Inflammation of the cervix. Cervicitis can be a harbinger of cancer! Chronic cervicitis disease

Inflammation of the cervix is a well-known gynecological problem. Most often, cervicitis is detected in women of childbearing age, but sometimes this diagnosis is made on the eve of and even during menopause. The complexity of the disease is that it contributes to the appearance of various pathologies of the reproductive sphere, and during pregnancy it threatens the abortion or intrauterine infection of the child.

In the body of a healthy woman, the cervix acts as a filter that protects the genitals from invasion of pathogenic microorganisms. The mucous membrane of its canal contains special bactericidal enzymes that can neutralize most pathogenic agents. And the narrow channel prevents mechanical penetration.

However, under unfavorable factors, the function of the vaginal cervix and cervical canal is impaired. This part of the organ remains defenseless against infection and is the first to take the blow. Its tissue is affected by an acute inflammatory process - cervicitis, which can last up to one and a half months and then become chronic.

Depending on which part of the organ is affected - internal or external, the disease is divided into endocervicitis and exocervicitis, respectively.

The reasons that cause such an illness in the female body can be of a different nature. Most often, doctors identify the following situations.

Infectious diseases

The most common provocateurs of cervicitis are pathogens for which the cervix is a favorable environment. They can get to this area in the following ways:

during unprotected sexual intercourse;
through blood;
by contact, for example, from the intestines if the rules of intimate hygiene are not observed.

When treating cervicitis, gynecologists have to deal with:

cocci;
coli;
chlamydia;
plasmas;
trichomonas;
viral microorganisms (herpes, HPV, CMV and others);
fungi (candida and the like).

Often, cervicitis is a secondary disease, that is, it occurs as a consequence of the inflammatory process in adjacent structures, as well as in other parts of the genital organs (for example, with colpitis, adnexitis).

Mechanical damage

Another cause of inflammation in the cervical area is trauma. A hastily placed contraceptive (cap or ring) or too deep insertion of a hygienic tampon can damage the delicate mucous membrane and make it vulnerable to any bacteria. The same can be observed after installation of an intrauterine device and after injuries during childbirth.

Mechanical damage can occur after artificial termination of pregnancy. Even if we omit the negative consequences of the procedure for reproductive function and psychological state, the technique of its implementation itself remains very traumatic. Therefore, even under sterile conditions, the body is not protected from complications, among which cervicitis is often encountered.

The mucous membrane of the vaginal part of the cervix can also be damaged when douching with potent solutions. Concentrated liquids can not only leave a burn, but also “wash out” all the beneficial microflora that protects against infections.

Women with allergies have a particular predisposition to cervicitis. An unsuccessfully selected lubricant, spermicidal lubricant or contraceptive material (barrier) can cause an inflammatory process after sexual intercourse, even if the partner is not a carrier of the infection.

Other factors

Girls who began to have an active sex life before reaching adulthood have an additional risk of getting cervicitis. The fact is that the microflora of young representatives of the fair sex is not yet able to adequately respond to the changes taking place.

Therefore, any interventions quickly lead to imbalance and disrupt the maturation process. This makes the genitals accessible to infections, which are more intense than in older women.

Women during menopause also remain vulnerable to cervicitis. Due to decreased estrogen production, the entire reproductive system suffers. The mucous membranes of the reproductive organs become more vulnerable, the epithelium becomes thinner, so the protective forces weaken.

Symptoms of the disease

The insidiousness of cervicitis is that it occurs on its own without noticeable symptoms. A woman can assume that something is going wrong by the “unusual” lack of orgasm, pain during intimacy and spotting after it, not related to menstruation. However, this situation occurs rarely.

Basically, cervicitis becomes a companion to another disease, which is provoked by the same pathogen. That is, it is not inflammation of the cervix or its canal that manifests itself, but another pathology, for example, colpitis or adnexitis.

Complaints are varied and can be as follows:

pain in the lower abdomen, which may radiate to the lower back;
pain when urinating;
frequent “unreasonable” urge to go to the toilet;
unpleasant odor of intimate parts of the body;
unusual discharge (cloudy, curdled, foamy, etc.);
irritation or itching in the genital area.

Symptoms of vaginitis and cervicitis caused by various microbes

If treatment is not started during the acute period of cervicitis, it becomes chronic. At this stage, the disease affects the internal tissues of the organ, changing their structure. Adnexitis and other forms of the inflammatory process occur. This happens almost asymptomatically.

Diagnostic methods

The disease can only be detected by examination in a gynecological chair. Since acute cervicitis shows little sign of itself, it is most often discovered by chance. Visually, inflammation confirms swelling of the surface of the vaginal part of the cervix, which bleeds when touched. Often ulcerations are noticeable on it. The cervical canal can also be filled with ichor or other biological fluid that should not normally be there.

In fact, one gynecological examination in the speculum is enough for the doctor to diagnose cervicitis. Much more difficulties arise when establishing the cause of this disease. The exception is sexually transmitted infections, which have a specific pathogen and clear symptoms.

To choose the right treatment tactics, the gynecologist prescribes special manipulations and tests. Most often, the list of diagnostic procedures looks like this:

During the examination, the specialist may take a small piece of inflamed tissue for further examination - a biopsy is performed.

Cytological examination. These are smears for oncocytology. Cells are collected from the cervical canal and the vaginal part of the cervix, after which they are studied under magnification. This makes it possible to assess the risk of oncological processes and the severity of inflammation.
Bac sowing. He will determine the causative agent of the disease (if it is a bacterium) and a group of drugs that can be used to eliminate it.
PCR research(polymerase chain reaction). It allows you to identify viruses and sexually transmitted infections.
. With its help, the doctor will get an idea of the composition of the vaginal microflora.

Treatment of acute cervicitis

After receiving the results of all tests, the doctor determines the necessary therapy. In a situation where the cause of cervicitis is an infection, the main efforts are aimed at sanitizing the cervix and its canal in order to prevent the spread of the inflammatory process to other parts of the genital organs, and if a woman is “pregnant,” to her baby. Depending on the pathogen, you will have to treat:

(pregnant women are mainly prescribed Erythromycin or Ceftriaxone);
antiviral agents containing acyclovir or other substances;
drugs that suppress fungi (in the form of suppositories or vaginal tablets).

Vaginal suppositories in the treatment of cervicitis

In addition, it is additionally necessary to adjust the composition of the microflora to prevent the recurrence of cervicitis. To do this, the doctor prescribes medications or dietary supplements containing the necessary strains of lactobacilli.

The treatment of cervicitis in women during menopause includes the use of hormonal agents. Regardless of the form (tablets or cream), they must be used regularly and in accordance with the regimen determined by the gynecologist.

After finishing taking all medications, you need to visit the gynecologist again and take control tests. If conservative methods of combating acute cervicitis are ineffective, the inflamed tissue of the cervix will have to be removed. For this purpose, cryotherapy, electrocoagulation or cauterization with a laser are prescribed. Radio wave treatment of cervicitis using the Surgitron device

At the same time as a woman, her sexual partner also needs to sanitize her genitals. This is important because the pathogen can circulate from one organism to another, preventing medications from properly performing their function. In general, it is better to abstain from sexual relations during treatment.

If left untreated

Any disease of the genital organs should not be ignored. A frivolous attitude towards acute cervicitis can lead to changes in the cervix and the appearance of erosions on it. This will become a serious obstacle if a woman wants to become a mother, or even deprive her of such an opportunity.

This condition is especially dangerous if the lady is already “in position.” Cervicitis allows infection to reach the child, even in a situation where the disease is caused by another cause. If left untreated, the result can be very tragic.

For information on the diagnosis and treatment of cervical diseases, watch this video:

Prevention

The main way to protect against cervicitis is considered to be that every woman takes care of her health. Since this disease is often caused by infection, it is important to avoid factors that lead to its acquisition. Ideally, before starting an intimate relationship, a man and a woman should check whether they are carriers of a disease that can be transmitted to their partner.

But such consciousness does not occur very often. Therefore, in order to protect yourself from cervicitis and other problems, it is important:

do not have casual sex;
insist on the correct use of a condom (before sexual intercourse);
strengthen immunity;
fully treat all diseases (especially infectious ones);
monitor intimate hygiene;
Visit your gynecologist regularly.

No matter in what life situation a woman encounters cervicitis, it is important to understand that successful relief from this disease is possible only under the supervision of a doctor. If his recommendations are strictly followed, the prognosis is positive in most cases. But it is better to avoid using traditional methods for treating cervical inflammation; they will not have a therapeutic effect to the required extent or, even worse, will aggravate the disease.

Useful video

For prevention and treatment options for gynecological diseases, watch this video:

Cervicitis, what is it? How to treat cervicitis of the cervix

Cervicitis is classified as an inflammatory pathology of the female genital area. It is an inflammation of the mucous membrane of the cervix (vaginal part) and its cervical canal. Very often it accompanies more extensive pathological processes (vulvovaginitis, colpitis), and is rarely an independent disease.

The cervix is a kind of barrier, the task of which is to prevent the spread of infection through the ascending route into the uterus and its appendages. If its protective function is impaired, then pathogenic microorganisms penetrate the upper parts of the woman’s internal genital organs, provoking the development of cervicitis. The woman begins to be bothered by atypical discharge, periodic or constant pain localized in the lower abdomen, which intensifies during sexual intercourse or urination.

What it is?

Cervicitis is an inflammation of the cervix, to put it briefly in simple language. But, not everything is so simple - let's look at the issue in detail.

Causes of cervicitis

The main cause of cervicitis are diseases that are sexually transmitted. With the development of a certain sexually transmitted disease, thick mucus gradually liquefies, resulting in inflammation of the mucous membrane. After this, the infection begins to spread to the base of the cervix. Due to such changes, microbes gradually enter the uterus, appendages, and later spread to the bladder, kidneys and other organs. As a result, pathological phenomena develop in the woman’s pelvic cavity, including peritonitis.

If sexually transmitted diseases are considered the main cause of the development of cervicitis in a woman, then doctors also identify a number of factors that contribute to the development of this disease. The risk of developing cervicitis increases significantly if a woman has been infected with the herpes virus or. Cervicitis can overtake a girl at a time when she is just beginning to have an active sexual life. Also, cervicitis of the cervix can manifest itself as a consequence of mechanical or chemical irritation (we are talking about contraceptives or hygiene products). In some cases, the inflammatory process occurs as a result of an allergic reaction of the body to latex or other components of contraceptives or personal hygiene products.

A factor that provokes the disease is also weakened immunity due to other somatic diseases. In addition, cervicitis can develop as a result of injuries caused during abortion or childbirth (in this case, it is important to properly suture all ruptures of the perineum and cervix caused during the birth process), with. The disease also often affects women who have entered menopause.

All the reasons described above contribute to the active reproduction of microorganisms classified as opportunistic (staphylococci, streptococci, enterococci, E. coli). In a woman’s normal health, such microorganisms are present in the vaginal microflora.

Symptoms of cervicitis

Manifestations of the acute form of the disease are significantly pronounced. The patient is bothered by purulent or profuse mucous leucorrhoea, vaginal itching and burning, which intensifies with urination. Pain due to cervicitis may also be bothersome. Usually these are dull or aching pain in the lower abdomen, painful sexual intercourse. Other signs of the disease are due to concomitant pathology.

If the inflammatory process of the cervix occurs against the background, frequent and painful urination is a concern. With the inflammatory process in the cervix, there is an increase in temperature from subfebrile (above 37) to febrile numbers (38 and above). When pseudoerosion and cervicitis are combined, spotting and spotting may appear after coitus. A distinctive feature of the disease is the exacerbation of all clinical symptoms after menstruation.

Chronic inflammation of the cervix

A disease that was not adequately and timely treated in the acute stage becomes chronic. Signs of chronic cervicitis are less pronounced or practically absent. The discharge becomes cloudy and mucous in nature, the flat epithelium of the vaginal part of the cervix is replaced by cylindrical epithelium from the cervical canal, and pseudo-erosion of the cervix is formed.

Inflammatory phenomena (redness and swelling) are mild. When inflammation spreads to the surrounding tissues and deeper, the cervix becomes denser, and it is possible again to replace the columnar epithelium with flat epithelium during ectopia, which is accompanied by the formation of nabothian cysts and infiltrates.

Lymphocytic cervicitis

The disease is also called follicular cervicitis. This form of inflammation is asymptomatic and occurs in menopausal women. The process is a lymphoid “impregnation” of the walls of the cervix, resulting in the formation of follicular benign formations. If this form of inflammation is detected, the doctor will definitely carry out a differential diagnosis with malignant lymphosarcoma.

Candidiasis cervicitis

Occurs in a situation where there is already a fungal infection in the vagina (). When examining the cervix in the speculum, white deposits are detected, which are easily scraped off, resulting in exposure of the inflamed red mucosa.

Viral cervicitis

The disease appears as a result of infection with the herpes simplex virus, human papilloma,. It is somewhat difficult to recognize because it has no specific features. During the examination, the doctor may see blisters characteristic of a herpes infection, or only a laboratory will confirm the diagnosis.

Cystic cervicitis

It is a form of the disease in which benign formation occurs. As a result of the inflammatory process, blockage of the glands that secrete mucus occurs and their subsequent proliferation, which the gynecologist will detect during examination or colposcopy.

Atrophic cervicitis

Most often this is a chronic and nonspecific form of the disease. Frequent causes of atrophic inflammation are traumatic manipulations associated with disruption of the integrity of the cervical canal of the uterus or childbirth.

Diagnostics

The diagnosis is made by a gynecologist based on the results of examination and additional research methods. He collects anamnesis, studies complaints and symptoms. During the examination on the chair, the doctor sees foci of inflammation, pinpoint hemorrhages on the surface of the exocervix, an increase in its size due to swelling, redness and swelling of the walls of the vagina and external genitalia.

The gynecologist takes a smear from the surface of the cervix for further examination under a microscope - cytology. The resulting material is also sown on nutrient media - the grown colonies of the pathogen make it possible to determine its type and sensitivity to antibiotics. If necessary, the doctor measures the pH of vaginal discharge - its increase indicates changes in its microflora.

Chronic cervicitis leads to the appearance of pathological foci on the cervix - they are detected when it is treated with iodine solution. In this case, colposcopy is performed - studying the epithelium of the exocervix under high magnification to exclude malignant degeneration of its cells. To diagnose chronic endocervicitis, curettage of the cervical canal is performed, followed by studying the cellular composition of the resulting material. To exclude tumors of the female reproductive system, they are examined using ultrasound.

Treatment of cervicitis

First of all, it is necessary to identify and eliminate factors that could cause cervicitis. It is worth noting that if sexually transmitted infections are detected, the woman’s sexual partner must also undergo treatment.

The treatment strategy for cervicitis depends on the identified cause of the disease. Treatment regimen for different types of cervicitis:

For fungal infections, use antimycotics: Fluconazole orally, Natamycin tablets in the vagina, suppositories with econazole;
For chlamydial infection, a combination of several antibiotics (Tetracycline + Azithromycin) is prescribed for a period of at least 21 days;
With atrophic inflammation, the introduction of suppositories, creams, gels containing estriol (Divigel) into the vagina helps;
For bacterial infections - treatment with antibiotics (Neomycin, Metronidazole suppositories), combined anti-inflammatory and antibacterial drugs (Terzhinan). After sanitation, suppositories with beneficial lactobacilli are prescribed to restore normal microflora (Acilact).

After the acute stage of the disease subsides, local treatment methods can be used. The use of creams and suppositories (terzhinan) is effective. It is recommended to treat the mucous membranes of the vagina and cervix with solutions of silver nitrate, chlorophyllipt or dimexide.

In advanced cases of the disease, when atrophic changes are observed in the mucous membrane of the cervix, local hormonal therapy (ovestin) is indicated, which promotes the regeneration of the epithelium and the restoration of normal vaginal microflora.

Conservative treatment may not give the desired results in the chronic stage of cervicitis. In such cases, the doctor may recommend surgical treatment (cryotherapy, laser therapy, diathermocoagulation).

To assess the effectiveness of treatment, a control colposcopy and laboratory tests are performed.

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 illness 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).

If pregnant women have cervicitis, the risk of complications such as miscarriage and premature birth increases. Infection of the fetus is possible, which leads to abnormal development, the appearance of deformities, intrauterine death, and death of the newborn in the first months of life.

Cervicitis poses a greater threat in the early stages of pregnancy, when organs and systems are being formed in the fetus. Most often, a woman has a miscarriage. If acute cervicitis occurs in the middle or end of pregnancy, the child 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 immune system. Treatment is mandatory, as the risk of complications is very high.

Cervicitis (from the Latin cervix - cervix) is an inflammatory disease of the outer or inner part of the cervix. As a rule, it develops together with inflammation of the uterus and vagina, since all these structures are closely connected to each other. The disease occurs in women of reproductive age and in the postmenopausal period. Often, cervicitis is caused by an infection that is sexually transmitted, especially if it is a virus. An unpleasant feature of the disease is its frequent chronicity and inconspicuous course, which leads to delayed diagnosis. How dangerous is cervicitis and what consequences await a woman?

What is cervix?

The cervix or cervix is the narrowest part of the organ, a kind of entrance to the uterus. The uterus is a hollow muscular organ that can be imagined as a sac, turned upside down. Its lower part looks like a dense tube several centimeters long - this is the neck. Inside it runs a narrow cervical canal, normally tightly closed and filled with mucus.

The cervix canal opens into the vagina - this is the vaginal portion or ectocervix. She is seen by a gynecologist when examining a patient’s vagina. A woman herself can feel it with her fingers when inserting a hygienic tampon, vaginal suppository or cervical cap. The ectocervix looks like a pale pink disc with a hole or small gap in the center.

During pregnancy, the cervix contracts tightly and holds the fetus with amniotic membranes and water in the uterus. Just before birth, it softens and relaxes, and immediately during the birth of the child, the cervical canal expands to 10 cm to let the baby out. Cervical dysfunction leads to miscarriage and disruption of the biomechanism of childbirth.

The function of the cervix is to provide a safe connection between the uterine cavity and the vagina. On the one hand, the cervical canal freely allows sperm and menstrual blood to pass through, and on the other hand, it reliably protects against the penetration of pathogenic microbes. It is filled with mucus produced by the epithelial glands of the cervix. The consistency of mucus changes throughout the menstrual cycle. It is most fluid during the period of ovulation, in order to allow sperm to pass freely and facilitate conception. Closer to menstruation and immediately after it, the mucus is dense, thick and contains a large number of protective antibodies. Thus, it prevents the spread of infection from the vagina to the uterus and above.

The immediate causes of cervicitis in most cases are bacteria, viruses and protozoa:

gonococci;
Trichomonas;
genital herpes virus;
human papillomavirus;
streptococci;
staphylococci;
mycoplasma;
chlamydia;
ureaplasma;
Mycobacterium tuberculosis;
pathogenic fungus candida.

Of all the bacteria listed, only gonococcus is aggressive enough to penetrate through the cervical mucus into the cervix and cause inflammation in it. Most other pathogens require additional factors that undermine the immune system and reduce protection:

childbirth, abortion, miscarriage;
surgical intervention, endoscopic examination of the uterus, appendages;
HIV infection;
malformations of the reproductive system;
chronic infectious and somatic diseases;
hormonal imbalance;
menopause;
prolapse of the uterus and vagina;
traumatic sexual intercourse;
the use of irritating compounds for personal hygiene and contraception (one of the exotic methods is douching with lemon juice).

Immune cells completely or partially eliminate the pathogen. In the first case, the disease goes away completely, and in the second it goes into a chronic stage. Some microorganisms hide inside epithelial cells for years and periodically cause exacerbation of the disease.

The outcome of inflammation is complete restoration of the cervix or excessive growth of connective tissue in it with the formation of adhesions. Prolonged cervicitis can lead to thickening of the cervical epithelium and blockage of the mouths of the mucous glands in its thickness. In this case, the secretion accumulates inside the gland, gradually stretching it, which is why a cyst is eventually formed. This type of cervicitis is called cystic (follicular).

Types of pathology

Cervicitis is a broad pathology, so doctors, for convenience and to understand the causes of the process, divide it into different types. According to the duration of the flow, they are distinguished:

acute – lasts no more than 6 months;
chronic – lasts more than six months.

Depending on the cause, cervicitis can be:

specific - it is caused by pathogenic bacteria (gonorrheal, viral, chlamydial, ureaplasma);
nonspecific - develop under the influence of opportunistic microorganisms (staphylococcal, streptococcal, candidal). Often the cause of inflammation is an association of bacteria - several types are isolated at once.

Nonspecific cervicitis is a consequence of a hormonal imbalance or immune defense of the body. A specific one can develop against the background of complete health, if the pathogen is quite aggressive and enters the vagina in large quantities. Candidal cervicitis develops only against the background of severe immunodeficiency, for example, in women infected with HIV. Cervicitis is often observed during pregnancy.

In women during menopause, atrophic cervicitis develops, associated with a decrease in the concentration of estrogen in the blood. The secretory epithelium of the cervical canal produces insufficient mucus and becomes thinner, which leads to persistent, low-grade inflammation.

Based on the nature of inflammation, we can distinguish:

purulent cervicitis - the cervical canal is filled with pus, usually caused by gonococcus and opportunistic microflora;
productive – healing processes predominate through excessive formation of connective tissue – scars, septa;
proliferative - chronic inflammation leads to the proliferation of the epithelium of the cervical canal with the formation of polyps.

Occasionally, cervicitis is allergic in nature. An inflammatory reaction can develop to latex, spermicides, and intimate lubricants.

How does the disease manifest itself?

The symptoms of cervicitis are so nonspecific and vague that the patient often does not pay attention to them and misses the acute stage of the disease. It may manifest itself:

Signs of chronic cervicitis are quite difficult to track. It proceeds through stages of complete calm and exacerbations, and inflammation when the disease is activated is expressed very moderately. The main symptoms of ill health that attract attention are vaginal discharge - cloudy, mucous, white or yellowish in color, practically odorless. Pain during friction during sex is also possible.

Occasionally, a long delay in menstruation develops if the walls of the cervical canal are completely fused with each other. Chronic cervicitis is usually found during a screening examination, since often a woman does not have any signs of the disease.

How does inflammation affect pregnancy?

The cervical canal passes directly into the uterine cavity, as a result of which it is in close contact with the developing child, its membranes and waters. At a short stage of pregnancy, an ascending infection from the cervix can lead to damage to the embryo, its death and miscarriage.

At later stages, pregnant women also remain at risk of infection of the fetus, due to which it may lag behind in development or even die. In addition, there is a risk of developing cervical insufficiency. The cervix, thinned by many years of inflammation, is not able to withstand the pressure of a growing child and opens prematurely. This leads to premature birth and often to the loss of the baby.

Is it possible to get pregnant with cervicitis if the inflammation of the cervix has been going on for a long time? If the cervical canal is intact, there is no obstacle to the passage of sperm and pregnancy can occur naturally. If the processes of formation of adhesions, scars predominate, or complete fusion of the walls of the cervix occurs, then the woman becomes infertile. Such infertility is considered reversible: the patency of the cervix is restored surgically.

How is cervicitis diagnosed?

The diagnosis is made by a gynecologist based on examination of the woman, collection of anamnesis and familiarization with the symptoms of the disease. Cervicitis is supported by the patient's fertile age, frequent change of sexual partners, neglect of condoms, and recent venereal disease. Moderate pain or its complete absence, unusual vaginal discharge also indicate inflammation of the cervix.

During a chairside examination, the doctor examines the vagina and cervix using a speculum. He sees inflammation of the vaginal portion of the cervix as bright red erosion on its surface. Unlike true erosion, the cause of which is a change in the type of epithelium on the cervix, cervicitis leads to the appearance of pseudo-erosion. It is inflammatory in nature, but the epithelium remains the same - flat multirow.

Gonorrheal lesions manifest themselves clearly: the cervix is swollen, bright red, and pus oozes from the cervical canal. Trichomonas infection is characterized by a granular appearance of the ectocervix, in appearance it resembles a strawberry. Herpetic cervicitis occurs with severe inflammation: the cervix is red, a focal erosive process develops on its surface - an analogue of bubbles with liquid in herpes of a different localization. Bacterial cervicitis, caused by nonspecific microflora, also leads to the development of obvious inflammation with swelling and redness of the cervix.

Acute cervicitis leads to pain during doctor manipulation of the cervix, so taking a smear can be unpleasant and painful. The gynecologist uses a special small brush to scrape epithelial cells from the cervical canal, the analysis of which provides rich information. I use the resulting material for microscopy - a cytogram of cervicitis is compiled. It is dominated by inflammatory cells (leukocytes), destroyed or modified epithelial cells.

The smear is also plated on nutrient media to grow bacterial or fungal colonies. Next, they are examined to determine the microflora and its sensitivity to drugs. It takes at least 3-5 days before results are obtained, so they are usually used to adjust previously prescribed therapy.

In case of persistent chronic cervicitis, a small piece of tissue is taken for analysis - a biopsy. The material is examined under a microscope and in special analyzers. A sign of chronic inflammation is lymphocytic cervicitis, in which the submucosal layer is filled with immune cells (lymphocytes).

Treatment of pathology

Treatment of cervicitis allows you to eliminate the cause of the disease, stop the inflammatory reaction, and restore the woman’s reproductive function. It is carried out on an outpatient basis; hospitalization and sick leave are usually not required. If an STI is detected, both partners should be treated.

Treatment regimen for different types of cervicitis:

for bacterial infections - treatment with antibiotics (Neomycin, Metronidazole suppositories), combined anti-inflammatory and antibacterial drugs (Terzhinan). After sanitation, suppositories with beneficial lactobacilli are prescribed to restore normal microflora (Acilact);
for fungal infections, use antimycotics: Fluconazole orally, Natamycin tablets, econazole suppositories in the vagina;
for chlamydial infection, a combination of several antibiotics (Tetracycline + Azithromycin) is prescribed for a period of at least 21 days;
with atrophic inflammation, the introduction of suppositories, creams, and gels containing estriol (Divigel) into the vagina helps.

Cysts, adhesions, adhesions, and polyps of the cervical canal are surgically removed to restore patency of the cervix.

Since cervicitis and erosion (pseudo-erosion) are essentially the same disease, after treatment the woman needs to be observed by a gynecologist and undergo treatment. The inflammatory process of the cervix increases the risk of developing cancer, but a thorough examination using colposcopy can detect it in its earliest stages and successfully eliminate it.

is an inflammation of the cervical tissue caused by bacteria, viruses or other pathogens, which can occur in acute or chronic form. Clinical symptoms are often absent; discharge, itching, burning, and pain are possible. For diagnosis, a smear from the external pharynx, simple and extended colposcopy are used. Bacteriological methods and PCR diagnostics help to identify the pathogen; the condition of the cervix is additionally assessed using ultrasound. Treatment is carried out with medications; destructive and surgical methods are used according to indications.

General information

Cervicitis is more often detected in women 19-45 years old who are sexually active. Inflammation rarely occurs in isolation. The cervix forms a single system with the vagina and vulva, so cervicitis is combined with vulvitis and vaginitis. The pathology is found in 70% of women of reproductive age; the exact prevalence has not been established due to the possible asymptomatic course of the disease. Chronic cervicitis, combined with infection with the human papillomavirus (HPV), increases the risk of developing neoplastic processes of the cervix.

Causes of cervicitis

In healthy women, mucus from the cervical canal acts as a protective factor that prevents the growth of pathogenic microflora. Infection prevents normal vaginal biocenosis and the production of lactic acid by Dederlein's bacilli. If their content decreases, conditions arise for the proliferation of opportunistic flora or the penetration of pathogens. The following types of infection lead to symptoms of cervicitis:

Opportunistic microorganisms. They are the main cause of the disease. Gram-negative flora (Klebsiella, Escherichia coli, enterococci), non-clostridial anaerobes (Proteus, Bacteroides) are more often detected. Staphylococci and streptococci may be detected.
Viruses. In women with symptoms of chronic cervicitis, HPV is diagnosed in 80% of cases. A viral infection is characterized by a subclinical or latent form; sometimes the pathogen is detected only during an in-depth examination. Cytomegalovirus, herpes virus, and less commonly adenovirus can also act as a pathogenic agent.
Chlamydia. They are the causative agent of acute cervicitis. Found in 45% of patients. In its pure form, chlamydial infection is not typical for the symptoms of chronic inflammation; its association with obligate flora is more common.
Trichomonas. They are detected in 5-25% of women who visit a gynecologist with symptoms of inflammation. Cervicitis often occurs with minimal signs of infection. The peak incidence occurs at the age of 40 years.
Gonococci. They cause acute vaginitis and cervicitis, which can be combined with symptoms of urethritis. In chronic infections, they are detected in 2% of patients. They often spread to the overlying parts of the reproductive system, which causes a combination of symptoms of cervicitis with manifestations of chronic endometritis and adnexitis.
Candida. A fungal infection develops when immune factors are reduced and the vaginal biocenosis is disrupted. Candidal cervicitis is complemented by symptoms of colpitis. Exacerbations can be provoked by chronic diseases, antibacterial therapy, and hormonal changes.

The cause of the disease can be pathogens of syphilis and tuberculosis. Sometimes there is a combination of several infections. Risk factors for the development of cervicitis are abortions and any traumatic manipulations that damage the cervix. The likelihood of pathology increases with cervical ectopia or ectropion. The spread of sexually transmitted infections is facilitated by low sexual culture, frequent changes of sexual partners, and refusal of barrier contraception.

Pathogenesis

The exocervix performs a protective function. Its cells contain lumps of keratin, which provide mechanical strength, and glycogen is a nutrient substrate for the vaginal microflora. The cylindrical epithelium of the endocervix performs a secretory function; it secretes mucus, the composition of which changes in each phase of the cycle. The peculiarity of the secretion is the content of immunoglobulins.

With a decrease in protective functions and cervical injury, pathogenic microorganisms penetrate the epithelium of the exo- or endocervix. After the alteration stage, desquamation of the surface epithelium begins, the basement membrane is exposed, and the glands are damaged. The composition of the secretion changes, as a result, intercellular contacts are disrupted, and immune cells are activated: macrophages, lymphocytes, histiocytes. The inflammatory reaction leads to a disruption of the nuclear-cytoplasmic ratio in cells.

When acute cervicitis transitions to chronic, the infection penetrates into the deep layers of tissue, and destructive changes are observed in the cells. Cellular regeneration is activated, while apoptosis is slowed down, which leads to the appearance of young undifferentiated cells. When chronic cervicitis is combined with papillomavirus, dysplastic changes occur that can develop into cancer.

Classification

Cervicitis is classified based on the clinical and morphological picture and the characteristics of the course of the disease. The duration of the inflammatory process and its prevalence are taken into account. Particular attention is paid to the severity of changes in the stromal and epithelial components of cervical tissue. The type of cervicitis can be determined during colposcopy and using histological examination:

Acute cervicitis. Characterized by severe symptoms of an inflammatory reaction, serous-purulent discharge. The mucous membrane of the cervix is edematous, prone to bleeding. The pathology can be focal, when delimited round foci appear on the surface of the exocervix, and diffuse, when inflammation spreads to a significant part of the cervix.
Chronic cervicitis. Cervical hypertrophy is observed, thickened folds of the mucous membrane of the cervical canal are formed. Cells are dystrophically changed. With endocervicitis, there is no hyperemia around the external pharynx, cloudy mucus is secreted, sometimes mixed with pus.

The structure of the outer part of the cervix differs from the mucous membrane of the endocervix. Outside, the epithelium is multilayered flat, in the cervical canal it is cylindrical. The inflammatory reaction may involve one of these areas, then cervicitis is classified as follows:

Endocervicitis. An inflammatory reaction that occurs in the cervical canal.
Exocervicitis. The epithelium of the vaginal part of the cervix became inflamed.

The etiological classification of cervicitis is based on the types of pathogens that cause inflammation. It is necessary for choosing a method of therapy, correctly selecting medications and determining the prognosis. The type of infection can be assumed from the colposcopy picture; confirmation is obtained by culture or PCR. The following types are distinguished:

Nonspecific cervicitis. Symptoms appear when obligate microflora multiply (Escherichia coli, staphylococci, streptococci), as well as during hormonal changes in the body.
Specific cervicitis. Manifestations of pathology occur after infection with sexually transmitted infections. More often it is chlamydia, trichomoniasis, gonorrhea, HPV. Less commonly, specific cervicitis develops with syphilis and tuberculosis.

Symptoms of cervicitis

Symptoms are often absent; manifestations depend on the nature of the course and the type of pathogen. In acute cervicitis, mucous or purulent discharge appears. Symptoms are more pronounced when cervicitis is combined with colpitis. The discharge is accompanied by itching and burning, discomfort when urinating. Pain during sexual intercourse sometimes bothers me. Pulling or aching pain in the lower abdomen, in the lumbosacral region, is rare.

The signs of chronic cervicitis are similar, but less pronounced. Exacerbation of the process is provoked by menstruation, hypothermia, and a change of sexual partner. Sometimes painful sensations over the womb persist without exacerbation and intensify during intimate relationships. A characteristic symptom of chronic inflammation is contact bleeding. Spotting is observed after sex, examination by a doctor, or taking a smear.

The causative agents of nonspecific cervicitis give approximately the same symptoms; for specific infections, the clinical picture may vary. The chlamydial process is often asymptomatic and quickly becomes chronic. Gonorrheal cervicitis is characterized by striking symptoms: copious purulent discharge, dysuric disorders. When infected with Trichomonas, greenish discharge and an unpleasant odor appear.

There is no deterioration in the general condition with cervicitis. An increase in temperature, abdominal pain, and signs of intoxication indicate the spread of infection to the uterus and appendages. If cervicitis is detected simultaneously with vaginitis, endometritis, salpingitis, the amount of discharge increases and the pain syndrome intensifies. Symptoms of cervicitis are often nonspecific, making it difficult to suspect inflammation of the cervix.

Complications

The danger is posed by severe, protracted course of cervicitis and lack of timely treatment. Severe chronic inflammation provokes ulceration of the cervix; upon healing, scar tissue is formed, which deforms the cervix and leads to stenosis of the cervical canal. This becomes a risk factor for infertility. Cervix stenosis causes complications during childbirth, the cervix loses its ability to open, and ruptures form.

Infection from the endocervix often spreads to the endometrium and further upward to the appendages, causing inflammation of the pelvic organs, which over time leads to menstrual irregularities and infertility. Chronic cervicitis without treatment leads to the development of dysplasia. This is a precancerous disease, which is characterized by the appearance of atypical cells. Of particular danger is the combination of inflammation with the detection of HPV of high oncogenic risk.

Diagnostics

An obstetrician-gynecologist examines women with cervicitis. If gonorrhea is suspected, a dermatovenerologist is involved in diagnosis and treatment. The absence of symptoms in the acute stage often leads to a delayed start of treatment due to untimely examination. To confirm the diagnosis, a combination of several diagnostic methods is used:

Gynecological examination. In the speculum, in the acute type of cervicitis, an inflamed, hyperemic cervix is detected. Petechial hemorrhages may appear on the exocervix. Touching with a tampon causes bleeding. With endocervicitis, the external pharynx protrudes in the form of a bright red rim. Mucopurulent discharge may be noticeable.
Vaginal smear. The composition of the microflora is examined - with cervicitis, the number of lactobacilli is reduced, cocci are present, gonococci and intracellularly located Trichomonas can be detected. The number of leukocytes is increased, there is a lot of mucus.
PAP test. In a cytological smear from the exo- and endocervix, signs of dyskeratosis may appear, which disappear after treatment - this distinguishes cervicitis from neoplasia. Epithelial cells have signs of cytoplasmic degeneration and hypertrophied nuclei. If symptoms of dysplasia are detected, a biopsy is necessary.
Colposcopy. After treatment with acetic acid, cervicitis is manifested by whitening of the epithelium and fine red punctures. Treatment with Lugol's solution normally causes brown spots to appear; this does not happen with cervicitis. The epithelium looks embossed. Finely speckled iodine staining may persist.
Biopsy. For histological examination in patients with chronic cervicitis, a section of the epithelium is taken during colposcopy. Symptoms of acute inflammation are a contraindication for biopsy.
PCR diagnostics. The DNA of the causative agents of cervicitis is determined. The method is valuable for diagnosis in the absence of pronounced clinical symptoms and minimal changes in the cervix. Using PCR, papillomaviruses are detected and their oncogenic type is specified.

Treatment of cervicitis

The goal of treating pathology is to suppress the inflammatory process using etiotropic antibacterial, antiviral, and antifungal therapy. Immunomodulatory drugs can be used at the same time. Treatment is carried out by local or systemic means with subsequent restoration of the vaginal biocenosis.

Conservative therapy

In an acute process, treatment is selected depending on the type of pathogen. Local exposure is allowed for candidiasis infection and nonspecific inflammation. If there are symptoms of chlamydial, trichomonas or viral cervicitis, systemic therapy is necessary. For etiotropic treatment, the following groups of drugs are used:

For candidiasis. Clotrimazole, nystatin vaginal tablets, and butoconazole cream can be used locally in the form of suppositories or cream. In some cases, treatment is carried out with fluconazole capsules. For manifestations of candidal colpitis and cervicitis, anti-relapse therapy is carried out more often than 4 times a year after suppressing the acute process.
With chlamydial cervicitis. Local treatment is ineffective; systemic antibacterial therapy is prescribed. The drug of choice is azithromycin. Alternative agents belong to the groups of tetracyclines, macrolides, and quinolones. After completing the course, monitoring of cure is necessary.
For trichomonas. Trichomonas are protozoan microorganisms; a drug with antiprotozoal action, metronidazole, is used against them. If trichomonas are resistant, detected in 2-5% of women, tinidazole is prescribed.
For gonococcal infection. When determining the symptoms of gonorrheal cervicitis, broad-spectrum antibiotics are used. 3rd generation cephalosporins in combination with azithromycin are recommended. The second line drug is doxycycline. Treatment is provided to both sexual partners.
For HPV. A unified antiviral treatment regimen has not been developed. The drug based on inosine pranobex has proven itself well. It is used in long courses simultaneously with immunocorrection using suppositories with interferons.
For herpes. The main drug that suppresses the activity of the herpes simplex virus is acyclovir. It is used in the acute phase in the presence of clinical symptoms - vesicles with liquid contents on the exocervix. An additional line drug is famciclovir.
For mixed infection. Most often, during exacerbations of chronic cervicitis, a combination of nonspecific microflora and fungi occurs. Combination drugs are prescribed, including antibiotics of different groups and antimycotics.

Subsequent restoration of the microflora is carried out with local preparations, which include lactobacilli. Treatment results can be improved by eliminating the causes of cervicitis and correcting neuroendocrine changes. Lifestyle changes, dosed physical activity, and proper nutrition help. Treatment is effective using physiotherapy methods: diadynamic currents, magnetotherapy, electrophoresis.

Destructive methods

Methods of destructive treatment of cervicitis are used only when inflammation is combined with other background processes in the cervical area. For symptoms of papillomatosis, polyps, leukoplakia, ectropion, true erosion in nulliparous women, gentle methods are first used. If they are ineffective, additional examination is carried out and the approach is changed. Treatment is allowed in the following ways:

Chemical cauterization. It is performed with preparations that are solutions of acetic, nitric, and oxalic acid. Medicines are applied to a swab and applied to the lesion. This type of treatment does not lead to the formation of scarring and is well tolerated.
Cryodestruction. A solution of liquid nitrogen or carbon is used. A prerequisite for treatment is that the size of the lesion must correspond to the diameter of the cooling nozzle, therefore the technique is not indicated for diffuse exocervicitis. After exposure to liquid nitrogen, pathological cells freeze out. The tissues do not scar or deform during healing.
Laser vaporization. Pathological areas on the cervix are precisely removed using a laser, which heats up the altered cells and leads to their death. The treatment method does not cause severe complications, scar deformation of the cervix, and can be used in nulliparous patients.
Radio wave treatment. Produced by the Surgitron device. The procedure is painless, and a delicate young epithelium is formed in place of the changed tissues. During treatment, healthy cells remain intact, radio waves affect only the pathological epithelium.
Argon plasma ablation. It is carried out contactlessly using radio waves enhanced by the action of the inert gas argon. The procedure can be prescribed to women of any age, including those planning pregnancy. Healing is fast, rough scars are not formed.

Surgery

Surgical treatment of cervicitis is recommended in case of simultaneous diagnosis of dysplasia, cervical polyps or papillomatosis. The indication for surgery is cicatricial deformity of the cervix. Hospitalization to the gynecology department is required. Cervical polyps are removed and the bed is cauterized with liquid nitrogen. Other treatment methods may also be used:

Loop electrosurgical excision. It is carried out after relief of acute inflammation of the cervix. Using an electric loop, the altered area of tissue is removed, while the vessels are sealed, which reduces the risk of bleeding. The resulting tissues are examined histologically.
Knife conization of the neck. Performed using a scalpel. A cone-shaped section of tissue is removed, with its apex directed into the cervical canal. The operation can be complicated by bleeding, and is rarely used today. After manipulation, the resulting tissues are sent for histological analysis.

Prognosis and prevention

With timely treatment, it is possible to eliminate the symptoms of cervicitis and prevent it from becoming a chronic disease and the appearance of complications. Prevention involves preventing infection with STIs. It is necessary to refrain from casual sexual contacts and use barrier contraception. You can prevent cervical injury by not having abortions. If it is necessary to terminate a pregnancy, it is safer to carry out the procedure early with medication.

Since the vulva, vagina and cervix form a single ecosystem, then cervicitis are rarely isolated. They are often combined with vulvitis, vaginitis, and sometimes with salpingo-oophoritis and endometritis.

The cervix is the third biological barrier in the biological protection of the woman’s reproductive system from infections. Protection is provided by the narrowness of the cervical canal and the presence of mucous secretion, which contains a large number of immune factors and has a bactericidal effect.

Causes of cervicitis

Conditions that violate barrier defense mechanisms:

cervical ruptures, which cause gaping of the external pharynx or the appearance of ectropion, which disrupts the bactericidal properties of cervical mucus, as well as the narrowness of the cervical canal;
uncontrolled use of disinfectants that destroy the saprophytic autoflora of the vagina;
intrauterine contraceptives
improper use of tampons, which adsorb blood and create optimal conditions for the rapid proliferation of pathogenic microorganisms.

The occurrence of inflammatory processes is facilitated by:

extragenital pathology, including metabolic disorders;
chronic infections;
ovarian hypofunction;
stressful conditions.

Classification of cervicitis

According to localization they distinguish:

exocervicitis(damage to the vaginal segment of the cervix);
endocervicitis(damage to the inner lining of the cervical canal of the cervix).

According to the clinical course there are spicy and chronic cervicitis, according to the type of lesion - focal and diffuse.

In acute cases, the patient experiences copious mucopurulent discharge, less often dull pain in the lower abdomen, swelling and hyperemia of the cervix, minor hemorrhages and even possible erosive damage to the mucous membrane. Often cervicitis occurs in an erased form in the absence of pronounced symptoms. In this case, it is detected during an examination by a gynecologist.

Exocervicitis, which was not promptly identified and treated in the acute stage, turns into a protracted chronic process. The discharge becomes cloudy and mucous. It is possible that the mucous membrane of the cervical canal is also involved in the pathological process, with the development of proliferative changes, which can be localized near the external pharynx and be mistaken for small polyps, as well as resemble pseudo-erosion of the cervix. Inflammation can also spread to surrounding tissues to form cysts.

There are cervicitis:

nonspecific(caused by opportunistic flora, which can be found in small quantities in the vagina of a healthy woman, but if concomitant additional risk factors occur, this flora can become pathogenic and cause an inflammatory process);
specific(caused by pathogens of sexually transmitted infections. The most common are chlamydia trachomatis, mycoplasma genitalium, neisseria gonorrhea, trichomonas vaginalis, treponema pallidum, Koch bacillus, herpes simplex virus, human papillomavirus and others).

Recently, the number of cervicitis associated with mixed infections has increased, which is extremely difficult to treat due to developing antibiotic resistance and immune disorders. At the same time, gram-negative and gram-positive obligate anaerobic microorganisms are most often detected in chronic inflammation of the cervix, and Escherichia coli, Proteus, Klebsiella, and enterococci are also often detected.