The vast majority of women who seek help from a gynecologist suffer from inflammatory diseases of the reproductive system. If such diseases are not identified and treated in time, they progress to the chronic stage, periodically reminding of themselves with exacerbations.
It is extremely difficult to cope with this form of inflammation, so it is important to consult a doctor for help at the first signs of an acute process. The inflammatory reaction that occurs in the cervix is called cervicitis and is often a consequence of sexually transmitted infections (STIs).
Causes and classification
The cervix is the narrowest part of the uterus and communicates with the vagina. The cervix has the shape of a cylinder and is pierced through by a narrow cervical canal, which is like a continuation of the uterine cavity. Normally, it is closed by a dense mucous plug, which protects the overlying genital organs from the penetration of microorganisms from the external environment into them. It is produced by cells of the mucous layer of the cervical canal.
The structure of the female reproductive system
They are hormone-dependent, so the viscosity of the mucus depends on the phase of the menstrual cycle. During ovulation, their secretions thin out to make it easier for sperm to penetrate from the vagina into the uterus. Accordingly, at the same time, the risk of infection of the overlying female genital organs increases.
Under the mucous layer there is a muscle layer - it is quite powerful, since during pregnancy it is responsible for holding the growing fetus in the uterine cavity. A dense serous membrane separates the cervix from other organs. The cervix has two parts:
- Ectocervix– the gynecologist sees it in the vagina during examination in the mirrors. This is the outer part of the neck, it looks like a dense disk with a hole in the middle. Covered with flat non-keratinizing epithelium, the same as the walls of the vagina.
- Endocervix- this is a part invisible to the eye during normal examination, which directly passes into the uterus. From the inside it is lined with secretory columnar epithelium, into which microorganisms easily penetrate during various types of infections.
The inflammatory process can be localized in:
- Exocervix – exocervicitis;
- Endocervix – endocervicitis;
- In both parts of the cervix there is cervicitis.
Since the cervix and vagina are closely connected to each other, it is extremely rare that cervicitis develops in isolation. As a rule, it is a consequence, or and easily turns into inflammation of the mucous layer of the uterus.
Due to the inflammatory process there are:
- Nonspecific cervicitis– it is caused by opportunistic bacteria that live on the skin and in the rectum (Escherichia coli, staphylococci and streptococci) when they are introduced into a woman’s genital tract. In addition, it also develops under conditions of insufficient estrogen production during menopause and ovarian hypofunction.
- Specific– it occurs when exposed to STI pathogens, most often a genital virus, a yeast-like fungus. Tuberculous cervicitis of the cervix also occurs if Koch's bacillus penetrates it with the flow of blood or lymph from foci of tuberculosis.
According to the duration of the flow, they are distinguished:
- Acute cervicitis– lasts up to 2 weeks;
- Subacute– from 2 weeks to 6 months;
- Chronic- over six months. It is characterized by periods of remission - subsidence of the symptoms of the disease and exacerbation, when they again gain strength. The causes of chronic cervicitis are usually chlamydia, myco- and ureaplasmas, as well as hormonal disorders.
In a healthy woman, the cervical canal is reliably protected from infectious agents, since its mucus contains lysozyme, immunoglobulins - substances that are harmful to them. The normal microflora of the vagina also plays an important role: it prevents the reproduction of pathogenic microbes, acidifying the environment. Cervicitis develops under the influence of provoking factors, which include:
- Childbirth, abortion;
- Invasive interventions (hysteroscopy, IVF);
- Infectious diseases;
- Exacerbations of chronic diseases;
- Hormonal disorders;
- Metabolic diseases;
- Injuries of the pelvis and female genital organs;
- Lack of personal hygiene.
All of them lead to local and general immune disorders and create a favorable situation for the introduction of the pathogen into the epithelium of the cervical canal.
What happens in the body
Microorganisms enter the cervix through:
- Vagina- during unprotected intercourse or with insufficient hygienic care;
- Blood or lymph- from foci of chronic inflammation, which are located in any part of the body.
Having penetrated the mucous membrane of the cervical canal, the pathogen begins to actively multiply, releasing its metabolic products into the surrounding tissues. The latter cause cell death and a reaction of the immune system, and therefore an inflammatory process develops. At the injection site, blood stagnates, blood vessels dilate and their permeability increases. Liquid plasma, together with immune cells, enters the tissue and forms edema - this is how the source of inflammation is localized. If the first reaction is adequate, then the pathogen cannot spread beyond the mucous membrane and inflammation is limited only to it. After this, the foreign microflora is destroyed and removed from the cervical canal along with mucus, and the damaged tissue is gradually restored.
With an insufficient immune response or certain characteristics of the pathogen, inflammation becomes chronic. The microorganism remains in the body for a long time, as it is able to penetrate inside cells or evade the immune response and the action of antibiotics in other ways. From time to time it becomes active, destroys tissue, and causes inflammation. As a rule, exacerbations are of low intensity, but prolonged damage to the mucosa and deeper layers leads to excessive growth of connective tissue. As a result, the cavity of the cervical canal narrows, becomes deformed, or mucous cysts form in its thickness. They appear when the connective tissue elements close the excretory duct of the cervical gland. The cells of the latter continue to produce mucus, which accumulates inside the cavity, gradually stretching it. The cyst grows in size and can significantly disrupt the anatomy of the cervix. A chronic focus of inflammation is fraught with another danger. Damage to epithelial cells sooner or later leads to their degeneration - dysplasia followed by malignancy.
Purulent cervicitis develops most often under the influence of nonspecific microflora– Escherichia coli, staphylococcus, Proteus. They trigger a powerful inflammatory response that involves neutrophils, a type of immune cell. Dead neutrophils and remnants of destroyed tissue form purulent detritus, which is released through the genital tract to the outside. This form of the disease usually occurs with a disturbance in general well-being and pronounced signs of intoxication, since decay products are partially absorbed into the blood and distributed throughout the body.
Cervicitis during pregnancy is dangerous because it is fraught with intrauterine infection of the fetus and can cause miscarriage.
Symptoms
It is extremely rare that cervicitis develops separately, so its symptoms are usually combined with damage to the underlying parts of the genital tract. These include:
- in the external genital area, in the vagina;
- Redness and swelling of the labia;
- Unpleasant.
Symptoms of cervicitis of the cervix appear acutely; it is often possible to trace their relationship with previous unprotected sexual intercourse. A woman is concerned about pulling, aching pains in the lower abdomen, fever, decreased appetite and general weakness. Discharge appears from the genital tract– from mucous membranes to yellow-green purulent, with an unpleasant odor, sometimes foamy. With a pronounced inflammatory process, streaks of blood can be observed in them. With fungal cervicitis, the discharge is cheesy and has a sour odor.
symptoms of cervicitis are redness of the cervix and discharge from the genital tract
In some cases, acute inflammation goes unnoticed by a woman, with a slight pain in the lower abdomen and discomfort during sexual intercourse. In this case, there is a high risk of the infection progressing to the chronic stage. Outside of exacerbations, the disease does not manifest itself in any way, mucous or cloudy discharge from the vagina can only disturb. With a relapse, their volume increases, the character changes: color, smell, texture. There are minor aching pains in the suprapubic region, which intensify during sex. A woman may not suspect the presence of cervicitis for a long time until serious consequences of the disease appear. Most often, exocervicitis is detected during a gynecological examination, and endocervicitis is detected during an examination for leucorrhoea, pain during sexual intercourse, and infertility.
Chronic atrophic cervicitis, which develops with insufficient estrogen production, appears gradually and is accompanied by other signs of hormonal imbalance. A woman is worried about dryness and itching in the vagina, deterioration in the quality of skin, hair, nails, and decreased libido. If the disease develops before menopause, the leading symptoms are often menstrual irregularities and problems conceiving a child.
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. Gynecologist takes from the surface of the cervix for further study 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. Doctor if necessary 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, carry out colposcopy– study of 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.
in the photo: an image obtained during colposcopy - an inflammatory process in the cervix
General clinical blood and urine tests are rarely performed, since changes in them are non-specific or absent altogether. The biochemical composition of plasma also changes little. However, pathogen-specific STIs such as gonococcus, chlamydia, and genital herpes virus can be detected in the blood. Such diagnostics allows you to avoid waiting for results to select the most effective therapy.
Treatment
As a rule, treatment of cervicitis of the cervix is carried out on an outpatient basis, unless surgical intervention is required. The main goal of therapy is to eliminate the pathogen and provoking factors of the disease. When STI pathogens are identified, treatment of cervicitis must be carried out in both partners, and for the duration of therapy they are advised to abstain from sexual intercourse or use condoms.
The gynecologist selects drugs, taking into account the causative agent of the disease:
- At nonspecific microflora they use broad-spectrum antibiotics, often combine two drugs (amoxiclav, ciprofloxacin), prescribe them orally in the form of tablets;
- At fungal infection use vaginal suppositories with nystatin (fluconazole);
- Herpes virus infection treated with acyclovir orally;
- Atrophic cervicitis requires hormone replacement therapy.
Additionally, drugs are prescribed that improve the immune response - polygynax, lycopid, thymalin. Patients are advised to take multivitamins, good nutrition, therapeutic exercises and physiotherapy.
It is most difficult to treat the disease during pregnancy, since most medications are contraindicated during this period of life. As a rule, a suppository with an antiseptic is prescribed - hexicon.
Folk remedies for cervicitis should be used as an addition to the main therapy. You can irrigate the vagina with infusion of chamomile, calendula, oak bark, and make sitz baths with the same herbs.
Surgical treatment of cervicitis is required when there is significant scarring of the cervical canal or the formation of cysts in it. After treatment, the woman is observed by a gynecologist at her place of residence, as there is a possibility of relapse of the disease.