Endocervicitis - is inflammation of the mucous layer of the surface of the cervical canal.In 70% of applicants to the outpatient department of young patients diagnosed inflammation in the neck of varying severity and location. appearance of inflammatory changes in the cervical canal is almost always combined with those of the vagina (vaginitis), because they have a common cause - the infection.At the root of infectious inflammation are both non-specific micro-organisms and pathogens of sexually transmitted infections (trichomoniasis and gonorrhea).Also endocervicitis often develops on the background of false erosion cervical ectropion.
cervix, contrary to popular among the patients the wrong opinion, is not a separate agency.In fact, it is lower, considerably narrowed segment of the uterus facing into the vagina.The mucosa of the cervical canal (endocervical), lining its cavity, forms numerous folds to the cervix during childbirth can stretch.Under a layer of epithelial cells
Cervical mucus is a mechanical barrier to getting infections in the uterine cavity, and also plays the role of a biological anti-infective barrier, so most women have cervical canal yourself successfully coping with infectious aggression.Infectious inflammation is only possible if the protective function is impaired endocervical or injury has occurred cervix.
infection gets into the cervical canal downstream from the vagina during vaginitis, or (much less likely) down from the uterine cavity with endometritis or salpingitis.
vaginal mucosa protects the cervix from infection.In healthy women, the vagina is dominated lactoflora (98%).Lactobacilli are able to maintain this level of acidity (3.8 - 4.5), in which the undesirable microorganisms can not vegetate.
Along with lactobacilli in the vagina there is a small number of opportunistic pathogens that are not capable of causing damage to the mucosa of the small number.Reducing the number of lactic acid bacteria can cause increased proliferation of opportunistic pathogens and the subsequent development of inflammation of the vagina, and then in the cervical canal.
endocervicitis symptoms are often mild, so most women do not pay them enough attention.Without treatment, acute endocervicitis acquiring the features of a chronic inflammatory process.
endocervicitis severity of symptoms depends on the nature of the infectious agent.Expressed endocervicitis with bright symptoms develop as a result of specific inflammation and oligosymptomatic moderate endocervicitis provoke pathogenic microflora.
According to the extent of inflammation, endocervicitis can be local or diffuse.
Diagnosis "endocervicitis" put simply.The only symptom of an infectious inflammation of the endocervical are often pathological mucopurulent vaginal discharge, but this symptom is not specific, as is present in the clinic, most inflammatory diseases of genitals.To help make the correct diagnosis helps to check the cervix in the mirrors, and the type of infection is established by laboratory tests.
endocervicitis acute therapy involves the elimination of infection and the causes of its development.Making timely treatment of acute endocervicitis completely eliminate the disease.Symptoms of chronic endocervicitis appear after incorrect treatment of acute process or are a consequence of untreated acute inflammation.
Sometimes you hear endocervicitis called "endocervicitis uterus" or "endocervicitis neck."Diagnosis "endocervicitis" already indicates the presence of inflammation in the endocervical - internal mucous layer of the cervical canal.Employed patients of the terms "endocervicitis uterus" and "endocervicitis neck" is not correct.
only credible reason endocervicitis considered infection.Non-specific inflammation in the endocervical often provoke microbial associations, of which consists of a vaginal opportunistic microorganisms: streptococci, staphylococci, E. coli, Corynebacterium and others.
Specific endocervical inflammation associated with the presence of pathogens in the vagina genital infections: trichomonas, chlamydia, gonococcal viruses.
provoke infectious inflammation in the cervical canal "helps" a number of predisposing factors:
- related infectious-inflammatory processes in the uterus (endometritis), fallopian tubes (salpingitis), the vagina (vaginitis), or disease of the lower urinary tract infections (cystitis).
- Mechanical damage (injury) tissue of the cervix to form cracks, abrasions or ruptures mucosa.There may be a result of abortion, diagnostic procedures, labor.Mucosal injury in terms of reduced local immunity can not resist infection and passes it to the underlying structures.
Concentrated solutions of iodine, potassium permanganate, used for therapeutic or diagnostic purposes, can sometimes cause a burn injury and subsequent inflammation of the mucous.
cervical mucous can be damaged when using spermicides with aggressive chemical composition.
- casual sex.Frequent change of partners in the absence of adequate contraception not only can cause genital infections, but also lead to a change in the microbial composition of the vaginal environment.
- dysbiotic changes in the vaginal environment.Reducing the amount of lactic acid bacteria provoke excessive multiplication of opportunistic pathogens that can cause inflammation, which later spread to the tissues of the cervix.
- Offset genitals.When deletion of the uterus and the vagina is disrupted power surrounding tissue, reduced local immunity, is changing the composition of the vaginal microenvironment.
- hormonal dysfunction.Vaginal mucosa depends on cyclic changes in estrogen content.Estrogens control the quantitative composition of the vaginal microflora.With their deficit reduced the number of lactobacilli and develop local dysbiosis vagina.Because of hypoestrogenism in elderly patients develop atrophic endocervicitis, when the background of thinning mucous inflammatory lesions appear on the cervix, rising into the cervical canal.
All these factors increase the risk of an infectious inflammation of the endocervical only in violation of the local immune defense, and in healthy women, as a rule, the immune system will cope with the negative situation.
Symptoms and signs endocervicitis
endocervicitis Clinical signs are not always expressed in the same way.The most vivid picture of an acute inflammation provokes endocervicitis against the backdrop of gonorrhea and chlamydia in the disease is nearly asymptomatic.
Like any inflammation of the external genitalia, classified endocervicitis:
- of symptoms (acute or chronic);
- according to the nature of the spread of inflammation (focal or diffuse);
- origin infections (specific or nonspecific).
often in medical records can be found another, unofficial, classification, which featured "expressed endocervicitis" or "moderate endocervicitis."To avoid confusion, it is necessary to know that the diagnosis "expressed endocervicitis" implies an acute inflammation with bright external symptoms, and subacute or chronic inflammation of the endocervical called "moderate endocervicitis."
In most cases, the beginning of an infectious inflammation in the cervical canal occurs at a single scenario, and its further course depends on the individual clinical situation.Most perpetrators of inflammation are opportunistic microbes that live in the vaginal environment every woman.In unfavorable situations, they begin to vegetate and displace normal lactoflora, as a result of the vagina begins the inflammatory process.
If the infection manages to overcome the barrier of the cervix, it rises into the cervical canal, which damages the mucous layer (endocervical), and enters the glandular structures.In response to the aggression of infectious cervical glands start to produce mucous secretion hard, trying to "clean up" pathogenic microbes.At this stage, the amount of vaginal discharge increases slightly.
Over time, the amount of mucous secretion becomes larger, it loosens the surrounding tissue, helping to spread the infection.Vaginal discharge is more abundant, and pus-like.Abundant bleach can irritate the vagina and vulva, causing discomfort, burning or itching sensation.If at the stage of acute inflammation of the disease is not diagnosed and not treated, the infection begins to penetrate deeper, and on the surface of the mucous starts the process of regeneration (healing).All external clinical manifestations subside, simulating the "recovery", but in reality just an infection deep "hidden", leading to the development of chronic inflammation with periods of exacerbation and subsided.
Acute endocervicitis any origin accompanied by abnormal vaginal discharge, which in most cases are the only symptom of the disease.Their number, color and consistency depend on the pathogen and the area of mucosal lesions.Specific acute inflammation in the endocervical gonorrhea or trichomoniasis when developing rapidly and is characterized by abundant purulent belyami, unpleasant subjective sensations (itching, burning, pain) in the vagina, dull pain in the lower abdomen, urinary disorders and fever.
If acute endocervicitis not be liquidated in a timely manner or treated incorrectly, it is transformed into a chronic inflammation.Clinical signs of chronic endocervicitis are not always well defined or may not exist at all, so often in the endocervical infection is detected only by laboratory methods.
endocervicitis symptoms are not specific, since most of the inherent inflammatory gynecological diseases.Identify the exact localization of the disease helps the pelvic exam, and set the cause of inflammation in laboratory research.
On examination, the cervix in the mirror visualize the typical signs of inflammation:
- redness and swelling of the mucous of the cervix;
- the presence of eroded areas on the cervix;
- profuse muco-purulent discharge from the cervix, chronic process it may be scanty, turbid liquid resembling mucus;
- small pinpoint hemorrhages (petechiae) on the cervix;
- related inflammatory changes in the vaginal mucosa, indicating vaginitis.
all patients with signs of inflammation of the external cervical colposcopy.Is an additional method for the diagnosis of inflammatory changes in the mucous and comorbidities of the cervix (true or false erosion, ectropion).
often visualized on the cervix is very small (pinhead) gray-yellow rounded cysts - Nabothian clogged gland duct.Their formation is associated with the processes of mucosal regeneration after infectious aggression, when "new" mucosal cells grow and cover the outflow of secretions from glands downstream.
diagnose endocervicitis much easier than to determine its cause.Sometimes diagnostic search ends quickly, and in other cases, it consists of a large number of surveys.
taken for laboratory testing vaginal contents, because it includes a discharge and cervical canal.To identify the pathogen are used:
- smear "flora";
- bakposev cervical secretions with a mandatory identification of antibiotics to eliminate infection;
- PCR diagnosis of the main sexually transmitted infections gonorrhea, chlamydia, trichomoniasis, candidiasis, mycoplasmosis, HPV, and so on;
- the study of cellular composition of the mucosa of cervical and cervical canal swab after "cytology";
- the study of venous blood for HIV and RW.
number of examinations in patients with endocervicitis not equivalent.Typically, diagnostic search begins with the most basic and simple methods, and continues as long as the source of infection can not be detected.
endocervicitis uncommon cause can not be found.It is believed that similar processes are at the neck after an episode of hormonal dysfunction or infection, who have been on their own.
Ultrasound examination with vaginal probe is carried out for the diagnosis of related endocervicitis inflammation in the uterus and appendages.Sometimes conclusion appears the phrase "ehopriznaki endocervicitis."Not to be confused with its definitive diagnosis.Most often during the survey recorded a thickening and inhomogeneity of the mucosa of the cervical canal and the presence Nabothian cyst.Without proper clinical symptoms ehopriznaki endocervicitis not a valid diagnosis.
Endocervicitis and pregnancy are unfavorable combination.Such a diagnosis is pregnant often.The level of risk of complications depends on the cause endocervicitis.Specific endocervicitis provoke the development of ascending infection, which is very dangerous to the fetus.
If the basis of an infectious inflammation is conditionally pathogenic microflora, the disease process is delimited and does not extend beyond the cervical canal.However, structural alterations occur in the wall of the cervix may lead to cervical injury (fractures, cracks) during childbirth.Endocervicitis and pregnancy always require additional therapeutic measures.
of chronic endocervicitis always precedes the acute phase of infectious inflammation.Unfortunately, patients often try to get rid of the symptoms of inflammation yourself using inappropriate drugs.The disappearance of symptoms after self-treatment creates a false impression about treatment, but after some time the disease is diagnosed in the chronic form.
In the absence of proper treatment of infections caused by sharp endocervicitis, "leaves" with the mucosal surface into the underlying layers, and its clinical manifestations are virtually disappear.Often chronic inflammation of the endocervical diagnosed by chance.
Patients indicate a change in the nature of vaginal discharge.Secretions become sticky, a yellowish or white color and become turbid.However, such a vaginal leucorrhea not always associated with inflammation of the endocervical, they can trigger an infectious process and in the vagina.To differentiate these conditions, it is necessary to conduct additional diagnostic procedures.
Damaged infection cervical mucus is relatively easy to injured, so the combination of chronic endocervicitis and cervical erosion are not uncommon.You may also receive contact spotting.
Laboratory diagnosis can not reveal any inflammatory abnormalities or detect the presence of microbial associations of opportunistic microbes.
substantial assistance in the diagnosis of chronic endocervicitis has cervical examination in the mirror.The cervix looks hypertrophied, there are signs of pronounced edema.Surrounds the outer mouth portion eroded mucosa.Education erosion on the neck due to the incorrect processes sprawl damaged mucosa of the cervical canal when it goes beyond it and "creeps" to the surface of the cervix.Sometimes affected most of the surface of the cervix, this leads to the formation of extensive ulceration.