Cervicitis is an inflammatory process in the vaginal segment of the cervix. The course is characterized by turbid (mucous or purulent) secretions, pulling or dull pain in the lower abdomen, painful urination and sexual intercourse. Prolonged chronic cervicitis leads to the development of erosion, hypertrophy (thickening) of the cervix, the spread of infection to the upper parts of the reproductive apparatus. Under exocervicitis means inflammation of the vaginal segment of the cervix or exocervix. Endocervicitis is an inflammation of the inner cervical cervical canal – endocervix.
Cervicitis is an inflammatory process in the vaginal segment of the cervix. The course is characterized by turbid (mucous or purulent) secretions, pulling or dull pain in the lower abdomen, painful urination and sexual intercourse. A chronic chronic cervicitis leads to the development of erosion. hypertrophy of the cervix. spread of infection to the upper parts of the genital apparatus.
The cervix is a barrier preventing penetration of the infection into the uterus and upper genital tract (narrow cervical canal, mucous plug, protective secret). At certain factors, there is a violation of its protective function, the penetration of a foreign microflora and the development of an inflammatory process – cervicitis, including exocervicitis and endocervicitis. Under exocervicitis means inflammation of the vaginal segment of the cervix or exocervix. Endocervicitis is an inflammation of the inner cervical cervical canal – endocervix.
Cervicitis can occur with nonspecific infection caused by a conditionally pathogenic microflora: staphylococcus, E. coli, streptococcus. fungi and specific (chlamydia, mycoplasma, gonococcal, syphilis, trichomonas, viruses), some parasitic and protozoal infections (amoebiasis). Conditionally pathogenic microflora, which causes cervicitis, enters the cervix via a contact route from the rectum, either through blood and lymph, specific – through the sexual way.
The development of cervicitis is facilitated by certain factors: birth injuries of the cervix, during diagnostic curettage. Pregnancy abortions, use of contraceptives (installation and removal of IUDs). Provoke cervicitis scar scarred and benign cervical formation of the uterus, decreased immunity.
Cervicitis rarely develops in isolation, usually it is accompanied by other diseases of the reproductive system: vulvitis. vaginitis. bartholinite. pseudo erosion of the cervix. ectropion (eversion of the cervix). Cervicitis is more common in women in reproductive age (up to 70%), less often in menopause. Cervicitis is a common cause of miscarriage and premature birth. The consequence of cervicitis is polyps and cervical erosion, inflammation of the upper genital tract.
Symptoms of cervicitis.
Acute and chronic cervicitis are distinguished along the course of the disease, with focal cervicitis and diffuse cervicitis according to the degree of damage. Sometimes a cervicitis can initially flow in an erased form. In acute cervicitis there are abundant mucous or purulent discharge, less often dull pain in the lower abdomen. There are edema and hyperemia of the outer opening of the cervical canal, protrusion of the mucosa, minor hemorrhages and ulceration.
Cervicitis has various manifestations depending on the nature of the pathogen and the state of immunity. Cervicitis of a gonorrheal nature usually proceeds sharply, with distinct signs, with chlamydial infection the signs are less noticeable. In herpetic cervicitis, the cervix is bright red, loose, with ulceration (a symptom of “continuous erosion”). With trichomonadal cervicitis, small hemorrhages (“strawberry cervix”), atypical cells in the smear are revealed. When affection with actinomycetes, a symptom of the “yellow granular spot” is observed. The human papilloma virus can cause the formation of genital warts and ulceration of the cervix of various sizes.
Cervicitis, undiagnosed or untreated in acute stage, passes into a protracted chronic process. Allocations become dull-mucous, pseudo-erosions are observed on the vaginal part of the uterus (proliferation of the cylindrical epithelium). In the chronic stage of cervicitis, signs of inflammation (hyperemia, edema) are weaker. A replacement of the cylindrical epithelium by a flat one can occur. Inflammation can spread to surrounding tissues and glands, with the formation of infiltrates, cysts, there is a consolidation of the cervix.
Diagnosis of cervicitis.
Cervicitis often occurs asymptomatically, which does not cause patients to consult a doctor. Most cervicitis is detected by routine medical examinations accidentally or when women contact a gynecologist for advice on other diseases. Diagnosis of cervicitis is primarily aimed at identifying the causes that caused inflammation of the cervix.
The diagnosis of cervicitis is based on the following data.
examination of the cervix with the help of mirrors.
the result of colposcopy. which allows us to detail the pathological changes in the epithelium of the cervix in cervicitis (flushing, swelling of the mucosa, the presence of vascular loops, ectopia, erosion, diffuse or focal nature of inflammation.
laboratory methods (microscopy of the smear of bacteriosum on the microflora and sensitivity to antibiotics, PCR – diagnostics, cytomorphological research.
In acute cervicitis, smears contain many leukocytes (more than 30), as well as lymphocytes and histiocytes, a cylindrical epithelium with a hypertrophic nucleus and a flat epithelium with dystrophic changes. In chronic cervicitis, cells of cylindrical epithelium of different sizes are visible, sometimes the phenomenon of cytolysis (cell destruction.
Bacteriological study can identify the genus and species of microorganisms, as well as select the appropriate antibiotic. Cytomorphology of the smear in cervicitis shows structural cell damage and dynamic changes in the treatment process. Detection of some infections (gonorrhea, chlamydia, mycoplasmosis, papillomavirus, herpes) with cervicitis is impossible without conducting PCR – diagnosis and enzyme immunoassay (ELISA.
Treatment of cervicitis.
Modern gynecology uses in its practice a fairly large number of different treatments for cervicitis. But first of all the treatment of cervicitis should be aimed at eliminating predisposing factors (hormonal, metabolic, immune disorders) and concomitant diseases.
Treatment of cervicitis includes the use of antibacterial, antiviral and other drugs and depends on the identified pathogen, its sensitivity to this drug, the stage of the inflammatory process. Thus, with chlamydial cervicitis, antibiotics of the tetracycline series (doxycycline, monomycin), macrolides (erythromycin), quinolones (ofloxacin, lomefloxacin), and azalides (azithromycin) are prescribed. Candidiasis cervicitis shows the use of fluconazole. Combined local preparations are widely used in the therapy of cervicitis. Drugs can be in the form of candles and creams.
Local treatment of cervicitis is recommended when the severity of the process is abated and consists of treating the vagina and cervix with a 3% solution of dimethyl sulfoxide, 1-2% chlorophyllipt solution, silver nitrate solution.
Viral cervicitis is difficult to treat. In genital herpes, long-term therapy is required, including antiviral drugs (acyclovir, valaciclovir), the use of specific antiherpetic Ig, vitamins, immunostimulants. In the treatment of papillomovirus infection, use of interferons, cytostatics, and removal of genital warts. In the treatment of atrophic cervicitis, estrogen is used topically, in particular, ovine, which helps restore the epithelium of the vaginal mucosa and cervix and natural microflora. In specific infections, the sexual partner is treated in parallel.
In the chronic stage of cervicitis, conservative treatment is less successful, so surgical methods are used – diathermocoagulation, cryotherapy, laser therapy; An obligatory condition is the absence of infections. Simultaneously, the concomitant pathology (ectropion, colpitis, salpingo-oophoritis, functional disorders) is treated, and the natural microflora is restored. Treatment of cervicitis is carried out under the control of colposcopy and laboratory tests.
Prevention of cervicitis is the observance of personal hygiene, the exclusion of sexual infections, the prevention of abortion, the proper management of labor, the treatment of endocrine disorders.