Cervicitis: symptoms and treatment
Cervicitis is an inflammatory process, the localization of which is concentrated in the area of the vaginal segment of the cervix. Cervicitis, the symptoms of the course of which are characterized by turbid secretions, pain in the lower abdomen (pulling or dull), painful intercourse and urination, in prolonged chronic form can lead to erosion. In addition, such a course of it can provoke thickening (ie hypertrophy) or thinning of the cervix, and also cause the spread of infection to the upper parts of the genital organs.
The cervix itself acts as a barrier, which is an obstacle to penetration into the uterus, as well as into the upper genital tract (in the form of a protective secretion, mucous plug and cervical canal) infection. The influence of certain factors provokes a violation in its protective functions, which leads to the entry into this area of a foreign microflora, thereby contributing to the development of the inflammatory process. Cervicitis, which also includes exocervicitis (inflammation of the exocervix, or vaginal segment in the uterus), and endocervicitis (inflammation of the endocervix, or inflammation in the area of the inner membrane belonging to the cervical canal of the cervix) is also such a process.
Cervicitis may appear as a result of the effects of a nonspecific infection that arises from a conditionally pathogenic microflora. In particular, these include staphylococcus aureus and streptococcus, E. coli and fungi. In addition, the disease also occurs due to the effects of specific viruses: chlamydia, gonococci, Trichomonas, etc. The influence of protozoal infections and parasitic infections is not excluded.
This conditionally pathogenic microflora, which provokes cervicitis, appears in the uterus through contact through the lymph and blood, and also through the rectum. As for specific viruses, they enter the uterus through sexual contact.
It should be noted that cervicitis can develop under the influence of certain factors, which include birth trauma related to the cervix, diagnostic cramping and abortion, and the use of contraceptives (in particular, the installation and removal of the intrauterine device). As cervicitis-provoking factors, various types of cicatricial deformation, as well as formation in the cervix of the benign type, are distinguished. It is also possible that immunity decreases when considering actual factors leading to the development of cervicitis.
The peculiarities of the development of cervicitis indicate that this disease rarely occurs in isolation — mainly its «satellites» are those or other diseases relating to the reproductive system: vaginitis, vulvitis, pseuderosion or eversion of the cervix, bartholinitis.
As for the age category, most often the disease we are considering is found among women of reproductive age (about 70% of incidence cases), less often cervicitis occurs with menopause. It is noteworthy that cervicitis is one of the most common causes in which pregnancy is not possible, in addition, it is cervicitis that in most cases provokes premature birth. As a consequence of this disease, polyps are formed, as well as cervical erosion and inflammation in the upper genital tract. Cervicitis flows in acute or chronic form, in addition to other varieties of it, which we will also consider below.
Acute cervicitis is, respectively, acute inflammation that occurs in the cervix. Most inflammation concerns only endocervical glands in this case, and in rare cases, lesions of the flat epithelium can also be noted. Some researchers hold the view that the nature of the inflammation (that is, its constancy, the area of localization, the path of spread) is directly determined based on the specific type of pathogen. Gonococci, for example, affect only the epithelial cells belonging to endocervical glands, while their spread occurs along the surface of the mucosa. If it is an inflammation provoked by staphylococci or streptococci, their localization focuses directly in the endocervical glands with affecting the stromal cervix of the uterus. The current of the lymph ensures that the pathogens reach other organs in the small pelvis, which, accordingly, leads to their infection.
Pausing specifically on the symptoms, it should be noted that the first of them at the initial stage of the disease manifests itself in the form of secretions, and the nature of these secretions may be different. Meanwhile, most often there is a content of pus in them, while their profuse nature, which is especially important in case of the urgency of such a disease as gonorrhea.
In addition, the acute course of the disease is often accompanied by a slight increase in temperature, the appearance of dull pain in the lower abdomen. Often there are feelings of hot flashes, concentrated in the pelvic area of the organs. In addition, patients often experience back pain, urination disorders (polyuria or dysuria, increased urine output or decreased urine output, respectively) and pain that occurs in the genital area and pelvic organs during sexual intercourse.
When diagnosing acute cervicitis, in addition to gynecological examination, a microscopic examination of smears is used, as well as the sowing of cervical canal discharges directly onto the nutrient medium.
If it is a diagnosis of gonorrheal cervicitis in acute form, then, as a rule, it is performed extremely rarely due to the treatment of patients to the doctor only in those cases in which the inflammatory process passes to the appendages of the uterus. Considering this, in the presence of pain in the subordinate area in the acute form of the flow of gonorrhea cervicitis, it is necessary to use a slightly different treatment than with an ordinary acute cervicitis, because in this case the inflammatory process is quite specific.
Chronic cervicitis is formed when various genital organs are affected by various bacteria, as well as when they are affected by fungi and viruses. The onset of an infectious process in this case can occur when the cervix or vagina is lowered, or if hormonal and contraceptive medications are used improperly. In addition, concomitant factors in the development of chronic cervicitis include promiscuous sexual life, impaired hygiene and inflammatory diseases in the pelvic organs.
Clinical manifestations of this form of cervicitis are determined by the specific type of pathogen, as well as by the general reactivity in each specific case of the patient’s body. Among the main symptoms are scanty mucous discharges of a turbid consistency, in some cases, an admixture of pus is possible. There is also a reddening of the uterus and its edema. The acute form of the manifestation of the chronic form of pathology is manifested, respectively, in a greater degree of symptomatology. Again, there are blunt pains appearing in the lower abdomen, itching, pain and burning with urination, bleeding that occurs after intercourse.
The disease is more than serious for a woman, because untimely treatment leads to thickening of the walls of the cervix with subsequent hypertrophy, which contributes to the formation of a different type of pathology. This also increases the risk of possible oncological diseases, infertility and dysplasia in the examined genital area.
For the diagnosis, the uterus is examined using a colposcope and a mirror. Blood and urine are examined for the presence of sexually transmitted infections. Also, ultrasound is carried out followed by a study of the pelvic organs.
Purulent mucous cervicitis requires the presence of an inflammatory process in the region of the cylindrical layer of epithelial cells, as well as the relevance of subepithelial lesions of the cervical region. In addition, damage can also occur in all simultaneously areas of the cylindrical epithelium, which is ectopically concentrated on the outside of the cervix (i.e., the unnaturalness of the epithelial displacement is noted).
What is noteworthy, in the presence of a purulent cervicitis in a woman, one can almost certainly assert the presence of urethritis in her partner, caused by a similar type of pathogens, but with great difficulties being diagnosed. Purulent cervicitis is one of the most common sexually transmitted diseases, as well as employees are the most frequent cause of inflammatory processes localized in the pelvic organs. In the presence of symptomatic purulent cervicitis among expectant mothers, the risk of disrupting the normal course of the entire pregnancy, as well as subsequent births, is significantly increased.
As a rule, the reason for the formation of pathology is in the gonorrhea or trachoma stalk. Unofficial statistics indicate that one of three cases is marked by the onset of the disease due to the impact of ureaplasma. Symptomatics in this case is similar to diseases caused by the herpes virus and trichomonads. In general, purulent cervicitis is formed against the background of gonorrhea.
Viral cervicitis with a characteristic inflammatory process occurs when the infection is transmitted sexually. The localization of the inflammatory infectious process determines such forms of the disease as exocervicitis and endocervicitis, with the defeat of the outer tissues of the cervix and the lesion of its internal part, respectively.
The generally accepted classification determines the division of the inflammatory process into a specific form of its course and nonspecific. Specific form is a concomitant manifestation of viral cervicitis, respectively, this refers to the viral etiology with the actual transmission of the virus during sexual intercourse (genital herpes, HPV).
As a rule, women are exposed to age of the reproductive group. Among the main symptoms are the painful sensations arising in the lower abdomen, general discomfort and the strongest itching that appears on the outside of the genitals. In addition, there are discharges with impurities in the form of pus or mucus. In the acute stage of viral cervicitis, discharge is characterized by abundance, in chronic — scarcity.
Bacterial cervicitis is also quite common in cases of treatment of patients to a gynecologist. The disease is contagious, while its localization is concentrated in the cervical canal or in the vagina in the area of the site bordering the neck. Accompanying its course is a violation of the vaginal microflora, a strong inflammatory reaction is absent.
Cervicitis is exogenous, and its development occurs against the background of infected mucous viruses such as herpes, papillomavirus, trichomoniasis or syphilis, but there is no connection with sexually transmitted infections in this case. In addition to these causes, which cause bacterial cervicitis, urinary tuberculosis is also isolated. Bacterial vaginosis is the most common cause for the formation of nonspecific chronic cervicitis.
The most common symptoms of this form of the disease are dysuria (i.e., disorders of urination), dull pulling pains that arise in the lower abdomen, as well as painful feelings accompanying sexual intercourse. In addition, patients have vaginal discharge of different consistency, while their abundance or, conversely, scarcity. There is also an impurity in the form of mucus or pus.
Atrophic cervicitis has a number of characteristics, but its development proceeds in accordance with general principles that are relevant for cervicitis. The causes provoking the emergence of this form of cervicitis are various types of diseases that form in the genitourinary system (erosion of the cervix, cystitis, endometritis, inflammation of the appendages). In addition, the development of an atrophic form of cervicitis is also possible with unprotected sexual intercourse, in particular when it enters the organism of pathogens of one type or another of diseases that are transmitted sexually. As infectious agents are gonorrhea, trichomoniasis, chlamydia, mycoplasmosis, as well as viral diseases. In addition, nonspecific infections (staphylococci, streptococci) are also isolated.
Development of atrophic cervicitis occurs also in the area of the damaged area. The cause of injury in this case can serve as scraping, abortion, rupture of the uterus in the process of its generic activity. Atrophic cervicitis is accompanied by a characteristic thinning that occurs in the tissues of the cervix. In severe forms of atrophy, there are abnormalities in urination. As a rule, this form of the disease is the result of chronic course of cervicitis.
In this case, a combination of infections (chlamydia, gonococcus, streptococcus, fungi, staphylococcus, gardnerella, trichomonads, etc.) is identified as a cause of the disease, which leads to the proliferation of the cylindrical epithelium along the uterine surface. This, in turn, leads to a gradual and continuous overgrowth of cysts. Often cysts are combined with manifestations in the form of erosion.
Diagnosis of cervicitis
Quite often, as we have already noted, cervicitis proceeds without any symptoms, which, accordingly, leads to an untimely appeal to a specialist. Typically, the detection of the disease occurs randomly during a scheduled physical examination or when you see a doctor with a suspicion of another disease.
Diagnosis of cervicitis occurs on the basis of data such as:
- examining the cervix by using mirrors for this
- when receiving the results of colposcopy, allowing to make detailed the pathological changes in the epithelium in case of the urgency of cervicitis
- Based on the results of laboratory tests (smear microscopy, microflora seeding, PCR).
Treatment of cervicitis
In modern conditions, gynecology has a variety of different methodological possibilities that allow the treatment of cervicitis. Meanwhile, the first thing that needs to be done in this treatment is to eliminate the factors predisposing to the development of the considered disease.
In the treatment of cervicitis, antiviral, antibacterial and other agents are used, which is determined on the basis of a specific pathogen and the characteristic sensitivity for the selected drug. It also takes into account the stage in which the inflammatory process resides. Local preparations of a combined type, as well as creams and suppositories are widely used in the treatment of cervicitis.
Specific infections require parallel treatment of a partner.
The chronic stage of the disease is characterized by less success of conservative treatment, which, accordingly, determines the need for surgical methods (cryotherapy, diathermocoagulation, laser therapy) with preliminary disposal of infections.
In case of suspicion of cervicitis, as well as the presence of symptoms corresponding to this disease in some form of their manifestation, you should contact a gynecologist. Additionally, a urologist may also need to be examined.