Tubo-Ovarian Abscess: A Literature Review

Abstract

Tubo-ovarian abscess (TOA) is a severe complication of pelvic inflammatory disease (PID), primarily affecting women of reproductive age. It arises from a polymicrobial infection, often involving both aerobic and anaerobic pathogens, and presents with a highly variable clinical picture, ranging from mild, nonspecific symptoms to acute pelvic pain and high fever. The diagnosis of TOA is based on a combination of clinical evaluation, laboratory markers of inflammation, and imaging techniques, with ultrasound serving as the first-line modality. In more complex or ambiguous cases, CT and MRI are valuable in distinguishing TOA from other pelvic pathologies such as malignancies, ovarian torsion, or gastrointestinal conditions. Treatment has evolved significantly, favoring conservative management with broad-spectrum antibiotics and minimally invasive drainage techniques guided by ultrasound or CT. Laparoscopy remains a valuable tool in selected cases, allowing both therapeutic and diagnostic interventions. However, surgical management is indicated in cases of rupture, failed conservative treatment, or diagnostic uncertainty. Despite advances in treatment, complications such as abscess rupture, sepsis, infertility, and chronic pelvic pain remain significant concerns. Preventive strategies focus on reducing the incidence of PID through comprehensive sexual education, barrier contraception use, STI screening, and empirical treatment of sexual partners. Given the asymptomatic nature of many STIs, the development of rapid diagnostic tools and vaccines for pathogens such as Chlamydia trachomatis and Neisseria gonorrhoeae is essential. TOA management thus requires a multidisciplinary approach aimed at early recognition, individualized treatment, and preservation of fertility.