Chronic cervicitis is a long—running inflammatory process in the mucous membrane of the vaginal and supravaginal part of the cervix, which in some cases extends to its connective tissue and muscle layer. During remission, the symptoms are limited to an increase in the amount of vaginal discharge. With exacerbation, the volume of secretions increases, they become mucopurulent, the patient notes pains in the lower abdomen. When making a diagnosis, the data of extended colposcopy, bacteriological, serological and cytological analyses, gynecological ultrasound are taken into account. Antibiotics, hormonal drugs, eubiotics, and immune remedies are used for treatment.
N72 Inflammatory disease of the cervix
Chronic cervicitis is one of the most common gynecological pathologies. It accounts for more than half of all cases of identified inflammatory diseases of the pelvic organs. According to experts in the field of practical gynecology, up to a quarter of women of reproductive age suffer from chronic inflammation of the cervix. Taking into account the low-symptom course of the process, the incidence rate may be significantly higher.
About 2/3 of the patients are women aged 25 to 45 years, less often the disease is detected during perimenopause and extremely rarely in girls before the onset of the first menstruation. There is a direct correlation between the risk of developing inflammation and the patient’s sexual activity.
In most cases, chronic inflammation of the cervical mucosa occurs against the background of an untreated acute inflammatory process, but it can develop gradually, without bright clinical signs. There are two groups of causes of cervicitis:
- Infectious agents. The disease is caused by STI pathogens — gonococci, chlamydia, trichomonas, genital herpes viruses and papillomatosis. Cervicitis also occurs when conditionally pathogenic microflora is activated (yeast fungi, staphylococci, streptococci, E. coli, etc.).
- Non-infectious factors. Inflammation complicates cervical injuries, neoplastic processes, allergic reactions to contraceptives, medicines and hygiene products. The reason for the development of atrophic cervicitis is a decrease in the level of estrogen during menopause.
Risk factors play an important role in the occurrence of the disease. Chronic cervicitis is provoked:
- Mechanical damage. The cervix is more often inflamed in patients who have undergone abortions, difficult childbirth, invasive medical and diagnostic procedures.
- Gynecological diseases. Chronic inflammation can develop against the background of vaginal prolapse or spread from other parts of the female reproductive system.
- Promiscuous sex life. Frequent change of partners increases the risk of STI infection. In this case, cervicitis is either the only manifestation of infection, or it is combined with vulvitis, vaginitis, endometritis, adnexitis.
- Decreased immunity. Immunodeficiency in women with severe concomitant pathology or taking immunosuppressive drugs contributes to the activation of opportunistic microorganisms.
- Hormonal imbalance. Inflammation often occurs when taking incorrectly selected oral contraceptives and diseases with reduced estrogen secretion.
- Concomitant diseases. The chronic course of cervicitis is noted in patients with Behcet syndrome, urological and other extragenital pathology.
The development of the disease is determined by a combination of several pathogenetic links. Signs of the inflammatory process are moderately pronounced and localized mainly in the endocervix. The mucous membrane of the cervical canal becomes edematous, thickened, folded. Vascular fullness is noted, lymphohistiocytic inflammatory infiltrates are formed, epithelial cells secrete more mucus.
Regenerative processes slow down in the exo- and endocervix and dystrophic changes occur. Connective tissue elements grow in the lower layers of the mucosa. The outlet openings of the glands are blocked by a flat epithelium with the formation of nabotovye (retention) cysts. As the disease develops, the connective tissue and muscles of the cervix are involved in inflammation.
The cellular and humoral immune systems function imperfectly: the number of B- and T-lymphocytes decreases, T-dependent immune reactions are suppressed, phagocytic activity is disrupted. As a result, the pathogens of infection are able to persist both in the cervical epithelium and in the cells of the immune system. In cervical mucus, the level of immunoglobulins G and M decreases against the background of increased IgA content. Autoimmune processes develop with the phenomenon of “molecular mimicry” between foreign proteins and proteins of their own tissues.
Chronic cervicitis is classified taking into account etiological factors, the degree of prevalence and the stage of the inflammatory process. Based on these criteria, the following forms of the disease are distinguished.
- Chronic specific cervicitis caused by STI pathogens.
- Chronic nonspecific cervicitis that has arisen due to the activation of opportunistic flora or the action of non-infectious factors.
- Chronic atrophic cervicitis, which is manifested by inflammation of the endo- and exocervix against the background of their thinning.
By the prevalence of inflammation:
- Diffuse — involving the entire mucous membrane in the process.
- Exocervicitis — with a lesion of the vaginal part of the cervix.
- Endocervicitis — with damage to the mucous membrane of the cervical canal.
- Macular — with the formation of separate foci of inflammation.
According to the stage of inflammation:
- The period of exacerbation with pronounced symptoms.
- Remission with minimal clinical manifestations.
Symptoms of chronic cervicitis
Usually the disease is asymptomatic. During remission, a woman notes scanty mucous or mucopurulent discharge from the vagina, which becomes more abundant before menstruation or immediately after menstruation. Pain syndrome, as a rule, is absent. Clinical signs are more noticeable during the period of exacerbation. The number of mucous vaginal secretions increases, becoming cloudy or yellowing due to the appearance of pus.
The patient is concerned about discomfort and dull pulling pains in the lower abdomen, which increase during urination and during sexual intercourse. After sex, spotting spotting occurs. If cervicitis is combined with colpitis, a woman complains of slight itching and burning in the vagina.
With untimely or improper treatment, chronic cervicitis is complicated by hypertrophy of the cervix, the appearance of erosions and ulcers on its mucous membrane, polypous growths. The inflammatory process can spread to the vaginal mucosa, bartholin glands, endometrium, fallopian tubes, ovaries, and other pelvic organs. With a chronic course of inflammation, dysplasia occurs more often and the risk of developing cervical cancer increases. Changes in the composition of mucus produced by the epithelium of the cervical canal and anatomical disorders due to inflammation can lead to cervical infertility.
Since the clinical manifestations of chronic cervicitis are nonspecific and usually poorly expressed, the data of physical, instrumental and laboratory studies play a leading role in the diagnosis. For diagnosis, the most informative are:
- Examination on a chair. A slight swelling of the mucous membrane is determined, the cervix looks compacted and somewhat enlarged. In the exocervix area, eroded areas and papillomatous growths are detected.
- Extended colposcopy. Examination under a microscope allows you to clarify the condition of the mucosa, in time to detect precancerous changes and malignant degeneration of the epithelium.
- Laboratory etiological studies. A smear on the flora and sowing with an antibioticogram are aimed at detecting the pathogen and assessing its sensitivity to etiotropic drugs. With the help of PCR, RIF, ELISA, it is possible to reliably determine the type of a specific infectious agent.
- Cytomorphological diagnostics. When examining the scraping of the cervix, the nature of changes and the state of exo- and endocervix cells are evaluated. Histology of the biopsy is carried out according to indications for the timely detection of signs of malignancy.
- Gynecological ultrasound. During the echography, deformed, thickened and enlarged cervix, nabotovye cysts are detected, the oncoprocess is excluded.
Additionally, the patient may be prescribed tests to determine the level of female sex hormones and the state of immunity. Differential diagnosis is carried out with tuberculosis, cancer, ectopia of the cervix. Oncogynecologist, phthisiogynecologist, dermatovenerologist may be involved to clarify the diagnosis.
Treatment of chronic cervicitis
Properly selected complex therapy allows not only to stop the signs of exacerbation, but also to achieve stable remission. As part of the treatment course , the patient is prescribed:
- Etiotropic drug treatment. In the infectious genesis of cervicitis, antibacterial and antiviral drugs are used. When selecting an antimicrobial agent, the sensitivity of the pathogen is taken into account. Hormonal drugs (estrogens) are used in the treatment of atrophic cervicitis in menopausal women.
- Restoration of the vaginal microflora. After a course of antibiotic therapy, eubiotics are recommended locally (in the form of candles, tampons, vaginal irrigation) and inside.
- Auxiliary therapy. To accelerate the processes of mucosal regeneration, strengthen immunity and prevent possible relapses, immunotherapy and phytotherapy, physiotherapy procedures are indicated.
In the presence of retention cysts, radiowave diathermopuncture is prescribed. In cases where conservative treatment is ineffective, or chronic cervicitis is combined with dysplasia, elongation, scar deformation and other diseases of the cervix, surgical techniques are used — cryo- or laser therapy, tracheloplasty, etc.
Prognosis and prevention
The prognosis of the disease is favorable. For timely detection of possible cervical dysplasia, the patient after the course of treatment needs to undergo colposcopy twice a year, take cytological smears and bacposev. Prevention of chronic cervicitis includes regular gynecologist examinations, adequate treatment of inflammatory diseases of the female genital area, reasonable appointment of invasive procedures.
It is recommended to observe the rules of intimate hygiene, regulate sexual life, use condoms (especially during sexual contacts with unfamiliar partners), exclude sex during menstruation. For the prevention of relapses, courses of general restorative and immunotherapy, adherence to sleep and rest, protection from hypothermia of the legs and pelvic area are effective.