cervicitis

cervicitis

Cervicitis is an inflammation of the mucous membrane of the cervix. Infectious cervicitis often occurs with sexually transmitted diseases (STDs). It can be caused by chlamydia (Chlamydia trachomatis), gonococci (Neisseria gonorrhoeae), HSV, trichomonads (Trichomonas vaginalis), less often by other microorganisms. In chronic cervicitis, pathogenic microorganisms are rarely detected. Frequency. Cervicitis is common among sexually active women.

    • Cervicitis with gonorrhea – 166 per 100,000 (in 2% of sexually active women under 30)
    • Chlamydial cervicitis – 1040 per 100,000 (within 15% of women)
    • Cervicitis with trichomoniasis – 1200 per 100,000 (in 5-25% of women). Etiology
    • Chlamydia trachomatis
    • Neisseria gonorrhoeae
    • HSV
    • Trichomonas vaginalis
    • The causes of chronic cervicitis are unknown. Risk factors
    • promiscuity
    • history of STDs
    • postpartum period.

Pathomorphology. Papanicolaou smears show inflammatory changes.

Clinical picture

    • Mucopurulent (yellow) discharge from the cervical canal
    • Hyperemia of the cervix, not often erosion
    • Easily occurs bleeding from the mucous membrane of the cervix (metroragiya, postcoital bleeding)
    • Soreness of the cervix
    • Dyspareunia
    • Possible dysuria and pain in the lower abdomen
    • Cervicitis is often asymptomatic.

Laboratory research

    • Examination of a smear taken from the cervical canal and stained according to Thunder: with cervicitis, 10 or more leukocytes are detected in a large field of view
    • Bacteriological culture for the detection of chlamydia and gonococci
    • Gonozimtest – solid-phase immunodiagnosticum for the detection of AT to Ag of gonococci
    • For accurate and quick diagnosis of chlamydia, a study based on direct immunofluorescence is carried out – fluorescence of labeled monoclonal antibodies to superficial chlamydial Ag when applied to a slide with a smear of endocervical cells
    • Enzyme test (chlamydiazyme and others) for mass research on chlamydia
    • Wet smear examination for the diagnosis of cervicitis due to Trichomonas vaginalis
    • Preparation of smears from the vagina and cervical canal in the solution of potassium hydroxide (excluding gardnerellosis)
    • With ulceration of the mucous membrane of the vagina and cervix, a study on HSV is indicated (obtaining a culture of HSV from vesicular fluid)
    • Laboratory tests to rule out syphilis. Special studies. In chronic cervicitis, colposcopy with a biopsy of suspicious areas is indicated. Differential Diagnosis
    • Vaginitis
    • Cervical cancer
    • Reiter’s syndrome.

Treatment:

Tactics of conducting

    • With the infectious nature of the disease – the identification of the pathogen and the conduct of etiological treatment (at the same time, the treatment of the sexual partner is carried out)
    • It should be borne in mind that it is not often that patients suffer from a mixed infection (for example, gonorrhea and chlamydia at the same time)
    • Chronic cervicitis in the absence of pathogens in biopsy specimens and bacterial cultures can be treated with cryosurgery.
    • Drugs of choice
    • If an infectious etiology is suspected, treatment should be started before bacteriological results are available.

studies – ceftriaxone 125 mg / m once, then either doxycycline 100 mg orally 2 times / day for 7 days, or azithromycin 1 mg once.

    • With trichomoniasis – metronidazole 2 g once, as well as either 1 g 2 r / day for 1 day, or 500 mg 2 r / day for a week. Contraindicated in the first trimester of pregnancy.
    • With chlamydia – doxycycline 100 mg 2 r / day for 7 days. Contraindicated in pregnancy and lactation.
    • For herpetic infection – acyclovir 200 mg 5 times a day for 7 days.
    • In chronic cervicitis with atrophic changes in the vaginal mucosa in postmenopause – creams (ointments) containing estrogens.
    • Alternative Products
    • Instead of ceftriaxone
    • Cefixime 400 mg orally as a single dose
    • Ofloxacin 400 mg orally as a single dose or 300 mg bid

within 7 days

    • Spectinomycin 2 g IM once.
    • Instead of doxycycline (for example, pregnant women) – erythro-

mycin 500 mg 4 r / day orally, erythromycin ethylsucci-

nat 800 mg 4 r / day inside.

    • Instead of metronidazole, a cream containing sulfanil-

mid-aminacrine-allantoin.

    • Instead of erythromycin – clindamycin.
    • Azithromycin 1 g as a single dose (if pregnant

be aware that the product is classified as category B).

    • Amoxycycline-clavulanate (Augmentin) 250 mg orally

after 8 hours for 7 days.

    • Precautions
    • Dairy products reduce the absorption of doxycycline
    • doxycycline causes photosensitivity
    • Due to the risk of developing a disulfiram (teturam) reaction, metronidazole should not be taken simultaneously or the next day after taking alcohol
    • When taking erythromycin, nausea and vomiting are possible.
    • Drug Interactions
    • Doxycycline reduces the effectiveness of oral contraceptives and indirect anticoagulants
    • Antacids and iron products impair the absorption of doxycycline
    • Erythromycin increases the concentration of terfenadine or astemizole in the blood, which leads to changes in ECG parameters, as well as the concentration of theophylline in the blood.

Observation

    • If the causative agent of cervicitis was chlamydia or gonococci, repeated examinations of vaginal smears after treatment are indicated. Criterion cured T of gonorrhea: within 3 months, a negative result of bacteriological examination after provocations
    • In chronic cervicitis in sexually active patients, an annual Pap smear test is performed.
    • Trichomoniasis – repeated studies of native products of vaginal secretions prepared in 0.9% solution of NaCl
    • After chlamydia, a second study is also indicated. Complications
    • In 8-10% of cases of cervicitis caused by chlamydia or gonococci, an inflammatory process develops in the pelvic cavity.
    • With cervicitis against the background of STDs (especially caused by chlamydia), bartholinitis, salpingitis, FitzHugh-Curtis syndrome are possible
    • Rarer complications are genital warts and cervical cancer.

Course and forecast

    • Infectious cervicitis has traditionally responded well to antibiotic therapy.
    • Chronic cervicitis responds worse to treatment, and careful monitoring will be needed for the timely diagnosis of cervical dysplasia.

Age features

    • Children. Infectious cervicitis in babies is a rare pathology; upon detection, the doctor should suggest possible sexual perversions
    • Elderly
    • Chronic cervicitis in postmenopausal women is more often caused by a lack of estrogen.
    • The possibility of infectious cervicitis should not be ruled out. Pregnancy
    • All pregnant women will need to be examined for the presence of infectious cervicitis, because. possible transmission of infection to the fetus
    • See Treatment, Precautions.

Prevention

    • Infectious cervicitis – treatment of the sexual partner and the use of barrier methods of contraception
    • Estrogen deficiency – estrogen replacement therapy.

Synonym. Mucopurulent cervicitis

See also Cervical Dysplasia, Gonococcal Infection, Trichomoniasis, Chlamydia Urogenital, Ectropion and True Cervical Erosion Reduction. STDs – sexually transmitted diseases

  • N72 Inflammatory disease of cervix
  • A54.0 Gonococcal infection of the lower genitourinary tract without periurethral or accessory gland abscess
  • A56.0 Chlamydial infections of the lower genitourinary tract

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