Cervicitis
1. Acute cervicitis.
2. Chronic cervicitis.
3. Cervical ectopy.
Acute cervicitis
Definition: acute inflammation of endocervical glands.
Aetiology: * Gonococci & chlamydia.
* Puerperal sepsis: infection of cervical laceration.
Diagnosis:
Symptoms:
General: fever, anorexia, headache & malaise.
Local: backache & mucopurulent discharge.
Signs:
General: fever & tachycardia.
Local: cervix is red, swollen with marked tenderness on mobility.
Treatment:
Antibiotics should be given in full doses & full course.
Chronic cervicitis
Definition: Chronic inflammation of endocervical glands.
1. Chronic specific cervicitis e.g. TB & bilharisiasis.
2. Chronic non-specific cervicitis.
Aetiology: follows acute cervicitis due to:
1. Racemose nature of endocervical glands so, drainage is difficult.
2. Absence of monthly shedding of the cervical mucosa.
Diagnosis:
Symptoms:
♦ May be asymptomatic.
♦ Symptomatic:
– Mucopurulent discharge.
– Pain:
a) Backache: spread of infection along uterosacral ligament.
b) Dysmenorrhea: due to pelvic congestion.
c) Dyspareunia: spread of infection to parametrium.
d) Dysuria & frequency of micturition: cystitis caused by lymphatic spread.
– Bleeding: menorrhagia & contact bleeding.
♦ Complications; infertility -hostile cervical mucous- & septic focus.
Signs (clinico-pathological types):
♦ Chronic endocervicitis: manifested by excessive cervical discharge.
♦ Nabothian follicles: blocked ducts affect glandular drainage resulting in small bluish
cysts projecting into portiovaginalis.
♦ Cervical ectopy.
♦ Cervical ectropion: eversion of cervical lips due to bilateral fibrosed cervical tears.
♦ Chronic hypertrophic cervicitis.
♦ Mucous polyp.
Investigations:
1. Cervical smears; to exclude cervical malignancy in patients with suspicious cervix.
2. Culture & sensitivity of discharge: with little benefits -mixed flora environment-.
Treatment:
A. Medical treatment:
– Antibiotics are of little value if used alone.
– Clindamycin can be used -Clindam 300 mg oral-.
B. Surgical treatment:
– Trachelorraphy: in cases of ectropion.
– Conization: in old patients with marked lesions.
C. Cautery treatment: the main line of treatment.
1. Electrocautery:
Precautions:
1. Done postmenstrual to allow healing before next menses.
2. Vaginal discharge ↑ for some days after the procedure (hyperemia).
3. No intercourse or douching during this period.
4. Regeneration of sq. epithelium takes 4– 6 weeks covering cauterized area.
Procedure:
1. Anesthesia: not needed except in nullipara if cervical dilatation is needed.
2. Take 3 linear burns in anterior & posterior lips extending to edge of ectopy.
3. Depth of cauterization: 2 mm.
4. Avoid lateral edge to avoid injury of cervical branch of uterine artery.
Values:
Cautery reveals infection by opening deeply seated glands & draining them.
It also deals with the superficial epithelium covering cervical canal.
Complications:
1. 2ry hemorrhage: occurs at 10th day (expholiation of epithelium and infection).
2. Ascending infection and upper genital tract spread.
3. Cervical stenosis: due to excessive fibrosis.
2. Cryo-cautery= freezing:
Idea: freezing of tissues to -60º c with 2 mm depth.
Advantages: better healing + less complications.
Disadvantages: excessive vaginal discharge for 3 weeks.
3. Laser cauterization :
Idea: CO2 laser used to destruct superficial layer of tissues by vaporization.
Advantages: as cryo-cautery.
Disadvantages: expensive & require training.
4. Endocoagulation:
Idea: Coagulation & necrosis of tissues without charring.
Advantage: Excellent.
Disadvantage: expensive.
5. Chemical Cautery: no longer used.
Cervical ectopy
N.B.: erosion is an old name.
Definition: red area surrounding external os of cervix covered by columnar epithelium instead of stratified squamous epithelium.
(The underlying vessels give this area the red colour through thin columnar epithelium).
Aetiology:
1. Congenital ectopy: persistence of an intra-uterine condition.
2. Hormonal ectopy: – Excess estrogen provokes creeping of columnar epithelium to
outside external os.
– Occurs during pregnancy also with OCP users.
3. Inflammatory ectopy: – Infected discharge of chronic cervicitis.
– Devitalization and denudation of area around external os.
– Columnar epithelium (instead of stratified squamous) rapidly
cover the denuded area.
Diagnosis:
Symptoms: like chronic cervicitis (mainly discharge and contact bleeding).
Signs: * like chronic cervicitis.
* Types of ectopy (flat, papillary & follicular).
Investigations:
* Cervical smear to exclude possibility of associated malignancy.
Treatment:
* No symptoms no treatment.
* Hormonal ectropion left to spontaneous recovery within 3 months.
* Cautery done only in:
– Symptomatic cases.
– Hormonal ectopy persisting > 3 months.
Cervicitis videos:
Ultrasound Video showing a Polyp in the uterus with cervicitis.
Cervicitis PPT (power point presentations):
Cervicitis Prof. Aboubakr Elnashar Benha University Hospital, Egypt