Endocervicitis is an inflammation of the mucous membrane of the cervical canal. Pathogens can be chlamydia, gonococci, trichomonads, viruses, fungi of the genus Candida (see Thrush), mycoplasmas, staphylococci, E. coli. Endocervicitis is often combined with other inflammatory processes of the genital organs, such as adnexitis, endometritis and condylomas. The penetration of microorganisms into the cervix is facilitated by cervical injuries during childbirth, abortion, intrauterine interventions. Chlamydia can penetrate the mucous membrane of the cervical canal without first damaging it.
The nature of the inflammatory reaction depends on the virulence of the pathogen and on the state of the body’s defenses, in particular local immunity. Therefore, endocervicitis can occur in both acute and chronic forms. The course of the disease also depends on the nature of the pathogen. In chlamydial etiology, the process primarily passes in an erased form with mildly expressed clinical signs, therefore it often acquires a chronic course. Endocervicitis of gonorrheal etiology is characterized by a more pronounced clinical picture, so it is more often diagnosed in the acute phase. In time, the endocervicitis, which is not diagnosed and not cured at the initial stage, turns into a long chronic process.
The duration of the flow is directly related to the penetration of pathogens into the branched glands (crypts) of the mucous membrane, where they become less accessible for the action of local medical procedures. Inflammatory process in the cervix is accompanied by mucosal edema, the formation of infiltrates in the subepithelial layer and stroma. Infiltrates consist of leukocytes, lymphocytes and plasma cells. In the chronic stage, the inflammatory reaction is not so pronounced, in the places of exfoliation of the epithelium, its regeneration gradually begins. During the regeneration, metaplasia of the epithelium may occur and partial replacement of the cylindrical epithelium by a flat epithelium.
Symptoms of endocervicitis.
For diseases of the cervix, pain is usually not characteristic. In acute endocervicitis, the main complaint of patients is mucopurulent discharge, which is occasionally accompanied by dull pain in the lower abdomen and lower back. The emergence of other complaints – pain with urination, cramping pain and others – is due mainly to concomitant diseases (urethritis, endometritis, salpingoophoritis, etc.)
When viewed with mirrors, there is hyperemia around the outer throat and mucopurulent discharge from the cervical canal. Inflammation of the cervix leads to the onset of a real, and later false erosion of the cervix. With a long course of the disease, the inflammation spreads not only to the mucous membrane, but also to the underlying tissues, their compaction takes place, the cervix is hypertrophied, and chronic cervicitis develops.
Diagnosis is based on examination with the help of mirrors, colposcopy and bacteriological examination of the discharge. In colposcopy, there is diffuse hyperemia, vascular loops, especially a lot around the outer throat of the cervical canal. In a cytological study, cells of cylindrical and multilayered flat epithelium are found without signs of atypia. Bacteriological study is necessary to identify the pathogen and the purpose of etiotropic treatment.
Treatment of endocervicitis.
In the acute stage of the disease, antibiotic therapy is carried out mainly, depending on the type of pathogen (gonorrhea, chlamydia, trichomoniasis). Local procedures are contraindicated because there is a risk of an upward spread of the infection, they are carried out after the damping of the inflammatory process. Apply syringing, a bath with chlorhexidine, rekutanom, dimexidom, balizom. Laser therapy is indicated in both acute and chronic stages of endocervicitis. Helium-neon and semiconductor lasers are used.
In chronic endocervicitis and cervicitis accompanied by cervical hypertrophy, especially in the presence of pseudo-erosions, operative treatment is shown – diathermoconization of the cervix, wedge or cone resection of the cervix.