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J Obstet Gynaecol Res 2021 Mar 31;47(3):1199-1203. Epub 2021 Jan 31.

Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, South Korea.

We present the case of a 26-year-old multiparous woman who experienced rupture of a tubo-ovarian abscess during the second trimester of pregnancy. She presented with epigastric and right lower quadrant pain at 12 + 0 weeks' gestation. There were no other specific findings on the magnetic resonance imaging images. Read More

MedEdPORTAL 2021 01 25;17:11080. Epub 2021 Jan 25.

Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth.

Introduction: Reproductive-age female patients commonly seek evaluation for pelvic pain in a variety of health care settings. Thus, teaching medical students how to effectively evaluate female pelvic pain is a necessary part of medical education. There are limited opportunities, however, to reinforce the needed skills for this common but sensitive presentation that can be anxiety-producing for preclinical students. Read More

Eur J Obstet Gynecol Reprod Biol 2021 Mar 15;258:253-257. Epub 2021 Jan 15.

Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey.

Introduction: We aimed to identify factors that would predict the success of antibiotic treatment and the need for surgical treatment in tubo-ovarian abscess (TOA) patients.

Materials And Methods: The data of 146 patients with a diagnosis of TOA were analyzed retrospectively. Patients were separated into two groups; successfully treated with antibiotics and going under surgery after antibiotic treatment failure. Read More

Cureus 2020 Nov 23;12(11):e11647. Epub 2020 Nov 23.

Emergency Medicine, Mayo Clinic, Jacksonville, USA.

Introduction Pelvic inflammatory disease (PID) is a spectrum of illness ranging from mild illness to more severe forms including tubo-ovarian abscess, hydrosalpinx, pyosalpinx, oophoritis (THPO). The objective of the study was to report rates and clinical characteristics of females presenting to the ED with a diagnosis of THPO in relationship to the presence or absence of sexually transmitted infections (STIs). Methods A database of ED patient encounters occurring from April 18, 2014, to March 7, 2017 was created. Read More

J Pediatr Adolesc Gynecol 2021 Jun 16;34(3):328-333. Epub 2020 Dec 16.

Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio.

Study Objective: We investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non-sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes.

Design: This is a retrospective observational case series of all non-sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed. Read More

Anaerobe 2021 Feb 30;67:102312. Epub 2020 Nov 30.

Monash Infectious Diseases, Monash Health, Clayton Rd, Clayton, Vic, 3168, Australia; School of Clinical Sciences, Monash University, Clayton Rd, Clayton, Vic, 3168, Australia.

Ruminococcus gnavus is a Gram-positive anaerobe and normal gut commensal in the human host. There have been a small number of reported cases of infections attributed to R. gnavus, and no cases of urogenital infections have previously been published. Read More

J Obstet Gynaecol 2020 Nov 28:1-5. Epub 2020 Nov 28.

Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.

This 5-year retrospective study aimed to investigate whether early surgical management improves outcomes in patients presenting with a tubo-ovarian abscess (TOA). Patient characteristics, investigation results and treatment outcomes were compared. 50 women were diagnosed with a TOA during the study period. Read More

Pediatr Rev 2020 Oct;41(10):522-537

Division of Adolescent and Young Adult Medicine and.

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Read More

J Minim Invasive Gynecol 2021 May 4;28(5):1060-1065. Epub 2020 Sep 4.

Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).

Study Objective: To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID).

Design: We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery. Read More

J Community Hosp Intern Med Perspect 2020 Mar 3;10(2):162-165. Epub 2020 Mar 3.

Internal Medicine Residency Program, Memorial Healthcare System, Hollywood, FL, USA.

 is a gram-positive bacillus in the female genital tract believed to be a commensal organism that inhibits the growth of more virulent pathogens.  is a gram-negative bacillus species also typically commensal in the female genital tract. as the primary causative agent in perinephric abscesses and bacteremia has been documented, albeit very uncommon and opportunistic. Read More

Ther Umsch 2020 ;77(4):164-170

Universitätsklinik für Frauenheilkunde, Inselspital Bern.

Management of Pelvic Inflammatory Disease Pelvic inflammatory disease (PID) is a common medical problem, but the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. As PID might cause late complications such as infertility or chronic pelvic pain, it is of prime importance that the diagnosis of PID is made promptly to assure the early onset of an adequate antibiotic therapy. Where uncomplicated PID usually has a favorable course, complicated forms with tubo-ovarian abscess generally require surgical exploration. Read More

ANZ J Surg 2021 01 12;91(1-2):204-205. Epub 2020 Jun 12.

Department of Surgery, Joetsu General Hospital, Joetsu City, Japan.

J Gynecol Obstet Hum Reprod 2021 Mar 17;50(3):101811. Epub 2020 May 17.

Department of Obstetrics & Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, IRCCS Sacro Cuore Don Calabria Hospital - Negrar (Verona), Italy, International School of Surgical Anatomy, Italy.

Objective: To study possible associations between endometriosis and pelvic inflammatory disease (PID).

Design: Retrospective cohort analysis over 14 consecutive years, based on medical records and insurance coding in a tertiary care endometriosis reference center.

Setting: Tertiary care reference center for endometriosis. Read More

J Gynecol Obstet Hum Reprod 2020 Nov 13;49(9):101789. Epub 2020 May 13.

Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.

Purpose: To evaluate and better characterize the incidence, clinical presentations and risk factors of TOA in postmenopausal women and to evaluate the incidence of underlying malignancy in postmenopausal women with TOA.

Methods: Electronic based search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials. The following medical subject heading (Mesh) terms, keywords, and their combinations were used: "tubo-ovarian abscess, pelvic inflammatory disease, menopausal and postmenopausal". Read More

Case Rep Womens Health 2020 Apr 24;26:e00192. Epub 2020 Mar 24.

Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia.

Haematogenous or direct spread of bacterial infection causing pelvic inflammatory disease of the upper female reproductive tract is uncommon. We report a diagnostically challenging case of a 41-year-old woman with a background of Stage 4 endometriosis presenting with fever, diarrhoea and abdominal pain with recent history of pyelonephritis. Initially managed for undifferentiated abdominal pain with unclear focus of infection, a broad range of investigations were undertaken. Read More

J Obstet Gynaecol 2021 Jan 9;41(1):118-123. Epub 2020 Mar 9.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. Read More

J Gynecol Obstet Hum Reprod 2020 May 20;49(5):101714. Epub 2020 Feb 20.

Société de Pathologie Infectieuse de Langue Française (SPILF), 21 rue Beaurepaire, 75010 Paris, France.

Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). Read More

Case Rep Womens Health 2020 Apr 8;26:e00181. Epub 2020 Feb 8.

Department of Obstetrics and Gynecology, Blacktown Hospital, NSW, Australia.

Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. Read More

ANZ J Surg 2020 10 20;90(10):2092-2093. Epub 2020 Feb 20.

Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia.

Emerg Med Clin North Am 2019 Nov;37(4):771-784

Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address:

The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Read More

Am Fam Physician 2019 09;100(6):357-364

Via Christi Health, University of Kansas, Wichita, KS, USA.

Pelvic inflammatory disease (PID) is an infection of the upper genital tract occurring predominantly in sexually active young women. Chlamydia trachomatis and Neisseria gonorrhoeae are common causes; however, other cervical, enteric, bacterial vaginosis-associated, and respiratory pathogens, including Mycobacterium tuberculosis, may be involved. PID can be acute, chronic, or subclinical and is often underdiagnosed. Read More

J Minim Invasive Gynecol 2020 02 31;27(2):541-547. Epub 2019 Aug 31.

Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors).

Study Objective: To evaluate the clinical parameters of hospitalized patients with pelvic inflammatory disease (PID) for the presence of tubo-ovarian abscess (TOA) and predict the need for intervention.

Design: A prospective cohort study.

Setting: A tertiary care university medical center. Read More

Int J Gynecol Pathol 2020 Sep;39(5):468-472

Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio.

There are approximately a dozen cases of xanthogranulomatous salpingitis reported in the literature, mostly as case reports. Thirteen such cases were identified from 2003 to 2018 at our institution. Patient's ages ranged from 21 to 75 yr old (median and mean, 49 yr). Read More

J Obstet Gynaecol Can 2019 Aug;41(8):1221-1234

Winnipeg, MB (GOC).

Objective: The primary objective of this document is to clarify the indications for pelvic examination.

Intended Users: Physicians, including gynaecologists, obstetricians, family physicians, and emergency physicians; nurses, including registered nurses and nurse practitioners; midwives, including midwives in clinical practice and midwifery trainees; medical trainees, including medical students, residents, and fellows; and all other health care providers who care for women.

Target Population: This publication provides evidence and expert-based recommendations for pelvic examination in adult women (18 years and older) both with and without gynaecologic symptoms. Read More

Arch Gynecol Obstet 2019 09 5;300(3):763-769. Epub 2019 Jul 5.

Department of Obstetrics and Gynecology, Affiliated to the Sackler School of Medicine, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel.

Purpose: To determine the impact of pelvic inflammation caused by tubo-ovarian abscess (TOA) on ovarian response to stimulation.

Methods: This retrospective longitudinal cohort analysis that was carried out in a tertiary university-affiliated medical center included 15 women with TOA during in vitro fertilization (IVF) cycles. The ovarian response to stimulation and the pregnancy rate were compared in two subsequent cycles, the initial IVF cycle that was complicated by TOA after oocyte retrieval (first treatment cycle) and the following IVF treatment (second treatment cycle) that occurred within a period of a year from the first cycle. Read More

Infect Dis Obstet Gynecol 2019 2;2019:4161394. Epub 2019 Jun 2.

Department of Obstetrics and Gynaecology, National University Hospital Singapore, Singapore.

Pelvic inflammatory disease (PID) complicated by tubo-ovarian abscesses (TOA) has long-term sequelae in women of reproductive age. Consensus on the optimal treatment of TOA remains lacking. Most clinicians utilize antibiotics as a first-line conservative approach, failing which invasive intervention is adopted. Read More

BMC Womens Health 2019 06 19;19(1):81. Epub 2019 Jun 19.

Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: A complete infectious focus survey relies on a thorough physical examination as well as a pelvic examination. Tubo-ovarian abscess, though less likely to occur in senior women, may become a life-threatening disease requiring emergent surgery. Hence, clinical awareness and aggressive management are warranted to avoid delayed diagnosis and subsequent complications. Read More

Obstet Gynecol 2019 06;133(6):1224-1230

Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, and the Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

Objective: To compare operative outcomes of laparoscopic surgery compared with laparotomy in patients with moderate to severe pelvic inflammatory disease (PID).

Methods: Using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, we performed a large, nationwide retrospective cohort study. We identified all patients aged 18 years or older who were diagnosed with PID with or without tubo-ovarian abscess and were admitted to a participating hospital from July 2010 to March 2016. Read More

Fertil Steril 2019 07 21;112(1):177-179. Epub 2019 May 21.

Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Education Hospital, University of Health Sciences, Istanbul, Turkey.

Objective: To present a case of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome complicated with pyometra and explain tips and tricks for laparoscopic hemihysterectomy.

Design: A step-by-step explanation of the technique with the use of video (Canadian Task Force Classification III). Patient consent and Institutional Review Board approval were obtained. Read More

Eur J Obstet Gynecol Reprod Biol 2019 Jul 6;238:20-24. Epub 2019 May 6.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Objective: Tubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA. Read More