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Cervicitis - main symptoms:
Cervicitis is an inflammatory process, localized in the vaginal segment of the cervix. Cervicitis, the symptoms of which are characterized by cloudy discharge, pain in the lower abdomen (pulling or dull), painful sexual intercourse and urination, in its protracted chronic form can lead to erosion. In addition, such a course can provoke thickening (i.e. hypertrophy) or thinning of the cervix, as well as cause the spread of infection to the upper genital organs.
general description
The cervix itself acts as a barrier that prevents infection from entering the uterus, as well as the upper genital tract (in the form of protective secretion, mucus plug and cervical canal). Exposure to certain factors provokes a disruption in its protective functions, which leads to the entry of foreign microflora into this area, thereby contributing to the development of the inflammatory process. Cervicitis is precisely such a process, which also includes exocervicitis (inflammation of the exocervix, or vaginal segment in the uterus) and endocervicitis (inflammation of the endocervix, or inflammation in the area of the inner lining belonging to the cervical canal of the cervix).
The specified opportunistic microflora, which provokes cervicitis, appears in the uterus through contact through the lymph and blood, as well as through the rectum. As for specific viruses, they enter the uterus through sexual contact.
It should be noted that cervicitis can develop under the influence of certain factors, which include birth injuries affecting the cervix, diagnostic curettage and termination of pregnancy, as well as the use of contraceptives (in particular, we are talking about the installation and removal of an intrauterine device). Various types of cicatricial deformities, as well as formations in the cervix of the uterus of a benign type, are identified as factors provoking cervicitis. A decrease in immunity is also not excluded when considering the actual factors leading to the development of cervicitis.
Features of the development of cervicitis indicate that this disease extremely rarely occurs in isolation - mainly its “companions” are certain diseases related to the reproductive system: vulvitis, pseudo-erosions or cervical inversion, bartholinitis.
As for the age category, the disease we are considering most often occurs among women of reproductive age (about 70% of morbidity cases), less often cervicitis occurs with. It is noteworthy that cervicitis is one of the most common reasons in which pregnancy becomes impossible; in addition, it is cervicitis that in most cases provokes premature birth. As a consequence of this disease, polyps are formed, as well as inflammation in the upper genital tract. Cervicitis occurs in acute or chronic form, in addition to its other varieties, which we will also consider below.
Acute cervicitis
Acute cervicitis is, accordingly, an acute inflammation that occurs in the cervix. In this case, inflammation mainly affects only the endocervical glands, while in rare cases, damage to the squamous epithelium may also occur. Some researchers are of the opinion that the nature of inflammation (that is, its persistence, area of localization, route of spread) is directly determined based on the specific type of pathogen. Gonococci, for example, infect exclusively epithelial cells belonging to the endocervical glands, and their spread occurs along the surface of the mucosa. If we are talking about inflammation provoked by staphylococci or streptococci, then their localization is concentrated directly in the endocervical glands, affecting the stroma of the cervix. The lymph flow ensures that pathogens reach other organs in the pelvis, which, accordingly, leads to their infection.
Dwelling specifically on the symptoms, it should be noted that the first of them, at the initial stage of the disease, manifests itself in the form of discharge, and the nature of this discharge may be different. Meanwhile, most often it is noted that they contain an admixture of pus and at the same time their profuse nature, which is especially true in the case of the relevance of such a disease as gonorrhea.
In addition, the acute course of the disease is often accompanied by a slight increase in temperature and dull pain in the lower abdomen. Often there are sensations of hot flashes concentrated in the pelvic organs. In addition, patients often experience lower back pain, disorders associated with urination (polyuria or dysuria, an increase in the volume of urine excreted or a decrease in the volume of urine excreted, respectively) and pain that occurs in the external genitalia and pelvic organs during sexual intercourse.
When diagnosing acute cervicitis, in addition to a gynecological examination, microscopic examination of smears is used, as well as inoculation of cervical canal secretions directly onto a nutrient medium.
If we are talking about diagnosing gonorrheal cervicitis in an acute form, then, as a rule, it is done extremely rarely due to patients turning to a doctor only in those cases in which the inflammatory process passes to the uterine appendages. Taking this into account, if there is pain in the adnexal region in the acute form of gonorrheal cervicitis, it is necessary to use a slightly different treatment than with ordinary acute cervicitis, because in this case the inflammatory process is quite specific.
Chronic cervicitis
Chronic cervicitis is formed when the genital organs are affected by various bacteria, as well as when they are affected by fungi and viruses. The onset of the infectious process in this case can occur with prolapse of the cervix or vagina, as well as with improper use of hormonal and contraceptive drugs. In addition, concomitant factors in the development of chronic cervicitis are promiscuous sex life, poor hygiene and inflammatory diseases in the pelvic organs.
The clinical manifestations of this form of cervicitis are determined by the specific type of pathogen, as well as the general reactivity in each specific case of the patient’s body. The main symptoms include scanty mucous discharge of a cloudy consistency, in some cases there may be an admixture of pus. Redness of the uterine mucosa and swelling are also noted. The acute form of manifestation of the chronic form of pathology manifests itself, accordingly, in greater severity of symptoms. Again, there is a dull pain that occurs in the lower abdomen, itching, pain and burning during urination, bleeding that occurs after sexual intercourse.
The disease is more than serious for a woman, because untimely treatment leads to thickening of the walls of the cervix with subsequent hypertrophy, which contributes to the formation of another type of pathology. Due to this, the risk of possible cancer, infertility and dysplasia in the genital area in question also increases.
To make a diagnosis, the uterus is examined using a colposcope and speculum. Blood and urine are tested for sexually transmitted infections. An ultrasound is also performed with subsequent examination of the condition of the pelvic organs.
Purulent cervicitis
Purulent mucous cervicitis involves the presence of an inflammatory process in the area of the cylindrical layer of epithelial cells, as well as the relevance of subepithelial damage to the cervical area. In addition, damage may also occur in all simultaneously areas of the columnar epithelium, which is ectopically concentrated on the outside of the cervix (that is, there is an unnatural displacement of the epithelium).
What is noteworthy is that if a woman has purulent cervicitis, it can almost certainly be said that her partner has it, which is caused by a similar type of pathogen, but is difficult to diagnose. Purulent cervicitis is one of the most common sexually transmitted diseases, and also serves as the most common cause of inflammatory processes localized in the pelvic organs. In the presence of symptoms of purulent cervicitis among expectant mothers, the risk of disruption of the normal course of the entire pregnancy, as well as subsequent childbirth, increases significantly.
As a rule, the cause of the formation of pathology is gonococci or trachoma bacillus. Unofficial statistics indicate that one out of three cases is due to the occurrence of the disease due to exposure to ureaplasma. The symptoms in this case are similar to diseases caused by the herpes virus and Trichomonas. In general, purulent cervicitis forms against the background of gonorrhea.
Viral cervicitis
Viral cervicitis with its characteristic inflammatory process occurs when the infection is transmitted through sexual contact. The localization of the inflammatory infectious process determines such forms of the disease as exocervicitis and endocervicitis, with damage to the external tissues of the cervix and damage to its internal part, respectively.
The generally accepted classification defines the division of the inflammatory process into a specific form of its course and a nonspecific one. The specific form is a concomitant manifestation of viral cervicitis; accordingly, we are talking about a viral etiology with actual transmission of the virus through sexual contact (HPV).
As a rule, women of childbearing age are affected. The main symptoms include pain in the lower abdomen, general discomfort and severe itching that occurs on the outside of the genitals. In addition, there is a discharge with impurities in the form of pus or mucus. In the acute stage of viral cervicitis, the discharge is characterized by abundance, in the chronic stage - by scarcity.
Bacterial cervicitis
Bacterial cervicitis is also quite common when patients visit a gynecologist. The disease is infectious, and its localization is concentrated in the cervical canal or in the vagina in the area bordering the cervix. Accompanying its course is a disturbance of the vaginal microflora; there is no strong inflammatory reaction.
Cervicitis occurs exogenously, and its development occurs against the background of mucous membranes affected by viruses such as herpes, papillomavirus, or, but in this case there is no connection with sexually transmitted infections themselves. In addition to the listed causes of bacterial cervicitis, genitourinary tuberculosis is also isolated. Bacterial vaginosis is the most common cause for the formation of nonspecific chronic cervicitis.
The most common symptoms of this form of the disease are dysuria (i.e., urinary disorders), dull nagging pain that occurs in the lower abdomen, as well as pain accompanying sexual intercourse. In addition, patients experience vaginal discharge of varying consistency while simultaneously being abundant or, conversely, scarce. The presence of impurities in the form of mucus or pus is also noted.
Atrophic cervicitis
Atrophic cervicitis has a number of features, but its development proceeds in accordance with the general principles relevant for cervicitis. The reasons that provoke the occurrence of this form of cervicitis can be various types of diseases that form in the genitourinary system (cervical erosion, inflammation of the appendages). In addition, the development of the atrophic form of cervicitis is also possible during unprotected sexual contact, in particular when pathogens of one or another type of sexually transmitted disease enter the body. Mycoplasmosis and viral diseases act as infectious agents. In addition, nonspecific infections (staphylococci, streptococci) are also isolated.
The development of atrophic cervicitis also occurs in the area of the damaged area. The cause of injury in this case may be curettage, abortion, or rupture of the uterus during labor. Atrophic cervicitis is accompanied by characteristic thinning that occurs in the tissues of the cervix. In severe forms of atrophy, disturbances in urination occur. As a rule, this form of the disease becomes the result of a chronic course of cervicitis.
Cystic cervicitis
In this case, the cause of the disease is a combination of infections (chlamydia, gonococci, streptococci, fungi, staphylococci, gardnerella, trichomonas, etc.), which leads to the proliferation of columnar epithelium along the surface of the uterus. This, in turn, leads to a gradual and continuous overgrowth with cysts. Often cysts are combined with manifestations in the form of erosions.
Diagnosis of cervicitis
Quite often, as we have already noted, cervicitis occurs without any symptoms, which, accordingly, leads to untimely contact with a specialist. As a rule, the disease is discovered accidentally during a routine medical examination or when visiting a doctor with suspicion of another disease.
Diagnosis of cervicitis is based on data such as:
- examination of the cervix using mirrors;
- upon receipt of colposcopy results, which make it possible to detail pathological changes in the epithelium in the case of actual cervicitis;
- based on the results of laboratory tests (smear microscopy, microflora culture, PCR).
Treatment of cervicitis
In modern conditions, gynecology has many different methodological options that make it possible to treat cervicitis. Meanwhile, the first thing that needs to be done in this treatment is to eliminate the factors predisposing to the development of the disease in question.
In the treatment of cervicitis, antiviral, antibacterial and other agents are used, which is determined based on the specifically identified pathogen and its characteristic sensitivity to the selected drug. The stage at which the inflammatory process occurs is also taken into account. Local combination medications, as well as creams and suppositories, are widely used in the treatment of cervicitis.