Chronic endocervicitis is an infectious inflammatory disease of the mucous membrane of the cervical canal, lasting from two months or more. It is characterized by poor clinical symptoms: an increase in the number of mucous vaginal secretions with the appearance of an admixture of pus in them and pulling pains in the lower abdomen. For the diagnosis of endocervicitis, examination in mirrors, extended colposcopy, transvaginal ultrasound, laboratory tests are used. During treatment, etiotropic antimicrobials, eubiotics, immunocorrectors, and physiotherapy are prescribed. According to the indications, minimally invasive surgical interventions, tracheloplasty and radioconidation are performed.
N72 Inflammatory disease of the cervix
Chronic cervicitis is one of the most common gynecological diseases. Due to the asymptomatic course, their true prevalence is extremely difficult to establish. Usually, inflammation of the endocervix is detected during routine occupational examinations or when contacting about other diseases of the reproductive sphere.
Women of childbearing age are most susceptible to the disease (up to 70% of patients with an established diagnosis), cervicitis occurs somewhat less frequently in perimenopause and in exceptional cases — in girls before menarche. The importance of timely diagnosis and treatment of chronic inflammatory disease of the cervix is due to the increased risk of inflammation spreading to the uterus with appendages and malignant degeneration of the affected endocervix.
The disease develops against the background of an untreated or undiagnosed acute inflammatory process and is caused by various microorganisms or their associations. Inflammation in the endocervix occurs with the participation of the following infectious agents:
- STI pathogens. According to the research results, the chronic inflammatory process in the cervical canal in half of the patients is caused by pathogens of chlamydia. The cause of the disease can also be herpes simplex viruses, human papillomavirus (HPV), gonococci, ureaplasma, mycoplasma, pale spirochetes.
- Conditionally pathogenic flora. Nonspecific inflammation occurs more often with pathological activation of gram-negative aerobes (enterococci, Escherichia, klebsiella, protea) and non-clostridile anaerobes (bacteroids and peptococci). Staphylococci, streptococci, Clostridium, Gardnerella are also sown from the source of infection.
Predisposing factors play an important role in the transition of the disease from the acute to the chronic phase. Chronization of the process provokes:
- weakening of immunity during prolonged physical exertion, stress, hypothermia, various diseases and taking immunosuppressants;
- cervical injuries during invasive procedures;
- constant irritation with the intrauterine device, contraceptive caps and diaphragms; chemical agents (acidic douching solutions, spermicides, low-quality latex).
The risk group consists of women with cervical and vaginal prolapse, as well as patients who lead a promiscuous sexual life without barrier contraception.
In the chronic course of endocervicitis, sluggish inflammation is constantly maintained in the focus of infection, penetrating into the parabasal and basal layer of the epithelium. At the same time, the direct damaging role of microorganisms decreases, and the leading ones are a decrease in local immunity and metaplastic processes. This leads to the development of a complex vascular-mesenchymal reaction, replacement of a part of the cylindrical epithelium with a flat one, infiltration and compaction of muscle and connective tissue.
The secretory activity of epithelial cells remains elevated, which, when the mouths of the cervical glands are blocked, contributes to the formation of nabot cysts. There is an accelerated renewal of epithelial cells with a slowdown in their differentiation, a progressive decrease in apoptosis and an increase in atypia. In some patients, the process is recurrent with periodic exacerbation.
The forms of chronic endocervicitis are the same as in the acute inflammatory process. The main classification criteria are:
- Type of infectious agent. The inflammatory process can be specific, resulting from infection with STIs, and nonspecific, caused by natural microflora during its pathological activation.
- The prevalence of inflammation. With focal (macular) endocervicitis, separate areas of the endocervix are affected, with diffuse, the entire epithelium is involved in the process. Chronic endocervicitis is usually diffuse.
Symptoms of chronic endocervicitis
The clinical picture of the disease is characterized by extremely poor symptoms. In most cases, chronically occurring endocervicitis becomes an accidental finding during a planned or unscheduled gynecological examination. Usually, patients note a slight increase in the volume of vaginal discharge and a change in their nature. The whites become cloudy, thick, sometimes they have an unpleasant smell or streaks of blood appear in them.
With an exacerbation of inflammation, a woman may be disturbed by dull, pulling, aching pains in the lower abdomen, itching and burning in the area of the external genitals. Sometimes the only sign of a long-term inflammation in the cervical canal is infertility or a habitual miscarriage.
Due to the decrease in the protective properties of the mucous plug and the presence of a permanent focus of inflammation, the risk of developing endometritis, salpingitis, adnexitis with long-term consequences in the form of infertility and miscarriage increases. In two thirds of cases, chronic endocervicitis is accompanied by ectopia of the cervix. According to experts in the field of gynecology, with this disease, the probability of tissue malignancy increases significantly. Inflammation of the endocervix plays a role in the development of obstetric pathology with intrauterine infection of the fetus and its membranes, premature discharge of amniotic fluid, postpartum purulent-septic complications.
Due to the nonspecific nature of symptoms, the data of physical, instrumental and laboratory studies are of primary importance when making a diagnosis. A patient with suspected chronic endocervicitis is undergoing:
- Examination on a chair. When examined in mirrors, the external pharynx of the cervical canal is hyperemic, the cervix is edematous. Areas of increased bleeding, mucous and purulent-mucous discharge may be detected.
- Extended colposcopy. The vessels of the epithelial layer of the cervix are dilated, foci with vascular loops are revealed. The mucous membrane looks edematous. Other pathological processes can be determined (pseudo-erosion, erosion, etc.).
- Laboratory tests. To determine the causative agent of the disease, microscopy and smear culture (with an antibioticogram), PCR diagnostics, special serological methods (RIF, ELISA) are carried out.
- Cytology of a smear from the cervical canal. Allows you to assess the degree of involvement in the inflammation of endocervix cells. The analysis is effective for early detection of dystrophic, dysplastic processes, atypia and possible malignancy.
- Ultrasound of the cervix. The cervix is enlarged in size, thickened. In its structure there are hypoechoic inclusions (nabote cysts). The method allows to exclude or timely detect combined cervical cancer.
Differential diagnosis is performed with ectopia and cervical cancer, tuberculosis lesion. In difficult cases, consultations are prescribed by an oncogynecologist, a phthisiologist.
Treatment of chronic endocervicitis
With a confirmed diagnosis of chronic inflammation of the endocervix, a comprehensive etiopathogenetic approach is recommended. Conservative therapy is preferred, the main objectives of which are:
- Elimination of the source of infection. Taking into account the sensitivity of the causative agent of the disease, antibiotics, antifungal, anti-trichomonas, anti-chlamydia and other drugs are prescribed. Usually, oral administration of drugs and their parenteral administration are supplemented with local exposure (vaginal candles, etc.).
- Restoration of vaginal biocenosis. Due to chronic inflammation and the use of antimicrobial agents in the vagina, the normal balance of microorganisms is disturbed. Timely administration of eubiotic drugs allows to prevent relapses of endocervicitis and activation of opportunistic flora.
- Immune-correcting therapy. Since immunodeficiency often becomes the background for the development of the disease, vitamin and mineral complexes and immune stimulants are shown to patients. Their use makes it possible to increase general and local resistance to infectious agents, as well as normalize the immune response.
In the treatment of chronic endocervicitis, a combination of medication and physiotherapy is effective. Physiotherapy techniques enhance the anti-inflammatory effect of antibacterial agents and accelerate the repair processes. Patients are prescribed:
- low-frequency and high-frequency magnetotherapy;
- magnesium electrophoresis in the uterine zone;
- diadynamic currents;
- vaginal laser therapy;
- darsonvalization through a vaginal electrode;
- mud tampons.
In some cases, conservative treatment of endocervicitis is supplemented with surgical methods. When a large number of nabotovye cysts are detected, in which the pathogen may persist, diathermopuncture is performed. With persistent flow, cryodestruction, laser vaporization, and radiocoagulation are shown. If chronic inflammation is combined with cervical deformity, epithelial dysplasia or elongation, radioconidation and tracheloplasty may be performed.
Prognosis and prevention
Despite the need for long-term treatment, the prognosis for chronic endocervicitis is favorable. Relapse of the disease is possible only with a persistent decrease in immunity and the presence of inflammation in other parts of the female genital area. For prevention, timely adequate treatment of acute endocervicitis, regular examinations by a gynecologist, an orderly sex life, barrier methods of contraception (especially with frequent changes of sexual partners) are recommended. The goals of secondary prevention are to prevent complications of the disease, primarily the development of malignant neoplasia and infertility.