5 | Signs of Infection |
Immune Responses
Many common symptoms of an infection do not directly result from metabolites of the multiplying microorganism; rather, they represent the body’s immune responses to the pathogens or their metabolites.
If these responses are absent, the following may occur:
in the best-case scenario, there are no symptoms, and the patient is not in danger.
in the worse case scenario (e.g., when the infection is developing very rapidly and the immune system has been weakened), the body is overwhelmed by the infection and the outcome is usually fatal (e.g., sepsis caused by group A streptococci).
Local Symptoms
Many gynecological infections begin as a local infection. In response to certain mediators, granulocytes and, later, macrophages invade the tissue, and this is associated with the typical signs of inflammation: swelling, reddening, hyperthermia, and pain.
In the region of the vulva, these signs of an infection are easily recognized. Diagnosis is more difficult in the region of the uterus and adnexa. Here, pain is one of the most reliable signs. If a secretion can be collected from the infected region, the increase in leukocytes is easily recognized under the microscope. In many cases, pathogens (fungi, bacteria, trichomonads) can readily be identified microscopically.
When the body is unable to confine the infection to a local area either the pathogen itself, or its toxic substances, will spread, thus causing general symptoms.
Local signs of an infection:
pain (spontaneous pain, tenderness to pressure)
reddening (vascular dilation associated with hyperthermia)
swelling (edema, followed by pus)
nodules (early manifestation of herpes simplex virus, Candida albicans, Staphylococcus aureus)
vesicular lesions (herpes simplex virus, varicella–zoster virus, Candida albicans)
ulcers (herpes simplex virus, though less typically; varicella–zoster virus, syphilis)
pus (Staphylococcus aureus, gonococci, chlamydiae)
discharge (trichomoniasis, herpes genitalis, bacterial vaginosis, chlamydial cervicitis)
crepitation (air in the tissue, such as in gas gangrene; much more often, however, this is of no importance after surgical intervention).
Systemic Symptoms
Pain
fever
weakness
malaise
tachycardia
tachypnea
hypotension
chills
pain in the limbs.
Pain 
Pain is usually associated withan inflammation. As a warning sign, it is more reliable than fever. Especially in cases of rapidly developing, severe infections (e.g., puerperal sepsis), the best indicators for a life-threatening condition are diffuse pain in the abdominal region and the malaise of the patient. In such a situation, it will be fatal to wait for fever to develop before administering an antibiotic.
Pain is caused by injuries and pathogens, and it is triggered by cytokines. Pain caused by injuries (surgery) or immune diseases (rheumatism, Behçet syndrome, etc.) can be distinguished from pain due to infections based on the patient’s history, course of the disease, and parameters of the inflammation.
When caused by local processes, such as wounds and abscesses, the pain is restricted to an area, while it is diffuse when caused by systemic diseases (sepsis).
Local or diffuse pain that cannot be controlled by painkillers should only be treated with more analgesics if infectious processes have been excluded by determining the inflammatory parameters, or if effective antibiotics are administered simultaneously.
Fever 
Etiology, Pathogenicity, and Symptoms
Fever is one of the most typical symptoms of an infection. It may be absent, however, when the inflammatory process is minor and locally restricted, or—a bad sign for the prognosis—when the infection is developing so quickly that the immune system is not able to initiate this mechanism of defense.
Fever develops either from exogenous pyrogenic substances, which are directly produced by viruses, bacteria, or other pathogens, or endogenously by means of interleukin-1, which plays a central role in the stimulation of various defense systems.
Fever is brought on when phagocytes contact microorganisms, thus triggering the release of interleukin-1 by means of various mediators. This activates T lymphocytes, B lymphocytes, and granulocytes, induces the production of acute phase proteins in the liver, and stimulates fibro-blast proliferation and prostaglandin synthesis.
Fever itself is a useful reaction to infection. Many metabolic processes are accelerated by elevated temperatures. In addition, fever is a measurable parameter that often provides information about the intensity of the infection.
The control centers for body temperature are located in the hypothalamus. Chills lead to a rapid increase in temperature and are characteristic for many bacterial infections. If chills are present, one should always run blood cultures because this is the best way of detecting the pathogen.
Fever is not always an indicator for an infection. Numerous noninfectious diseases and disturbances are also accompanied by elevated temperatures, for example, dehydration, trauma, cerebral thrombosis, malignant diseases, hemolysis, rheumatic fever, periarteritis nodosa, and erythema nodosum.
Elevation of the body temperature by 1 °C (1.8 °F) increases the metabolism by 12% and the heart rate by 15 beats per minute; it also leads to hyperventilation.
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