Tuboovarian Abscess Causes and Pathogenesis

Primary Causative Organisms

The Centers for Disease Control and Prevention recommends awareness that tuboovarian abscess is caused by ascending polymicrobial infection from the lower genital tract, most commonly involving sexually transmitted pathogens (Neisseria gonorrhoeae and Chlamydia trachomatis) along with anaerobic bacteria, gram-negative facultative bacteria, and streptococci, in women with pelvic inflammatory disease (PID) 1, 2
Chlamydia trachomatis has been recovered from the cervix of 5-39% of women with PID, with serologic evidence found in 20-40% of women with PID history, according to the Centers for Disease Control and Prevention 3
Neisseria gonorrhoeae shows isolation rates from the cervix ranging from 27-80% among women with PID, as reported by the Centers for Disease Control and Prevention 3
Between 10-40% of women with untreated gonococcal or chlamydial cervicitis develop clinical symptoms of acute PID, which can progress to tuboovarian abscess, according to the Centers for Disease Control and Prevention 3
Anaerobic bacteria are isolated from the upper genital tract of 25-50% of women with acute PID and include Bacteroides fragilis, Bacteroides bivius, Peptostreptococcus species, and Peptococcus species, as found by the Centers for Disease Control and Prevention 3
Facultative bacteria commonly involved include Gardnerella vaginalis, Streptococcus species, Escherichia coli, and Haemophilus influenzae, according to the Centers for Disease Control and Prevention 3

The primary route of infection is direct canalicular spread from the endocervix to the endometrial and fallopian tube mucosa, as reported by the Centers for Disease Control and Prevention 3
Uterine instrumentation, particularly intrauterine device insertion, facilitates upward spread of vaginal and cervical bacteria, according to the Centers for Disease Control and Prevention 3
Hormonal changes during menses lead to cervical alterations resulting in loss of mechanical barrier protection, as found by the Centers for Disease Control and Prevention 3
Retrograde menstruation may favor ascent to the tubes and peritoneum, according to the Centers for Disease Control and Prevention 3

The polymicrobial nature of tuboovarian abscess necessitates broad-spectrum antimicrobial coverage including anaerobes, as organisms like Bacteroides fragilis cause significant tubal and epithelial destruction, as recommended by the Centers for Disease Control and Prevention 1