Inflammation of the cervix (cervicitis)

One of the most common diseases of female genital organs is inflammation of the cervix or cervicitis (from the Latin cervix uteri - cervix). This pathology is classified in class XIV (diseases of the genitourinary system) and has a code for the ICD 10 - N72, an inflammatory disease of the cervix. To identify the infection that caused the disease, the code for bacterial, viral and other infectious agents is added (B95-B97).

With this diagnosis, an increasing number of women of childbearing age, and inflammation of the cervix, moving to the uterus and appendages, can cause irreversible consequences.

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Causes of the cervical inflammation

First of all, the causes of inflammation of the cervix are associated with the activation of such persistent conditionally pathogenic bacteria as Staphylococcus spp. And Streptococcus spp. Microorganisms are attacked when the system of congenital and adaptive cellular immunity of mucous (mucous) tissues of the cervix uteri fails. The local immune system - due to the presence in the epithelium of the cervical channel of T-lymphocytes and immunologically active cells secreting immunoglobulins IgA, IgG, IgM, is the "first line of defense" against foreign antigens.

In this case, as it turned out, the expression of the secretory component of the cervical canal mucosa is regulated and controlled by sex hormones - 17β-estradiol and progesterone - and changes with their release from the ovaries during the menstrual cycle. So fluctuations in the synthesis of hormones create certain conditions in which inflammation of the cervix can develop during pregnancy or in the period preceding the menopause.

This also relates to resistance to sexually transmitted infections. In many cases, the pathogenesis of the inflammatory processes of the mucous membrane of the cervical canal (endocervicitis) lies in the defeat of chlamydia (Chlamydia trachomatis), gonococci (Neisseria gonorrhoeae), mycoplasma (Mycoplasma genitalium).

Recognized in gynecology, the causes of cervical inflammation in the area of exocervix of its vaginal part - affecting the flat and cylindrical epithelium of exocervicitis - include Trichomonas vaginalis, Herpes simplex type II herpes simplex virus, HPV, Candida fungus infection, Gardnerella vaginalis actinobacteria, and also Treponema pallidum (causative agent of syphilis).

Inflammation of the cervix can result in her injury and subsequent infection, as it often happens when the inflammation of the cervix is diagnosed after childbirth or after a surgical abortion.

Gynecologists note the negative role in the development of cervicitis protection from pregnancy with the help of IUDs and chemical contraceptives (spermicides). Constant syringing of the vagina leads to a violation of the vaginal microbiocenosis, against which very often there is inflammation of the vagina and cervix, as the infection with colpitis (vaginitis) involved the same bacteria and viruses as in cervicitis.

[3], [4], [5], [6], [7], [8]

Symptoms of the cervical inflammation

With a mild form of inflammation of the cervix, many women do not even notice signs of pathology. Nevertheless, the first signs of inflammation can manifest immediately after the end of another menstruation.

Key symptoms of inflammation of the cervix are expressed as:

• pain in the lower abdomen during coitus and painful postcoital sensations in the vagina;
• vaginal prurit (pruritus);
• irritation of the genitals;
• muco-bloody vaginal discharge of varying intensity;
• bleeding between menstruation;
• burning with urination and increasing their frequency (since the inflammatory process can lead to urethritis).

According to experts, the temperature with inflammation of the cervix remains normal. But the complications of cervicitis, when inflammation passes to the uterus, fallopian tubes or ovaries, causing inflammatory diseases of the pelvic organs, not only increase pain in the lower abdomen, but also subfebrile body temperature.

Practically in two-thirds of cases of latent cervicitis, chronic inflammation of the cervix inevitably develops - asymptomatic or having similar signs. Complication of such inflammation often becomes erosion of the cervix.

The nature of the infectious agent depends on the discharge during inflammation of the cervix: when affected by chlamydia, they are mucous with an admixture of pus; with trichomonas etiology of inflammation - yellow or slightly greenish with foam and unpleasant odor; fungal infection gives a selection of cheesy species. A purulent inflammation of the cervix with greenish vaginal discharge is most often observed with gonococcal infection.

Particularly dangerous negative consequences result in chronic inflammation of the cervix during pregnancy. This is the termination of pregnancy, and premature birth, and antenatal infection of the fetus, and septic complications in parturient women. A chronic inflammation of the cervix, the cause of which is papillomavirus infection, threatens with oncology.

[9], [10], [11], [12],

Diagnostics of the cervical inflammation

Diagnosis of inflammation of the cervix begins with a gynecological examination of the cervix and assessment of its condition.

For laboratory studies, blood tests are required - general and biochemical, as well as an enzyme immunoassay for the presence of antibodies to Chlamydia trachomatis and herpes virus.

Also, compulsory use is made of scraping from the cervical mucosa and a swab from the cervical canal to a bacterial microflora (including DNA of trichomonads and gonococci); Pap smear (Pap test) for the presence of human papillomavirus (HPV).

The result of these morphological studies of the biomaterial from the place of the emerging pathological process becomes a cytogram of cervical inflammation - a detailed description of the state of endo- and exocervical cells, indicating all the detected infectious agents and pathological changes at the cellular level. In clinical gynecology, this diagnostic method, based on bacterioscopy, is considered the most informative and accurate.

Instrumental diagnostics is carried out with the help of colposcopy, which allows to visualize, with a multiple increase, the structural changes of the infected mucous membranes of the cervix and vagina. In the case of chronic inflammation of the mucous cervical canal and a positive result of a Pap smear, a biopsy is performed during colposcopy.

[13], [14], [15], [16], [17], [18]

Differential diagnosis

It is extremely important for cervicitis differential diagnosis, since only the correct determination of the pathogen of inflammation can give a positive result in the treatment of the disease. Also differentiate cervicitis with cervical cancer and other benign processes in this area.

Treatment of the cervical inflammation

The prescribed treatment for cervical inflammation necessarily takes into account the type of infection. The main medicines in cases of staphylo- and streptococcal inflammation, inflammation due to infection with gonococci, chlamydia or trichomonads are antibacterial.

Antibiotic for inflammation of the cervix is appointed taking into account the susceptibility of a particular microorganism to the preparations of this pharmacological group. So, with gonorrheal, staphylococcal and streptococcal cervicitis beta-lactam antibiotic Ceftriaxone is effective, which is injected intramuscularly (0.5-1 ml once a day).

As noted in the manual, its side effects can be in the form of nausea, diarrhea, allergic skin reactions, candidiasis and impaired kidney function. The intestinal microflora also suffers. The drug is not used in the first trimester of pregnancy.

The main antibiotics for chlamydial inflammation of the cervix - Azithromycin, Doxycycline and Ofloxacin - are taken internally. For example, Ofloxacin is recommended to take one tablet (0.2 g) twice a day for 7-10 days. In addition to the side effects inherent in most antibiotics, the use of this drug in the treatment of cervical inflammation can cause increased sensitivity to UV radiation.

Treatment of cervical inflammation caused by Trichomonas requires the use of Metronidazole (Trichopolum, Efloran, Novonidazole and other synonyms) in tablets of 0.25 g. The drug is given on a tablet twice a day (during meals), the duration of intake is from 5 up to 8 days. In addition, it is necessary to simultaneously use vaginal suppositories Metronidazole (two suppositories per day) within 10 days. Among the side effects of this medication are nausea, vomiting, dryness and taste of metal in the mouth, problems with the intestines and urination, dizziness, weakness, sleep disturbances, etc. And among the contraindications include pregnancy, epilepsy, kidney or liver failure.

In case of inflammation caused by the herpes virus, a 5-day course of aciclovir tablets (Zovirax, Geviran, Valtrex) is prescribed: one tablet (200 mg) every 4 hours during the day (with a glass of water). Taking this medication can cause urticaria, swelling, nausea, vomiting, increased levels of bilirubin in the blood, abdominal pain, sleep disorders, seizures, etc.

Operative treatment - in the form of coagulation of the affected tissue by electrocoagulation, cryo- or laser therapy - with this disease is carried out only in the absence of the effect of drug therapy and the appearance of erosion sites on the mucous cervix.

Local treatment of cervical inflammation

In gynecology, vaginal tablets and suppositories from inflammation of the cervix are very widely used.

In addition to the already mentioned vaginal suppositories Metronidazole, doctors recommend trichomonas inflammation Trichomonacid, Gainomax, Ginalg, etc. Suppositories from Candida inflammation - Ginezol, Neo-Piotrane (Metromicon-neo), Zalain. With nonspecific infections, a 3-5-day course of treatment with suppositories with antibiotics Klindacin (Dalacin) helps.

Often appointed antiseptic vaginal suppositories Hexicon for inflammation of the cervix (other trade name Chlorhexidine). It should be twice a day to enter one candle, the course of treatment can last up to three weeks. This remedy can be used by pregnant women.

Vaginal tablets Terzhinan with inflammation of the cervix act as a complex, because they contain an antibiotic (Neomycin), active against trichomonads, the imidazole derivative of Ternidazole, a polyenic antibiotic Nystatin (destroying yeast-like fungi), and also relieving local inflammation of Prednisolone. It is supposed to inject one tablet into the vagina once a day (preferably at night). After the introduction, a slight burning sensation can be felt, it is possible that irritations may appear. The drug is not used in the first three months of pregnancy.

In chlamydial inflammation, the cervix is treated with a 2% solution of silver nitrate, 1% alcohol or 2% oil Chlorophyllipt (based on eucalyptus leaf extract) or Malavit solution (from medicinal plants with the addition of mummies).

Also used is a method of local therapy, such as syringing with inflammation of the cervix. Gynecologists strongly recommend that the procedure be carried out at home with all the rules of antiseptics and do not rely on the fact that this method can replace systemic treatment of infections.

Among the means for syringing, 0.01% antiseptic solution of Miramistin is noted for inflammation of the cervix caused by strepto- and staphylococci, gonococci, chlamydia and Trichomonas. Also, every day, enter into the vagina abundantly moistened with this solution tampon.

Alternative treatment

In the presence of such serious pathogens of the inflammatory process in the cervical tissues, the decision to use alternative treatment should be discussed with your doctor who is unlikely to approve this idea.

However, herbal treatment for inflammation of the cervix is still practiced. Basically it includes vaginal douches with decoctions of medicinal plants.

Some "folk recipes" placed on the Internet, by their composition, have nothing to do with this pathology.

The most correct medicinal herbal collection, recommended by professional phytotherapeutists, is as follows. It should be taken: calendula flowers, chamomile flowers and St. John's wort (5 table spoons of dry raw material of each plant), and half the root of licorice naked, plantain leaves and grass sporish (mountaineer snake). All herbs are mixed, and to prepare the broth, take this mixture on a tablespoon "with a slide" at the rate of 250 ml of water. The grass is poured with steep boiling water, insisted in a sealed container for about 40 minutes, and then brought to a boil and cooked for 5 minutes.

After cooling the broth to + 37 ° C it must be filtered and used for its intended purpose - once a day (no more than 10 consecutive days).

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Prevention

Prevention in the form of "latex-protected" sex should protect against the infection of STDs and ensure that any other infectious agent can not enter. However, a conditionally pathogenic microflora is present in the vagina, there may also be no activity of herpesvirus or HPV ... And only a strong immune system prevents them from manifesting. Therefore, all doctors advocate strengthening immunity or, at least, advised to make efforts to protect the body is not weakened from unhealthy habits, lack of adequate nutrition and vitamins.

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Forecast

According to gynecologists, every woman should regularly undergo an examination (every six months). This will help to detect inflammation in time and to cure it faster.

Moreover, if the inflammation of the cervix is not treated, the prognosis is very disappointing: the inflammation can go higher and capture the uterine mucosa, fallopian tubes and ovaries, which can cause problems with fertility.

[25], [26], [27],