CERVICITIS - a common name for all the inflammatory processes of localization in the cervix.The etiology of cervicitis in different age groups is mixed.The infectious nature of the inflammation of the cervix diagnosed in young, sexually active patients, and atrophic cervicitis in women of advanced age is associated with natural hormonal changes and atrophic processes in the mucous membranes of the genitals.
Among the perpetrators of inflammation of the cervix are the most common representatives of conditionally pathogenic pathogens or specific genital infections.Symptoms of cervicitis depends on the nature of agent: usually symptomatic cervicitis indicates the presence of acute specific inflammation, most often acute purulent cervicitis developed with gonorrhea, at least - for trichomoniasis.
acute cervicitis often asymptomatic and diagnosed during a pelvic exam, such as the presence of chlamydial inflammation.Exacerbations of chronic cervicitis bright symptoms are no different
cervix is not a separate sexual organ, and a lower segment of the uterus, is shaped like a tube length of 3-4 cm and a width of 2.5 cm. The external examination is available only to her vaginal (lower) part.The cervix is covered by several layers of epithelial cells, giving it a pink color.
The cervix connects the cavity of the vagina and the uterine cavity through the cervical canal - the cervical canal.Appearance resembles a spindle cervical canal and lining the inner surface of its cylindrical epithelium forms numerous folds.
Under the epithelium of the cervical canal is a large number of active glands.They produce mucous secretion (cervical mucus), which does not allow microbes to climb from the vagina into the uterus and up.On the part of the vaginal cervical canal is closed by anatomical narrowing - the external os.The inner jaws located at the junction of the cervical canal into the uterine cavity.Cervix contains many muscle and collagen elastic elements ensuring its strength and good elongation.
cervix acts as an anatomical and biological barrier to the introduction of the infection in the genitals.The condition of the cervix affects the vaginal environment, since it is anatomically the most part located in the vaginal cavity and has with it a common epithelial cover.Organisms that enter the cervix, are always pre vagina.Healthy woman with a well-functioning immune system of the vaginal environment eliminates potentially dangerous germs and prevents them from reaching the cervix.
vaginal microflora has the ability to contain pathogens, preventing them from multiplying.As part of the vaginal flora dominated by lactobacilli (98%) and a small amount of pathogenic microflora (streptococci, staphylococci, Corynebacterium, mushrooms, etc.).In the vagina of healthy women anaerobic flora prevail over aerobic (10: 1) and acidity (pH) of the vaginal content resides within 3.8 - 4.5.Inside, a slimy layer of the vagina is constantly updated by desquamation (rejection) of the outer layer of cells, these cells are large reserves of glycogen.Lactoflora ability to break down glycogen to lactic acid, and thus to maintain the acidity of the medium at the appropriate level.In addition, lactobacilli form on the surface of the vagina kind of protective film, it does not allow bacteria to penetrate into the underlying layers and cause inflammation.
All processes in the tissues of the vagina and the cervix are affected by sex steroids and exposed cyclic hormonal changes.
Thus, due to the constancy of the vaginal environment, anatomy of the cervix and cervical mucus protective properties genitals resist disease.Cervicitis occurs if this protection system fails.
Diagnosis cervicitis usually does not cause difficulties.The diagnosis is made on the basis of inspection of the cervix in the mirrors and subsequent laboratory analysis.It is much more difficult to establish the cause of infection, as the vaginal flora presents a large number of microbial associations.The exception is sexual infections, which cause inflammation when a single pathogen, and the clinical picture of the disease is expressed clearly.
If inflammation delimited cervical canal to say about endocervicitis, and if the infection is embedded in the deeper layers of the vaginal part of it - about ekzotservitsite.
cervicitis therapy is determined by the source of the inflammation.Typically, treatment includes antibiotics etiotropic and eliminating background process.
use the term cervicitis cervicitis of the uterus or cervix are incorrect, since the diagnosis of cervicitis may imply the presence of a pathological process only in the cervix.Instead of the term cervicitis cervicitis of the uterus and the cervix should use the correct name of the disease - Cervicitis or endocervicitis ekzotservitsit or, depending on the clinical situation.
most popular reason for the start of cervicitis is an infection.The nonspecific cervicitis associated with opportunistic pathogens: E. coli, streptococci, staphylococci, mycoplasma and other microorganisms.Specific inflammation of the cervix provoking pathogens of sexually transmitted diseases, cervicitis diagnosed in every fourth patient with gonorrhea or trichomoniasis.
cervicitis emergence of a number of factors:
- Associated inflammatory diseases of the urinary tract and genitals.Since the cervix, vagina and urethra are common anatomical and fizioloigcheskuyu system, development of isolated inflammatory processes impossible.Typically, an inflammation of the cervix is combined with similar processes in the tissues of the vagina and / or urethra (colpitis, cystitis, etc.), or it is diagnosed in patients with endometritis or adnexitis.
- Traumatic injuries (fractures, breaks, etc.) tissue of the cervix during childbirth, abortion, or dilatation and curettage.After being damaged mucosa of the cervix and the cervical canal pathogens relatively easily penetrate into the underlying layers, causing inflammation.
Cervicitis can be caused by the use of concentrated solutions (iodine, potassium permanganate and the like), which are inserted into the vagina with the purpose of treatment.Such solutions can provoke a burn on the cervix, followed by addition of an inflammatory process.
- Very often, cervicitis accompanies pathology cervix - pseudo or ectropion.
- Omission of the cervix and vagina.By moving processes are violated genital tissue nutrition, reduced local immune protection.
- Irrational sexual behavior.Polygamous sexual relations, in addition to sexually transmitted infections, leading to changes in the composition of the vaginal microflora of normal, thus creating favorable conditions for the development of inflammatory processes.
- Incorrect use of contraceptives.Spermicides containing corrosive chemicals, lead to mechanical damage to the cervical mucosa.
- dysbiotic changes in the vagina.Changing the number of lactic acid bacteria and acidity helps offset unwanted microflora multiply, so sometimes bacterial cervicitis develops against the background of dysbiosis vagina.
- hormonal dysfunction.Since the vaginal mucosa is gormonalnozavisimyh tissue change hormonal regulation can lead to local pathological changes in the tissues of the vagina and cervix.It was on the basis of reducing the amount of estrogen in the body develop atrophic cervicitis in elderly patients.Without proper estrogen influence thins mucous, easily injured and becomes vulnerable to undesirable microorganisms.
- extragenital pathology.Cervicitis is not uncommon in women with diabetes, hormonal and metabolic diseases.
leading role in the development of tservtsita belongs to the immune system.In healthy women, local protection mechanisms in most cases can cope with adverse changes and prevent progression of the disease, or because of such disease is mild and responds well to treatment.The presence of precipitating factors in women with existing immune problems almost always lead to the development of cervicitis.
Symptoms and signs of cervicitis
cervicitis clinical picture depends on what kind of pathogen it has provoked, and the place of its implementation.
Tsevitsity classify the stream (acute or chronic), prevalence (focal or diffuse) and the origin of the pathogen (specific or nonspecific).Typically acute bacterial cervicitis has a specific nature.
cervicitis clinical manifestations are varied, so doctors sometimes use other, "hospital" classification, using such definitions as moderate or severe cervicitis cervicitis.Patients need to know that the expression and acute cervicitis cervicitis - similar definitions.Similarly, equivalent term moderate cervicitis and chronic cervicitis.
inflammatory process usually begins with the cervical canal (endocervite) and then penetrates more deeply located tissues.
Initially pathogen damages the mucosal surface layer of the cervix, in response to the invasion at a location glands produce a lot of mucus secretion.Over time, this becomes the secret of so much that the surrounding tissues become loose, thereby facilitating the process of spreading the infection to be layers.If the pathologic process is eliminated in this step, it penetrates deeper, and in the upper layers of the mucosal regenerative processes begin (healing).Clinically, the process subsides, it created a false impression of recovery but actually foci of infection "hiding" in the deeper layers, leading to the development of chronic inflammation.
Acute cervicitis any etiology can not be left unattended because if symptoms persist.Fast-paced acute purulent cervicitis, gonorrhea or trichomoniasis when accompanied by severe symptoms - copious purulent discharge, itching in the vagina, dull pain in the lower abdomen, and urinary disorders.
Chronic cervicitis is the result of incorrect treatment of the disease in the acute period.It can also develop in patients who have not undergone treatment for acute cervicitis.Clinical symptoms of chronic cervicitis is very scarce or nonexistent (for example, chlamydia).In such cases, the source of infection can be detected only by laboratory methods.
Diagnosis cervicitis supply is not always easy.The symptoms are not specific and can point to any infectious-inflammatory process in the genital area.Complicates the diagnosis associated gynecological and urological diseases: adnexitis, endometritis, cystitis, and so on.
self-diagnosis of the disease is unacceptable, because its symptoms are similar to symptoms of many other illnesses and untrue selected self-treatment leads to the aggravation of the inflammatory process.
Regardless of the severity of clinical symptoms of the disease pelvic examination reveals the typical outward signs of cervicitis and helps determine the stage of disease.Inspection of the cervix in the mirror reveals signs of inflammation (all or only some of them):
- flushing and swelling of the mucous of the cervix;
- eroded areas of mucous around the external os;
- copious purulent or muco-purulent discharge from the cervical canal in acute cervicitis, with chronic form of separation have become scarce and unclear appearance;
- small hemorrhages (petechiae) on the cervix.
Often, when viewed in addition to effects cervicitis diagnosed signs of inflammation of the vagina: edema and hyperemia of the mucous and abnormal discharge.
In postmenopausal women during the inspection revealed signs of atrophy of the mucous membranes of the external genitalia.
After gynecological examination all patients performed a colposcopy.The method allows to study the structural changes in the cervix, inherent in the inflammatory process.As a rule, further reveals the background processes on the neck - erosion, pseudo-erosion and so on.Often on the cervix are detected small (pinhead) rounded education gray-yellow - advanced glands (glands Nabothian) with clogged excretory duct.Colposcopic signs of chronic cervicitis: increase the size of the cervix due to its sealing tissue, numerous brushes on the surface, there may be moderately severe swelling of the cervix.
establish the authenticity of an infectious cause cervicitis only after the identification of the causative agent.Laboratory diagnosis includes:
- smear on flora;
- PCR diagnostics for major infections: gonorrhea, chlamydia, trichomoniasis, candidiasis, mycoplasmosis, HPV, and so on;
- bacteriological examination (seeding) vaginal contents;
- blood tests for HIV and RW;
Additional tests are assigned to identify concomitant gynecological pathology.The number of surveys appointed in different patients not equivalent, because the diagnostic search can be extended to determine the cause of cervicitis.
not often the true cause of cervicitis can not be established.Presumably, such cervicitises leave behind a temporary hormonal disorder or an infection which the body cope on their own.
include acute bacterial cervicitis most common gonorrheal cervicitis.Among other originators of infection in the cervix occur Streptococcus, Staphylococcus and other microorganisms.
clinic disease depends on the location of the inflammatory process.Most often, the infection penetrates into cervical cancer.In gonorrhea gonorrhea primarily affects only endocervical gland, and then spread over the surface of the mucous membrane of the cervical canal without affecting the deeper tissues of the cervix.In contrast, staphylococci and streptococci penetrate much deeper hit deeper structures of the cervix and lymphatic spread to nearby tissues and organs.
very first symptom of acute cervicitis are abnormal discharge.Their appearance and the number is largely determined by the nature of the pathogen.They are usually abundant (profuse with gonorrhea), purulent or mucopurulent.Beli may be accompanied by itching and burning in the vagina, which intensified when urinating.Occasionally acute cervicitis causes mild pain in the lower abdomen.
body temperature in acute cervicitis is normal or rises to subfebrile values.Heat is always associated with the aggravation of comorbidities.
Other symptoms of acute cervicitis associated with comorbidities.If the infection got into the urethra, the patient developed urinary disorders, and in the presence of erosion of the cervix have any contact bleeding.
On examination, the cervix is hypertrophied (increased in size) due to swelling.Around the external os revealed pronounced hyperemia.In acute cervicitis cervix is often eroded.Of the cervical canal flow copious pus-like discharge.On the cervix can be visualized ulceration.
Acute cervicitis caused by Trichomonas on the surface of the cervix are formed multiple small hemorrhages, and the cervix is like a strawberry ("strawberry cervix").