What is Cervicitis?

Cervicitis is one of the common gynecological diseases. It is more common in women of childbearing age. It is caused by cervical damage and pathogen invasion, including inflammation of the cervix and vagina and inflammation of the cervical mucosa. The cervix is an important line of defense to prevent lower genital tract pathogens from entering the upper genital tract. However, the single layer of columnar epithelium of the cervical canal itself is less resistant to infection. If it is damaged by mechanical stimuli such as sexual intercourse, childbirth, abortion, surgery, it is more likely to cause infection. . Cervitis is clinically divided into acute and chronic, with chronic inflammation as the most common. Acute cervicitis is mainly manifested by cervical swelling, cervical mucosal edema, often accompanied by acute vaginitis or acute endometritis. Chronic cervicitis includes cervical erosion, cervical hypertrophy, cervical polyps, cervical gland cysts, and cervical eversion. Chronic cervicitis is related to cervical cancer, so it should be actively controlled. Women with cervicitis over the age of 30 should have cervical smears regularly to check for cancer cells.

Basic Information

English name

cervicitis

Visiting department

Gynecology

Multiple groups

female

Common causes

Bacterial invasion and infection caused by surgical trauma such as childbirth, abortion and curettage

Common symptoms

Purulent leucorrhea, cervical hyperemia and tenderness, etc.

Causes of cervicitis

Acute cervicitis

Acute cervicitis is caused by sexual intercourse, miscarriage, childbirth, diagnostic curettage, etc., caused by cervical damage and pathogens invading the site of injury. There are several common pathogens:

(1) Pathogens of sexually transmitted diseases Neisseria gonorrhoeae and Chlamydia trachomatis are mainly found in high-risk groups of sexually transmitted diseases.

(2) Endogenous pathogens such as Staphylococcus, Streptococcus, E. coli and Trichomonas, Candida, Amoeba and so on.

2. Chronic cervicitis

Chronic cervical inflammation can be extended from acute cervical inflammation or caused by continuous infection of pathogens, which are similar to acute cervical inflammation. Unclean sex, decreased estrogen levels, and long-term stimulation of vaginal foreign bodies can all cause chronic cervicitis. Secondary infections after abortion, childbirth, and vaginal surgery may damage the cervix, but they can also cause chronic cervicitis without causing acute symptoms.

Clinical manifestations of cervicitis

Acute cervicitis

Mainly manifested by increased vaginal secretions, mucopurulent, vaginal secretions can cause itching and burning sensation of the vulva. May have sexual intercourse pain, lower abdominal pain and other symptoms. If urinary tract infection is combined, urgency, frequent urination, and dysuria may occur. If it is Neisseria gonorrhoeae infection, due to the involvement of the paraurethral glands and vestibular glands, the urethral and vaginal mucosal congestion, edema, and a large amount of purulent secretions can be seen. Often occurs simultaneously with vaginitis and endometritis. Staphylococcus, streptococcus and other pyogenic infections can spread upwards and cause pelvic connective tissue inflammation.

The symptoms of acute cervical inflammation caused by Chlamydia trachomatis infection are often inconspicuous, or even asymptomatic. Increased vaginal discharge, spotted bleeding, or urinary tract irritation are common symptoms.

2. Chronic cervicitis

(1) Increased leucorrhea Patients with chronic cervicitis may be asymptomatic, and sometimes the increase in leucorrhea may be the only symptom, which is pale yellow leucorrhea, sometimes with bloodshot blood, or contact bleeding. Occasionally, secretion irritation causes vulvar itching and discomfort.

(2) Pain in the lower abdomen or lumbosacral region is a common symptom. It may worsen during menstruation and defecation, and may have pain during sexual intercourse. Pain is even worse when the inflammation spreads to form chronic para-uterine connective tissue inflammation.

(3) Urinary tract irritation signs When inflammation spreads to the bladder triangle or connective tissue around the bladder, urinary tract irritation symptoms may occur, and frequent urination or difficulty in urination.

(4) Other symptoms Some patients may have irregular menstruation, dysmenorrhea, and a feeling of heavy pelvic cavity.

Cervicitis examination

Acute cervicitis

(1) Gynecological examination showed congestion, redness and swelling of the cervix, accompanied by edema of the cervical canal and cervical eversion. Cervical tenderness is obvious. Purulent discharge from the cervical canal.

(2) Leukocyte detection Examine white blood cells in cervical canal secretions or vaginal secretions. In patients with acute cervicitis, the neutrophil count of cervical canal purulent secretions is greater than 30 / high-power field. Vision.

(3) Pathogen detection Do smear or bacterial culture of cervical secretions to look for pathogenic bacteria. Enzyme-linked immunosorbent assay can be used to detect Chlamydia trachomatis antigen when chlamydia infection is suspected.

2. Chronic cervicitis

(1) Gynecological examination It can be found that the cervix has an erosion-like change and is easy to bleed. Or there is a yellow discharge covering or flowing out of the cervix, and there may be cervical tenderness. It can also manifest itself as cervical polyps, cervical gland cysts, or cervical hypertrophy.

(2) When colposcopy is used to treat cervicitis for a long time, contact bleeding, Pap smear level 2 or above, colposcopy may be used to detect early precancerous lesions (such as cervical intraepithelial neoplasia) or early Cervical cancer.

(3) Pathogen detection Pathogenic bacteria can be found on cervical secretion smears or bacterial culture. Cervical cell smears can also detect gonococci, trichomoniasis, and fungi. If necessary, check for chlamydia, mycoplasma, and human papillomavirus.

(4) Cervical curettage and cervical biopsy Chronic cervicitis should be routinely performed with cervical smear cytology to distinguish it from cervical precancerous lesions, cervical cancer, cervical tuberculosis and other diseases. Taking the pathological examination of the cervical erosion ulcer or the deeper lesion is the most accurate method. The vulva and vagina have acute inflammation, menstrual period, and pregnancy should be postponed.

Cervicitis diagnosis

Acute cervicitis

There are purulent or mucopurulent secretions visible to the naked eye on the cervical canal or cervical canal swab specimens, or when the cervical canal is swabbed with a cotton swab, it can easily induce cervical canal bleeding. The appearance of one of these two characteristic signs and the increased white blood cell count of the cervical or vaginal secretions at the same time by microscopy can make a preliminary diagnosis of acute cervical inflammation. After the diagnosis of cervical inflammation, further examination is needed to determine the pathogenic bacteria.

2. Chronic cervicitis

Based on clinical manifestations and gynecological examination results, a preliminary diagnosis of chronic cervicitis can be made, but attention should be paid to distinguish positive signs found in gynecological examination from common pathophysiological changes of the cervix (cervical precancerous disease or early cervical cancer).

Cervicitis treatment

Acute cervicitis

Mainly antibiotic treatment, systemic treatment is the main, and strive to be thorough, so as not to turn into chronic cervicitis.

(1) Empiric antibiotic treatment is used for patients with the following high risk factors for sexually transmitted diseases (such as younger than 25 years old, multiple sexual partners or new sexual partners, and unprotected sexual intercourse). Empiric antibiotic treatment of chlamydia.

(2) Antibiotic treatment for pathogens For those who have acquired pathogens, choose antibiotics for pathogens. Because Neisseria gonorrhoeae infection is often accompanied by chlamydia infection, if it is gonococcal cervicitis, in addition to anti-Neisseria gonorrhoea drugs, anti-chlamydia infection drugs should be used at the same time.

(3) Treatment of sexual partners If the pathogens of patients with cervicitis are Chlamydia trachomatis and Neisseria gonorrhoeae, their sexual partners should be examined and treated accordingly.

2. Chronic cervicitis

Local treatment is the main method, and different treatment methods are used for different lesions.

(1) Chronic cervical mucositis For persistent cervical mucosal inflammation, it is necessary to know whether there is reinfection of Chlamydia trachomatis and Neisseria gonorrhoeae, whether sexual partners have been treated, and whether vaginal microbiome disorders persist. Treatment for the cause. For those with unclear pathogens, there is no effective treatment method. Physical therapy can be tried. Including electric ironing, laser, freezing, microwave infrared and other methods, can also be given traditional Chinese medicine treatment or as an adjuvant treatment before and after physical therapy. However, screening must be performed to exclude cervical intraepithelial neoplasia and cervical cancer before treatment. For those with severe erosion or long-term cure, cervical cone cutting can be considered.

(2) Cervical polyps The polyps are removed, and the removed polyps are sent for histopathological examination.

(3) Cervical hypertrophy Generally no treatment is required.