”

Tubo-ovarian abscess in woman with an intrauterine device forgotten for 22 years

“…The antibiotic therapy should cover Neisseria gonnorrhoe, Chlamydia trachomatis and anaerobes, Gram-negative facultative bacteria and Streptococcus species [2]. The predisposing factors in the development of a TOA include nulliparity, sexual activity, previous episodes of PID, multiple sexual partners, lower socioeconomic status and the use of intrauterine devices [6,9]. Particularly, IUDs are associated with an increased risk for ascending infections [9] with high absolute numbers, especially as they are considered worldwide as one of the most preferred methods of reversible contraception [10].…”

“…They showed that the mean age of all 60 patients was >40 years. The authors thus concluded a new trend in the epidemiology of TOA, indicating a more aggressive compared to younger women [6,7]. One suggestion is that previous asymptomatic or subclinical infections may progress silently to the TOA stage over a long period of time.…”

“…Women in their third or fourth decade of life have predisposing factors to be affected by TOA [4,5]. In recent years, a new trend in the epidemiology of TOA has been observed that older women in their fifth and sixth decade of life and even in postmenopausal women suffer more frequently from TOA [6,7].…”