Cervicitis - inflammation term that includes all cervix, is very common in clinical pathology. Due to inflammatory damage of the vagina,(vaginitis) in most cases accompanies inflammation of the cervix and many doctors prefer the term colpitis - which means cervico-vaginal inflammation of. Therefore colpitis represents the reason of approximately one third of gynecological appointments. About 50 % of all women had a colpitis at some point in life. According to evolution cervicitis can be acute or chronic.
Top cervix is the lower uterine segment, which is visible through the vagina. It is an important part of the genital tract, fulfilling several functions such as:
- Menstrual function: the cervix is a channel through which blood flows from the uterus in the first quarter, in cases of congenital absence of the cervix or from its obstruction, the menstrual blood stagnates in the uterus.
- Static function: through its situation between the uterus and vagina, it maintains a normal position of the pelvic organs
- Sexual function: with a rich innervation, the cervix stimulates secretion of some hormones and cervical gland secretion
- Fertilization function: endocervical gland secretions (cervical glere) by composition favors the rise of sperm
- Pregnancy: the cervix is very important both during pregnancy, being a barrier between the vagina and uterus, also during labor.
Considering all these functions, preventing and treating diseases of the cervix may have numerous beneficial effects on women’s health.
The causes of cervicitis are very variable, most often being determined by:
- Infection with Chlamydia trachomatis
- Infection with trichomonas vaginalis
- Trichomoniasis association with Candidiasis
- Gonorrheae Neisseria (Gonorrhea)
- Herpes simplex virus
- Human papilloma virus (HPV)
- Other less common causes are: mycosis, syphilis, tuberculosis, mycoplasma.
Cervicitis Risk Factors
Cervicitis appearance is favored by the following factors:
- Cervico-vaginal infections
- Obstetric trauma – occurring during birth (cervix trauma)
- Local trauma secondary to sexual contact, use of internal buffers
- Intrauterine device (IUD)
- Ectopic congenital defects (glandular epithelium of the cervical canal slipps off the external orifice of the cervix)
- Local maneuvers: curettage, hysteroscopy, etc..
Cervictis Signs And Symptoms
The main symptom of chronic cervicitis is leukorrhea - a vaginal discharge, constant, philanthe not very abundant, which can sometimes contain blood grooves. The color and its appearance varies with the etiologic agent involved. Usually the presence of cervicitis does not cause pain, fever and menstrual disorders and can evolve for years. But if the ligaments that support the pelvic organs are aslo inflamed, back pain, dysmenorrhea, dyspareunia (painful intercourse), menorrhagia (heavy menstruation) may occur. Local inflammation causes changes in cervical mucus that may affect sperm and their ascent, leading to infertility.
Cervicitis Investigations And Diagnosis
The methods used for investigating diseases of the cervix are:
- Clinical examination: vaginal exams, by which the doctor notes pathological changes and possibly cervical secretions presence at this level
- Bacteriological examination of the cervical secretion, and possibly culture and sensitivity to antibiotic test are needed to determine the etiology of infection.
- Pap smear: cytological changes reveal (cellular) cervical
- Colposcopy: a method of inspection of the cervix using an optical instrument that enhances the image, called colposcope, during colposcopy the Lugol test is also performed (a solution is applied to the cervical mucosa)
- Anatomopathological examination: a piece of mucosa is taken for biopsy by conization or endocervical curettage (curettage inside the cervical canal).
Chronic cervicitis is suspected after the clinical examination highlights inflammatory changes, ulcerative lesions, deformities or secretions from the cervix. The certain diagnosis of chronic cervicitis is determined by colposcopy and a Pap smear test. Citobacteriologic examination of secretions is useful to detect the etiology of the cervical infection.
Cervicitis may progress for years, with a more or less abundant leucorrhea with that the woman gets used often without pain, fever, menstrual disorders or impaired sexual life. Sometimes cervicitis can be complicated by inflammation of the neighboring pelvic organs:
- Inflammation of the ligaments that support the uterus and pelvic organs that can cause abdominal pain, dysmenorrhea, dyspareunia, menorrhagia
- Salpingitis (inflammation of the fallopian tube) which can cause infertility, tubal obstruction secondary to the inflammatory processes
- Chronic urinary tract infections.
Chronic inflammation of the cervix can cause cervical stenosis which can be followed by infertility.
Also the chronic irritation can have a contributing role in causing cervical cancer. Chronic cervicitis is not the cause cancer but may promote its appearance. Therefore, treatment of chronic cervicitis can be considered a prophylactic measure in the fight against cervical cancer.
Treatment of chronic cervicitis is made up of two stages. The first stage consists of medical treatment that is etiologic, which aims to eradicate the infection. The next step is using a surgical procedure which can be one of the following:
- Laser therapy
- Loop excision (electrorezection)
- Amputation of the cervix.
All these methods destroy or remove the modified tissues. It is important to note that symptoms improve after several days of medical treatment and this does not coincide with the disappearance of tissue changes, so treatment must be complete.
Medical treatment aims, firstly to eradicate the infection, depending on the etiologic agent and the sensitivity of the etiologic agent found the result can be a local treatment (with eggs) and if necessary a treatment with antibiotics or oral antifungal drugs. Next a treatment for healing the muocasa it is recommended, but in most cases it fails to achieve complete remission of lesions, thus the patient will require a surgical treatment.
Only after about 2 months after the eradication of infection and if the cervical changes persist, surgery is indicated.
Surgery is done in the first days after menstruation, to let time for the scar to heal until the next menstruation and prevent infection. Before the procedure a gynecological examination is required to exclude an acute inflammation of the cervix, a condition which requires to postpone the procedure, due to the risk of inflammation extending.
Depending on age, lesion depth and surface, the appearance of colposcopic and cytological changes, one of the following procedures may be performed:
- Cryotherapy is the method by which the pathological tissue is destroyed to a depth of 3-4 mm, by freezing, using carbon dioxide, nitrogen and liquid freon
- Laser therapy: a modern method by which cells are vaporized, without causing tissue necrosis, no bedsores and therefore no subsequent secretion as in the case of electrocauterization
- Loop excision using an eletric current, the modified area is removed with the possibility to perform biopsies.
- Conization: a portion of cervix mucosa is excised. This method is used for old injuries, recurrent and dysplastic lesions
- Cervical amputation: surgical removal of the cervix, in case of cervical dysplasia associated with hypertrophy.
Electrocauterization is the procedure that is used most often and is a procedure in which tissues are coagulated (burned) under the caloric effect of an alternative current. It is carried out in the first few days after menstruation. No local anesthesia is required because there are very few nerve endings in the cervix. Before performing an electrocauterization a pelvic examination is required in advance to exclude states that contraindicate this procedure such as pregnancy, acute or sub-acute inflammation and feverish states in general. In the first 48 hours following the procedure bed rest is recommended, and in the first 5 days an oral antibiotic to avoid reactivation of a latent infection.
On the cervix, the place where the electrocauterization was performed will form a crust which will be removed in 3-4 weeks, during which a dirty vaginal discharge will persist which can be followed by a bloody discharge, not very abundant, which may take 10-15 days. Full healing is achieved in about 6 weeks, during which sexual rest is recommended. To promote healing vitamin C can be administered orally.