Endocervicitis is an inflammation of the mucous membrane of the cervical canal caused by conditionally pathogenic microflora or STI pathogens. The main clinical manifestation of the disease is abundant vaginal discharge, which can be combined with pain in the lower abdomen and back, occurring at rest or during sex. For diagnosis, examination in mirrors, cervical smear studies, extended colposcopy, ultrasound of the pelvic organs are used. Etiopathogenetic treatment is based on the use of antimicrobial drugs and agents that normalize the vaginal microflora, immunity and hormonal background.
ICD 10
N72 Inflammatory disease of the cervix
General information
Endocervicitis is one of the most common gynecological diseases detected in patients of reproductive age (from 20 to 40 years). According to statistics, inflammation of the cervical canal mucosa was observed at least once in half of women. At the same time, in more than 2/3 of patients, the inflammatory process is nonspecific. The high incidence of cervicitis is associated with a general tendency to increase the frequency of inflammation of the female genital organs (colpitis, endometritis, etc.), as well as an increase in the prevalence of immune and hormonal disorders.
Causes of endocervicitis
The main cause of endocervix inflammation is damage to the mucous membrane of the cervical canal by various infectious agents. The causative agents of inflammation are both conditionally pathogenic microorganisms (corynebacteria, staphylococci, streptococci, bacteroids, E. coli, etc.) and STI agents (genital herpes viruses, chlamydia, trichomonas, urea- and mycoplasmas, gonococci, etc.). Predisposing factors play no less a role in the development of endocervicitis than infection:
- Inflammatory processes in the pelvic organs — vulvovaginitis, endometritis, adnexitis, cystitis.
- Traumatic damage to the cervical canal during invasive diagnostic procedures, artificial termination of pregnancy, childbirth.
- Allergic reactions or irritation of the endocervix due to the installed IUD, the use of chemical spermicides, condoms made of low-quality latex, cervical caps and diaphragms, acid douching.
- Atrophic changes due to a decrease in estrogen levels during menopause.
- Violation of the location of the internal female genital organs when the vagina and cervix are lowered.
- General weakening of immunity against the background of somatic, infectious, endocrine diseases, with the use of immunosuppressive drugs.
- Promiscuous sex life without the use of barrier contraceptives.
Pathogenesis
The basis for the development of endocervicitis is gradual inflammation. First, microorganisms penetrate into the branching crypts of the cervical canal. At the same time, the cylindrical epithelium is damaged and exfoliated, the basement membrane is exposed, a mucous secret is secreted from the glands. Tissues are loosened, macrophages, lymphocytes, fibroblasts and other cells are activated, providing an immune response and regeneration. At the final stage, the tissues are restored, however, due to the overlap of the mouths of the cervical glands, in some cases, nabotov cysts are formed.
Since the cervix is a single anatomical and physiological system with the vagina, similar processes can occur in the vaginal mucosa and the vaginal part of the cervix (exocervix). In the chronic course of endocervicitis, epithelial metaplasia with partial replacement of cylindrical cells with flat ones is possible.
Classification
The classification of the disease is based on the features of the course, the severity of clinical manifestations, the degree of spread of the process and the type of pathogen that caused inflammation of the endocervix. In practical gynecology , the following types of endocervicitis are distinguished:
Downstream:
- Sharp: with a clear beginning, pronounced symptoms and visible inflammatory changes detected during gynecological examination;
- Chronic: with an erased clinical picture, minor discharge and slight swelling of the cervix during examination.
By the prevalence of the process:
- Focal (macular): with separate areas of inflammation in the cervical canal;
- Diffuse: involving the entire endocervix in the inflammatory process.
By type of pathogen:
- Nonspecific: caused by conditionally pathogenic microflora (most often vaginal);
- Specific: resulting from infection with sexually transmitted infections (STIs).
A separate type of the disease is atrophic endocervicitis, which is observed in the menopausal period and is manifested, in addition to inflammation, by thinning of the mucous membrane of the cervical canal.
Symptoms of endocervicitis
The disease has no specific symptoms. There are usually no signs of general intoxication (weakness, fever). The main violation in acute cervicitis is a change in the amount and nature of secretions. At the beginning of the disease, whites are released abundantly, become cloudy, turn white, turn yellow, become liquid or viscous. Depending on the causative agent, the discharge may acquire an unpleasant odor. Sometimes a woman feels discomfort in the pelvis, minor or moderate pain in the lower abdomen or back, observed at rest or during sexual intercourse. With concomitant vulvovaginitis, burning, itching and redness of the external genitalia may bother.
A more acute picture is observed in some types of specific endocervicitis. Thus, the inflammatory reaction is especially pronounced in gonorrheic endocervix lesion, accompanied by the formation of multiple periglandular infiltrates and microabsesses.
With untimely diagnosis or improper treatment of acute endocervicitis, the process can become chronic. At the same time, the clinical signs are smoothed out or disappear. The inflammation spreads deeper into the connective tissue and muscle fibers. The cervix looks edematous at first, and over time it becomes hypertrophied and thickened. Pseudoerosion can form on her vaginal part under the influence of constant pathological secretions from the cervical canal.
Complications
The most common complication of acute endocervicitis is the chronization of the disease with less clinical symptoms, but deeper tissue damage and the possibility of pseudoerosion of the cervix. Due to the constant presence of pathogenic microflora (especially with specific inflammation caused by gonococci and chlamydia), the process can spread to the uterus, fallopian tubes and ovaries, followed by the development of adhesions in the pelvis.
As a result, some patients have impaired reproductive function, which is manifested by the difficult onset of pregnancy, an increased likelihood of miscarriage, ectopic pregnancy, complicated childbirth and postpartum infections. With chronic endocervicitis, the risk of cervical cancer increases.
Diagnostics
Since the clinical symptoms of endocervicitis are nonspecific, a set of special examinations is prescribed to confirm the diagnosis. Usually, patients with suspected inflammatory lesion of the endocervix are recommended:
- Gynecological examination (in mirrors). It reveals swelling and hyperemia in the area of the external opening of the cervical canal, the presence of spot (petechial) hemorrhages, abundant discharge, in more severe cases — an eroded surface.
- Extended colposcopy. Allows you to examine the dilated vessels that spread from the cervical canal, to clarify the data of visual examination.
- Microscopy of a cervical smear. The preparation usually contains a lot (up to 50 or more) of leukocytes and pathogens of endocervicitis can be detected.
- Cytological examination. Allows an assessment of the structure and level of cellular tissue damage, the effectiveness of therapy in dynamics.
- Cervical biopsy. Histological analysis of the biopsy is aimed at excluding malignancy of the inflammatory process.
- Bacteriological sowing of a cervical smear. It is carried out to identify not only a specific microorganism, but also its sensitivity to antibacterial drugs.
- Special laboratory diagnostics (PCR, ELISA, IST, etc.) is necessary to detect specific infectious pathogens.
- Ultrasound of the pelvic organs. Confirms the deformation of the cervix, an increase in size and thickness, the presence of hypoechoic inclusions (nabotovyh cysts), and also allows you to exclude a combined oncoprocess.
During the examination, differential diagnosis of endocervicitis with other cervical lesions — ectopia, cancer, tuberculosis, syphilis is performed. At the same time, the patient, in addition to an obstetrician-gynecologist, can be consulted by a dermatovenerologist, oncogynecologist, phthisiogynecologist.
Treatment of endocervicitis
The goals of therapy are the relief of inflammation, the reduction or elimination of the action of predisposing factors and the treatment of concomitant pathology. The main treatment regimen, as a rule, is represented by the following stages:
- Etiotropic therapy involving oral, intramuscular, intravenous and topical use of special antimicrobial drugs to which a specific pathogen is sensitive. Patients are prescribed antibiotics, antifungal, antiparasitic agents and their combinations. Hormonal drugs that make up for estrogen deficiency during menopause and menopause are also etiotropic.
- Restoration of normal vaginal microflora using eubiotics to reduce the likelihood of relapses.
In addition to medications aimed at the immediate causes of endocervicitis, complex treatment includes other therapies. So, in order to accelerate recovery and reduce the likelihood of complications, the patient may be prescribed:
- Immunotherapy to increase general and local resistance to various pathogens, normalize the immune response;
- Physiotherapy to improve the recovery processes and enhance the anti-inflammatory effect of special drugs. In acute endocervicitis, UHF areas of the uterus and the UFO panty zone are particularly effective (according to Zhelokovtsev); in chronic — DMV, low- and high-frequency magnetotherapy, diadynamic currents, magnesium electrophoresis of the uterine zone, darsonvalization using a vaginal electrode, vaginal laser treatment and mud tampons.
In the presence of nabote cysts, which often contain infectious agents, diathermopuncture is recommended. Plastic surgery and other surgical methods are used in combination of endocervicitis with scar deformation, elongation, dysplasia, cervical cancer.
Prognosis and prevention
The prognosis for the treatment of the disease is favorable. Even in the acute period, the ability to work is preserved. Since patients who have endocervicitis are at risk for cervical cancer, they should be monitored by a gynecologist at their place of residence with periodic colposcopy, cytological and bacteriological examination. For prevention, personal hygiene, the use of condoms during sex, an orderly sex life, refusal of sexual contact during menstruation, and intrauterine interventions strictly according to indications are effective.