What is cervicitis and how is it treated?
When a woman comes to a gynecologist with symptoms of pelvic inflammatory disease, in 60-70% of cases, the symptoms are caused by cervicitis. However, the disease is often asymptomatic; many women do not notice any pathological changes. But at the same time, protracted inflammatory processes can become the basis of many problems and complications. Therefore, a healthy lifestyle, regular check-ups, timely detection, and treatment of problems is women's health.
Short information about cervicitis
Cervicitis is an Inflammation of cervix (neck of tissue that connects the vagina and uterus) of an infectious or non-infectious origin. Clinically, inflammation can be located on the vaginal part of the cervix - exocervicitis, or on the mucous membrane of the cervical canal - endocervicitis.
It occurs in women of different ages living a regular and irregular sex life. It must be understood that the vagina, vulva and cervix form an integral structure, so inflammation often occurs in conjunction with vulvitis or vaginitis.
The disease can be:
- Acute or chronic,
- Focal or diffuse,
- Specific (infectious) or non-specific, due to opportunistic vaginal flora and hormonal disruptions in the body.
Among the latter, special attention is paid to the use of contraceptives locally and douching with vaginal solutions to prevent pregnancy.
The main reason for the transition from acute to chronic cervicitis is poorly treated or missed acute process. Complaints and symptoms are practically absent, so the diagnosis of cervicitis is established at a scheduled appointment with a gynecologist.
It occurs due to gross interference in the process of childbirth, as a result of tearing of cervix with the dry birth canal. Cervicitis is actively developing simultaneously with endometritis and vaginitis. When examining the vagina in the mirror, hemorrhages, and wounds are found.
Reasons for the disease appearance
Normally, normal microflora is present in the vagina with a predominance of anaerobic bacteria over aerobic ones, which determines the protection of tissues from exposure to pathogenic factors. In the protection of the body is involved cervical mucus with a high concentration of bactericidal substances that prevent the penetration of inflammatory agents into the uterus. Violations arise due to the destruction of the anatomical and physiological defense mechanisms.
Causes of the disease:
- Viruses. In 75% of cases, the activity of the human papillomavirus (HPV) contributes to the disease development. The causative agent is difficult to detect due to the latent form of the course of the viral disease, however, modern PCR analyzes have simplified this task. In addition to HPV, cytomegalovirus, herpes virus and adenovirus can be the reason for the inflammation onset.
- Chlamydia. In 37% of women, the cause for the disease development is chlamydia.
- Trichomoniasis is found in 20% of cases of all women suffering from cervicitis. It proceeds in a chronic form, often without characteristic complaints and symptoms.
- Fungal infection. Candida albicans, less often its other forms, is another cause of cervicitis. It occurs as a result of an imbalance of microflora against the background of taking antibiotics, hormonal disorders, and latent chronic diseases.
- Conditionally pathogenic microflora. This is a group of bacteria that inhabit the vagina and do not cause inflammation normally. Cervicitis can develop in cases of careless use of local contraceptives, drugs, due to a general decrease in immunity, and imbalance in the microflora. Most often, in cervicitis, a gram-negative flora is determined (E. coli, staphylococci, streptococci).
- Local contraceptives (more precisely, the incorrect use of them). Incorrect insertion of cervical and intra-cervical contraceptives, the use of chemical spermicides and douching with chemical solutions as contraception can be the reasons for the disease onset.
- Age-related changes. In the premenopausal age, inflammation of the cervix associated with vaginitis with a decreased synthesis of estrogen can develop.
- Individual intolerance of latex can provoke cervicitis.
- Gynecological procedures, gross interventions in childbirth, traumatic childbirth with, abortion, surgical and diagnostic procedures with the expansion of the cervical canal can be the triggers for the disease onset.
- The omission of the pelvic organs.
- Immunodeficiency states reduce the body's ability to resist infections.
Symptoms and signs of cervicitis
The symptoms of cervicitis can be very different:
- In the acute course or exacerbation of the process, purulent discharge with a foul odor appears, complaints of burning and constant itching in an intimate place, discomfort during urination, and pain during coitus occur. Drawing and aching pains over the pubis are less common, but possible.
- In chronic cervicitis, the clinical picture is blurry or absent altogether. The situation is aggravated during menstruation, after hypothermia, with a change of sexual partner. A characteristic diagnostic symptom is bleeding after intercourse or when examined by a gynecologist.
- Gonorrheal cervicitis is manifested by the secretion of mucus and pus, and impaired urination.
- Chlamydia-caused disease is characterized by a rapid change from the acute to chronic asymptomatic form.
- Trichomonial cervicitis is distinguished by secretions of a greenish tint and an unpleasant odor.
Cervicitis and pregnancy
During pregnancy, cervix plays the role of a barrier that protects the uterine cavity and the fetus from exogenous factors. In cervicitis, the infection enters, in an ascending way, through the cervical canal to the embryo.
In the presence of chronic cervicitis, there is a high probability of spontaneous abortion, premature birth and a severe postpartum period.
In the first trimester, the infection provokes intrauterine malformations and primary placental insufficiency, which almost always ends in a miscarriage, a stillbirth, or a delay in the development of the fetus.
In the second and third trimester, through cervicitis, abnormal development of the already developed organs can happen.
When the amniotic fluid is infected (the infection enters the amniotic fluid), it spreads in the chorioamnial space, while the woman’s body reacts with leukocyte infiltration, forms a focus and, as a result, the fetus dies.
Diagnosis of the disease
Often, cervicitis is asymptomatic and is detected during a planned visit to the doctor. To clarify the diagnosis, several research methods are used. All of them are divided into subjective and objective.
1. Subjective diagnostic methods for cervicitis include complaints and a history of the patient. During the conversation, the gynecologist makes the first conclusions about a possible diagnosis.
2. The main, objective method for the study of cervicitis is a gynecological examination. Reddening in the cervix, rash, and slight bleeding after touching the area with swab are the main visual symptoms in the acute course of the process. The nature of the discharge is also determined. They can be mucous and purulent.
3. A swab is a qualitative and quantitative study of the vaginal microflora. In the inflammatory swab, the number of lactobacilli is reduced, coca, gonococcus, trichomonads, or leukocytosis can be found.
4. For a detailed study of cervix tissue, a PAP test is used.
5. Biopsy is a histological examination of cervix tissue. Under local anesthesia, a small fragment of the epithelium is taken from the patient for further study in the laboratory. In acute cervicitis, a biopsy is not performed.
6. For a final confirmation of the diagnosis, colposcopy is performed: the cervical mucosa is treated with acetic acid or an aqueous solution of iodine. In the first case, the affected epithelium turns white, in the second case, the mucous membranes do not stain with iodine solution, which also indicates inflammation.
7. If the pathogen cannot be determined, PCR diagnostics is used for the determination of the DNA of cervicitis virus pathogens. Also, this examination is carried out when the symptoms are not expressed. Using PCR analysis, HPV (human papillomavirus) can be found.
Complications of cervicitis
- Long-term ulcers of the cervix mucosa subsequently lead to the formation of a scar. The neck is deformed, stenosis of the cervical canal develops, provokes complications in the form of ruptures during childbirth.
- Menstrual irregularities and possible infertility due to chronic inflammation of the pelvic organs.
- The appearance of dysplasia is a pre-cancer condition. Often cervicitis combined with HPV is a risk of future uterus cancer. Thus, it is important to catch the disease early and treat it properly.
Cervicitis treatment methods
The basis of any therapy is the relief of the inflammatory phase with the help of medications or manipulations. With cervicitis, both local and systemic treatment is performed, and after – the control tests and the restoration of the vaginal microflora are made.
1. In cervicitis caused by candidiasis, medications are prescribed topically and systemically. Locally are prescribed suppositories or creams with clotrimazole and orally Fluconazole. If candidiasis returns more than once a quarter, anti-relapse treatment is prescribed.
2. In chlamydia, topical treatment makes little sense so oral antibacterial drugs are prescribed such as Azithromycin, macrolides or tetracyclines. After a course of medication, a control laboratory study is performed.
3. In trichomoniasis, Metronidazole is prescribed. If treatment is unsuccessful, then a course of tinidazole is prescribed.
4. Broad-spectrum antibiotics are prescribed for infections caused by gonococcus. Cephalosporins in combination with Azithromycin give good results. The therapy of two sexual partners is carried out simultaneously.
5. Pranobex is prescribed to patients with HPV, in addition to treatment, suppositories with interferon are prescribed to correct immunity. However, to date, there is no approved treatment regimen.
6. For herpetic infections, acyclovir and Famciclovir are used. The main diagnostic sign of cervicitis of herpetic etiology is the presence of vesicles with fluid inside.
7. In chronic cervicitis, non-specific flora and fungi are often associated with each other. In such cases, the doctor prescribes a combination of broad-spectrum antibiotics and antifungal drugs.
8. Physiotherapy. Sometimes, in the treatment of cervicitis, diadynamic current, magnetotherapy and drug electrophoresis are used. After conservative treatment, it is necessary to restore the microflora with medications containing lactobacilli. Gynecologists also advise to change a lifestyle, start doing regular physical exercises, and eat healthily.
Destructive treatments for cervicitis
There are different methods of the inflammation site destruction they are used if inflammation is burdened with concomitant pathology in the cervical region. With papillomatosis, leukoplakia, erosion, in women who are only planning the first pregnancy, destructive methods of therapy are used carefully.
1. Cauterization with solutions of acetic, nitric, oxalic acids. Medicines are administered on tampons in the area of inflammation. Scarring does not occur.
2. Cauterization with liquid nitrogen or carbon - cryodestruction. The peculiarity of the method lies in the fact that the pathological focus should coincide with the size of the instrument, therefore this is contraindicated in the diffuse form of cervicitis. The method is based on the freezing of inflamed tissues, after healing, the epithelium is scarred but not deformed.
3. Laser vaporization. Laser removal that heats and kills pathological cells. The method is widely used in women who are planning a pregnancy.
4. Radio waves. In place of the changed tissues, new epithelial cells are formed that do not affect healthy cells.
5. Argon plasma ablation. Non-contact method using a radio wave enhanced by the influence of argon gas. Suitable for patients of different ages. Rough scars do not form.
6. Surgery. It is used in the simultaneous diagnosis of cervicitis and dysplasia, cervix polyps or papillomatosis. The main indication is cicatricial deformity of the cervix. The operation is carried out exclusively in a hospital.
7. Loop electrosurgical excision. This method of treating cervicitis is available to patients with a chronic course of the disease. A mutated fragment of the epithelium is cut off with an electric loop, small vessels are cauterized, and the resulting material is examined in a laboratory.
To prevent the occurrence of the disease, you must follow these basic rules:
- Appoint annual preventive examinations by a gynecologist.
- Carefully and only after consulting a doctor use oral and topical contraceptives.
- Use of barrier methods of contraception to prevent infection.
Cervicitis is a silent, often asymptomatic disease that occurs in the lives of many women. It is important to identify the disease in a timely manner, to exclude possible complications from the genitourinary system. Properly and on time selected treatment can permanently relieve cervicitis.