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Cervicitis is a general condition characterized by inflammation of the cervix (a thickening of the tissue that connects the uterus to the vagina). More than half of all women have had cervicitis at least once. If you have cervicitis, it is important to recognize it and treat it in time, otherwise, it can lead to infection in the uterus, fallopian tubes, ovaries or, over time, to inflammation of the pelvic organs and infertility.
What is cervicitis
Cervicitis is a disease of the cervix associated with inflammation of its mucous membranes. With the transition of cervicitis to a chronic form, the process spreads to the connective tissue (stroma). If the muscle tissue of the cervix is also inflamed, then the so-called endomyometritis occurs.
The epithelium of the cervical canal (endocervix) connecting the uterine cavity with the vagina differs in structure from the epithelium lining the part of the neck that is located directly in the vagina (exocervix). Depending on which part of the cervix of the uterus inflammation occurs, endocervicitis and exocervicitis are distinguished, respectively.
The age of women who have cervicitis of the cervix uteri is 20-40 years old in 70% of cases, and only 30% of women are those who have had menopause.
The disease must be treated, since when it becomes chronic, there is a thickening of the walls of the uterus, narrowing of the lumen of the cervical canal. This can cause infertility. The spread of inflammation in the tubes and ovaries also leads to the impossibility of conception, the occurrence of an ectopic pregnancy, hormonal disorders.
A gynecologist can diagnose cervicitis not only with the patient’s treatment with characteristic complaints, but also during a routine examination, when the patient was not worried.
The examination begins with an examination of the cervix using a gynecological mirror. Depending on the causative agent of the disease, the cervix has the following form:
- with cervicitis of gonorrheal etiology, the vaginal part of the cervix has a bright red color, it is swollen, loose, with areas of ulceration (a symptom of "continuous erosion"),
- with cervicitis caused by trichomonas, the cervix is hyperemic, swollen, loose, small hemorrhages are detected (“strawberry cervix”),
- with chlamydial infection, which can also cause the development of cervicitis, the mucous membrane of the vaginal part of the cervix is slightly hyperemic, edematous.
Next, colposcopy is performed - a diagnostic method that allows you to assess the condition of the mucous membrane of the vaginal part of the cervix using a special optical device (colposcope). In the course of this study, the nature of the pathological change in the cervix is specified. In addition, colposcopy allows you to determine the location of the pathological focus, which is necessary for targeted biopsy of the cervix. There are 2 types of colposcopy:
- Simple colposcopy, during which the cervix is examined using a colposcope without conducting medical tests.
- Extended colposcopy, in which preliminary processing of the cervical mucosa with a 3% solution of acetic acid (or 0.5% salicylic acid solution) and an aqueous solution of Lugol (the so-called Schiller test) is performed, after which the cervix is examined using a colposcope .
The procedure is absolutely painless and does not require prior preparation by the patient. It is believed that colposcopy must be performed only if any changes in the cervical mucosa are detected during examination with a gynecological mirror. However, it is currently recommended that this study be performed by women who have sex, at least once a year for preventive purposes.
Next, a smear is taken from the cervical canal, which is sent for microscopic and bacteriological studies. Microscopic examination allows you to determine the number and ratio of normal, pathogenic and opportunistic microorganisms, as well as cellular elements, which allows us to conclude that there is an inflammatory process, its severity and the nature of the microflora that populate the vaginal part of the cervix. In acute cervicitis, a large number of white blood cells (30 or more), lymphocytes and pathogenic microorganisms are found. A bacteriological study allows you to identify the type of pathogen that caused the development of cervicitis, as well as determine the sensitivity of the microorganism to the spectrum of antibiotics, which will help in choosing a specific antibiotic for treatment. It is far from always possible to identify the causative agent of the disease with the help of a bacteriological examination of the smear, in such cases PCR diagnostics are performed. This, of course, is a fairly powerful and effective modern diagnostic method that allows you to quickly and accurately determine the causative agent of an infectious disease. It is also worth noting that PCR diagnostics have high specificity and sensitivity. Due to the numerous advantages of this diagnostic method, an existing disease in humans can be detected even at the stage of the incubation period, when there are no clinical and laboratory signs of the disease.
Treatment of cervicitis is aimed at eliminating the causes and predisposing factors to the onset of the disease. For this, antibacterial, antiviral or antifungal drugs are prescribed depending on the causative agent of the disease.
Local treatment is performed only after the acute process of the disease subsides. It includes douching, the introduction of vaginal creams, suppositories, treatment of the cervix with a 3% solution of dimethyl sulfoxide, and a solution of silver nitrate. It is important to emphasize that the use of local therapy in the acute period of cervicitis is strictly prohibited due to the risk of developing an ascending infection.
Physiotherapeutic treatment is also used, which is prescribed after the relief of the acute period of the disease. For example, vaginal laser therapy, magnetotherapy, darsonvalization and the like can be used.
Chronic cervicitis is poorly treated with medication. Therefore, the following surgical treatment options are used:
- diathermocoagulation is a treatment method whose action is to cauterize tissue with a high-frequency current,
- cryotherapy is a treatment method based on exposure to tissues with cold,
- laser therapy is a treatment method based on exposure to tissues with a concentrated beam of light.
Preventive measures aimed at preventing the development of cervicitis include the observance of personal hygiene rules, the avoidance of sexually transmitted infections, their timely treatment, and treatment of endocrine disorders. An important condition for the prevention of cervicitis is the timely treatment of thrush.
The appointment of antibacterial drugs is necessary for the bacterial etiology of cervicitis. The following groups of antibiotics are used:
- Tetracyclines. One of the representatives of this group of antibacterial agents is doxycycline, which is active against both gram-positive and gram-negative microorganisms. It is contraindicated in children under 8 years of age, pregnant and lactating women, people with liver failure, and also with myasthenia gravis (in case of intravenous administration of the drug).
- Macrolides. The most common macrolide is azithromycin. This antibiotic has a wide spectrum of antibacterial action, which allows it to be used in cases of damage to various gram-negative and gram-positive microorganisms. The mechanism of action of the drug is to slow the growth and reproduction of bacteria. Azithromycin is well tolerated, rarely, side effects occur while taking the drug, it is contraindicated only if the patient has an allergic reaction to any of the components of the drug, pregnancy and lactation, and also children under 12 years of age.
- moxifloxacin. It has a bactericidal effect that spreads to a wide range of microorganisms. The drug is well tolerated among representatives of different ages. If necessary, pregnant women are allowed to prescribe, since during the study on animals the teratogenic effect was not revealed, which means the occurrence of malformations due to the use of the drug. It is worth refraining from use by children under 18 years of age, since clinical trials of the drug have not been conducted, indicating the safety of the use of moxifloxacin in childhood,
- levofloxacin. The drug has a bactericidal effect, is active both in relation to gram-negative and gram-positive microorganisms. Levofloxacin is well tolerated, the following adverse reactions rarely occur: nausea, diarrhea, discomfort in the epigastric region (upper abdomen), muscle weakness.
Antiviral drugs are used, for example, for herpes infections. In this case, acyclovir is often prescribed. The dosage of the drug and the frequency of administration is determined by the attending physician, based on the severity of the process and the severity of the clinical manifestations. Adverse reactions while taking the drug are rarely detected. Most often, you may experience abdominal discomfort, nausea, vomiting, diarrhea, and headache. Detection of an allergic reaction is an indication for drug withdrawal. While taking acyclovir, it is recommended to monitor renal function, that is, monitor changes in indicators such as creatinine and urea in the blood chemistry.
If candida cervicitis is detected, antifungal drugs are prescribed. The most common drug in this group is fluconazole. The tolerability of this drug is very good, side effects are extremely rare. Of the adverse reactions, abdominal pain, nausea, flatulence, dryness of the oral mucosa, and stool disorder in the form of constipation can most often be noted.
The danger of cervicitis in pregnant women
Cervicitis is associated with the destruction of the mucous plug that protects the uterus from infection from the vagina. The likelihood of a disease and the transition of the inflammatory process to a chronic form increases due to the inevitable decrease in immunity during this period (this prevents fetal rejection).
In the presence of cervicitis in pregnant women, the risk of complications such as miscarriage, premature birth increases. Infection of the fetus is possible, which leads to improper development, the appearance of deformities, intrauterine death, and the death of a newborn in the first months of life.
Cervicitis is a great threat in the early stages of pregnancy, when the fetus forms organs and systems. Most often, a woman has a miscarriage. If acute cervicitis occurs in the middle or end of pregnancy, the baby may develop hydrocephalus, kidney disease, and other organs. Therefore, when planning a pregnancy, a woman should be cured of cervicitis in advance and strengthen her immunity. Treatment is mandatory, as the risk of complications is very high.
The treatment of cervicitis should be handled by a specialist in this field of medicine. Self-medication at home is not welcome, since the lack of timely qualified treatment for acute cervicitis can lead to a chronic course of the process.
As you know, in some cases, cervicitis has an erased clinical picture, because of which a woman does not seek timely help from a specialist. To avoid such situations, it is recommended not to forget about preventive examinations by a gynecologist, which should be carried out at least 2 times a year. In addition, it is important to observe the rules of personal hygiene in order to eliminate the appearance of favorable conditions for the infection to join. The number of sexual partners in a woman plays a significant role in the possibility of developing cervicitis. Therefore, the number of sexual partners should be limited, as well as the elimination of casual sexual intercourse. To prevent the occurrence of sexually transmitted infections, it is necessary to use the barrier method of contraception (condom) during sexual intercourse. In case of neglect of this method of protection it is strongly recommended to be examined for the presence of sexually transmitted diseases, especially if there is no permanent sexual partner. In addition, it is necessary to timely treat infectious and inflammatory diseases of the internal genital organs, as well as to prevent themselves from provoking factors leading to the exacerbation of chronic diseases. To do this, avoid hypothermia, various injuries, psycho-emotional stress. It is also important to take care of your diet, special attention should be paid to the use of vegetables and fruits, which are rich in various vitamins and minerals, dairy products, cereals. Particular attention is paid to the sleep and rest regimen, compliance with which helps to strengthen the general condition of the body.
Infectious causes of infection
The cervix separates the sterile uterine cavity from the vagina, the microflora of which normally contains beneficial lactobacilli and opportunistic microorganisms. Useful lactic acid bacteria create a healthy environment that prevents the growth of pathogens. The causes of cervicitis of an infectious origin are:
- Propagation of opportunistic bacteria. Conditionally pathogenic are called microorganisms, which are always present in the intestines and urogenital organs of a person in small quantities, without harm. But under certain conditions, they begin to multiply uncontrollably, which leads to illness. These include, for example, staphylococci, streptococci, Escherichia coli, fungi, gardnerella. They cause inflammation of the vulva and vagina, spreading to the cervix. Infection can enter the vagina directly from the rectum and urinary organs.
- Infection with human papillomaviruses and genital herpes.
- Infection with sexual infections (trichomonads, gonorrhea pathogens, mycoplasmas, chlamydia and others).
Non-infectious causes of cervicitis
These reasons include:
- prolapse of the cervix and vagina,
- injuries of the cervix (tears during childbirth or during abortion, as well as damage during curettage and cauterization, causing scarring),
- non-compliance with hygiene rules, use of unsuitable hygiene products,
- frequent douching with solutions that cause overdrying of the mucosa and disturbance of microflora,
- a change in the composition of the mucosa when using hormonal replacement therapy drugs or contraceptives,
- pseudo-erosion of the cervix, that is, the movement of cells of the cylindrical epithelium of the cervical canal into the region of the squamous epithelium of the vaginal cervix. This happens during abortion, childbirth, or surgery.
Contributes to the onset of cervical inflammation, a decrease in immunity, the presence of tumor diseases, uncontrolled intake of antibiotics.
Types and forms of cervicitis
There are various types of cervicitis of the cervix.
Purulent cervicitis. Sources of inflammation are gonococci, ureaplasmas, trachoma coli. The infection is sexually transmitted, affects the mucous membrane of the cervical canal (cylindrical epithelium). If there is a displacement of cylindrical cells in the region of squamous epithelium (an ectopia of the cervix appears), then the purulent process extends to the displaced areas. The process can also affect the stroma, which separates the mucous membrane from the muscles. Infection gets into other organs of the small pelvis and becomes the cause of their inflammation.
Viral cervicitis. Inflammation is caused by the human papillomavirus (HPV) or the causative agent of genital herpes (specific infections). Papillomas or herpes can occur both inside the cervical canal and on the vaginal surface of the neck. A characteristic sign is severe itching in the neck and pain in the lower abdomen. Most often, this kind of cervicitis occurs in women of childbearing age, who live sexually.
Bacterial cervicitis. The process of inflammation extends to all areas of the mucous membrane of the cervix: both the internal and its vaginal segments. Причиной является бактериальный вагиноз, то есть развитие условно-патогенных бактерий во влагалище из-за недостатка в микрофлоре полезных молочнокислых бактерий. При таком заболевании отсутствует опасность заражения полового партнера. Однако, если во влагалище попадает еще и половая инфекция, заболевание переходит в гнойную форму.
Атрофический цервицит. This is the name of the type of disease in which there is a decrease in the thickness of the mucous membranes of the cervix (atrophy). The causes of this process can be both specific (gonococcus, trichomonas, herpes virus and HPV), and non-specific infections (staphylococci, streptococci).
In addition, cervicitis of this type occurs due to traumatic lesions of the mucosa during abortion or curettage.
Cystic cervicitis. There is inflammation of the glands located in the cylindrical epithelium, an increase in its volume, the formation of many cysts in the mucosa and damage to its surface. This type is the advanced stage of the disease, in which a combination of different types of infection is observed.
The disease often proceeds in an acute form with pronounced symptoms. In the absence of treatment, the inflammation becomes chronic, passes to the glands and affects the mucosa inland. At the same time, treatment is hampered by the fact that the external signs of the disease are smoothed out, it is more difficult to diagnose cervicitis. Often it can be detected only at a late stage, when the inflammation passes to the uterine appendages.
Symptoms and signs of cervicitis
In some cases, even acute cervicitis is difficult to notice, as it proceeds without pain or other obvious symptoms. However, in severe form, acute inflammation can cause the appearance of copious purulent discharge with an unpleasant odor. There are pulling pains in the lower abdomen, in the lower back. Discharges with impurities of blood appear, especially after intercourse, which also becomes painful. Itching in the genitals. Possible fever, nausea, and dizziness. Frequent painful urination is observed.
Signs of the disease in the acute stage are swelling and redness of the mucous membrane on the surface of the vaginal segment of the neck. During the examination, a protrusion of the mucous membrane of the cervical canal to the external region is detected. It has minor hemorrhages and sores.
With the transition of the disease to a chronic form, the discharge becomes less abundant, since mucus production by the glands of the cervical canal is disrupted. Turbid discharge contains impurities of the blood. A woman feels constant aching pain in the lower back.
The degree of manifestation of the disease depends on the type of infection. When infected with gonococci, the manifestations, for example, are stronger than with chlamydia. If the occurrence of cervicitis is associated with the herpes virus, then on the mucosa there are separate sores, loose areas of bright red color.
In the presence of chronic cervicitis, swelling of the mucosa is reduced. It is possible to move the external epithelium of the neck into the cervical canal. The color of the mucosa is bright pink. Cysts and vesicles containing lymph and blood are detected. Inflammation spreads to neighboring tissues.
Treatment of cervicitis is to eliminate the causes of the disease, fight inflammation and strengthen the body's defenses.
To destroy pathogens, antibiotics, antiviral and antifungal drugs are used. When a papilloma virus is detected in a woman’s body, special attention is paid to treatment, since genital lesions are more likely to lead to the formation of malignant tumors. Immunomodulators (interferon, cycloferon, immunal) are primarily prescribed.
Vaccines, tablets and ointments are used to clear the mucosa of papillomas. However, there is a risk of relapse, so it is recommended that a woman regularly undergo gynecological examinations.
Often, getting rid of papillomas can only be done surgically. Such treatment is often used to eliminate chronic cervicitis of any nature. Methods such as laser destruction, cryotherapy, chemical cauterization, electrical destruction, radio wave coagulation are used.
Sometimes in the treatment of cervicitis, the simultaneous elimination of urological diseases is required.
Note: If the cause of inflammation of the mucosa is genital infections, then the woman's sexual partner should be treated at the same time.
In order to accelerate the restoration of the mucosa and improve the hormonal background, estrogen and progesterone preparations are used.
After eliminating inflammation, agents are prescribed that contain beneficial bacteria necessary to maintain the normal composition of the vaginal microflora. Lactobacterin, kipferon suppositories, as well as vaginal gynoflor tablets are used.
The most important preventive measures to reduce the likelihood of cervicitis are proper hygienic care of the external genitalia, the use of condoms during sexual intercourse. Properly selected contraceptives help to avoid abortion, possible injury to the cervix and infection. It is necessary to treat intestinal and urological diseases on time.
Cervicitis is a disease in which cervical inflammation in the vaginal area. Pathological process accompanied by purulent or secretions with impurities of mucuspain in the lower abdomen, pain during urination, as well as discomfort during intercourse. If a chronic form of pathology is diagnosed, then this condition is characterized by erosion, compaction of the uterine walls, and infection of the upper part of the vagina.
The cervix itself is a barrier that protects the internal cavity from the penetration of pathogenic bacteria into the uterus and upper genital tract. When exposed to adverse factors, the protective function is lost, which contributes to the defeat of foreign microflora and the development of inflammation.
At the initial stage of the pathological process, the clinical picture is mostly absent. The first signs appear as intense discharge for several days after the end of menstruation. Most often, they are ignored by women.
In the event that the following symptoms are present, it is necessary to immediately seek medical help:
- blood smearsobserved some time after the end of menstruation,
- sensation of itching in the organs of the reproductive system,
- soreness and discomfort during intercourse,
- burning when going to the toilet,
- pain in the lower abdomen and in perineum,
- discharge with blood after sex.
If the disease has a severe course, then the signs will be as follows:
- pungent odor
- intense purulent discharge,
- itching and abdominal pain.
The occurrence of the inflammatory process is facilitated by multiple provocative factors. They are divided into two types: infectious and non-infectious.
The first group includes:
- Propagation of opportunistic bacteriawhich are constantly located in the organs of the genitourinary system and in the intestine. Moreover, they are completely safe for human health. But under the influence of certain conditions, their intense activation occurs, against which the disease develops. These include fungi, E. coli, streptococci, staphylococci. These microorganisms provoke inflammation of the vagina and vulva, which leads to the spread of infection to the cervix.
- Genital infections It can be the causative agent of gonorrhea, trichomonas, chlamydia, mycoplasma and other pathogenic bacteria.
- Infection with genital herpes or human papillomavirus.
Among the causes of non-infectious type are:
- vaginal prolapse,
- non-compliance with hygiene procedures,
- uterine neck injury (tears during labor or abortion, as well as various tissue damage during cauterization or curettage),
- using low-quality cosmeticsintended for intimate hygiene,
- frequent douchingin which solutions are used that can provoke dry mucous membrane and disturbance of microflora,
- pseudo-erosionin other words, the movement of cylindrical epithelial cells of the cervical canal into the vaginal part of the cervix.
The inflammatory process can develop on the background lowering the immune systemwhen forming tumor neoplasmsas well as a result of long and uncontrolled antibiotic treatment.
Cervicitis of the cervix has many varieties.
This is a pathological process of the lower organ segment, accompanied by inflammation, mainly of the endocervical glands. Occasionally, squamous epithelium can be affected. According to some researchers, the pathological process directly depends on the type of pathogen. For example, when infected with gonococci only epithelial cells that belong to the endocervical glands are affected. With inflammation against the background of streptococci or staphylococci they will also be concentrated in the endocervical glands and in the stroma of the cervix. With lymph flow, pathogens penetrate the remaining pelvic organs and infect them.
The initial stage of the pathology manifests itself discharge of various kinds. In most cases, this purulent contents. But also noted fever, dull pain in the abdomen tides.
Diagnosed if the genitals are affected bacteria of various origins, as well as viruses and fungi. In this condition, the infectious process can provoke the prolapse of the vagina or cervix, the inappropriate use of contraceptives and hormones. The chronic form of cervicitis occurs due to the frequent change of sexual partners, non-observance of the rules of intimate hygiene and inflammatory pathologies that affect the pelvic organs.
Symptoms of this form of the disease depend on the pathogen and the reaction of the female body. The main symptom of a chronic type of illness is muddy mucous discharge with impurities of pus.
Other symptoms of pathology:
- dull pain
- itching and burning sensation during urination,
- swelling of the uterine mucosa,
- bleeding after intercourse.
This type of pathological condition is more serious for women's health. The lack of adequate treatment leads to the fact that the walls of the uterus begin to hypertrophy. But also against the background of the process, the risk of development oncological diseases and infertility.
With this form of the disease, not only the cylindrical layers of the epithelium are damaged, but also the subepithelial layers of the cervix.
The peculiarity of this process is due to the fact that when diagnosing it in a woman, in most cases, urethritis is detected in her partner.
Purulent cervicitis is a common form of the disease, which sexually transmitted. The causative agent of pathology is trachoma or gonococcus wand.
This form of ailment can be infected during sexual contact. Depending on the location of the inflammation, secrete endocervicitis and exocervicitis. In the first case the inside of the cervix is affectedin the second - outer fabrics.
According to the generally accepted classification, this form of the inflammatory process is divided into two types: non-specific and specific.
In most cases, the disease is diagnosed in the fair sex at childbearing age. Among the main symptoms are noted pain in the lower abdomenpronounced itching, purulent or mucous discharge.
Refers to common forms of the disease. The disease has an infectious nature of origin and is localized in the canal or in the vagina, in the place where the distinction with the cervix occurs. With the course of the pathological process, violation of the microflora of the vagina, but at the same time there is no strong inflammatory reaction.
One of the varieties of cervicitis, which is characterized by atrophy of the mucous membranes of the uterus. Among the triggering factors there may be both specific and non-specific causes.
The development of the disease contributes to unprotected sexual contactin which pathogenic bacteria enter the female body and provoke inflammation.
It is characterized by pathological processes occurring in the cylindrical epithelium of the glands. In addition, their volumes are increasing, multiple cysts form and surface damage. This type is considered the neglected stage of the pathological process, in which various types of infection are combined.