Moderate chronic cervicitis: causes, symptoms, diagnosis, treatment

Exocervicitis is an infectious inflammation of the outer surface of the cervix. The inflammatory process with exocervicitis extends only to that part of the cervix that protrudes into the vaginal cavity and is visualized during examination (vaginal part).

Inflammatory changes in the vaginal area and the part of the cervix located in it are diagnosed in 70% of patients. Isolated inflammation of the cervix practically does not exist; due to the anatomical proximity and the uniform structure of the integumentary epithelium, the vagina and cervix are involved symmetrically in the pathological process.

Since the formulations of the diagnosis regarding inflammatory changes in the cervix contain many similar terms, and sometimes they even refer to the same process, patients often cannot understand the essence of their disease. To correctly interpret any diagnosis, it is necessary to have a general understanding of the cervix.

The cervix is the lower, significantly narrowed segment of the uterus. It can be imagined as a hollow tube 3-4 cm long, the outer part of which protrudes into the vagina. The structure of the epithelium of the surface of the cervix is similar to the vaginal mucosa; it is represented by several layers of flat cells.

Inside the cervix is the cervical canal, which connects the vaginal and uterine cavities. The glandular structures of the cervical canal produce a lot of mucous secretion. Cervical mucus is biologically active against infection and is capable of destroying unwanted microorganisms, protecting the underlying structures from inflammation.

Inflammatory changes can only affect the area surrounding the outside of the cervix - the exocervix, then the term “exocervicitis” appears in the diagnosis. However, isolated inflammation of only the surface of the cervix can often not last long, especially in the presence of weakened local immunity. Often the inflammation spreads to the mucous membranes of the cervical cavity (endocervix). The inflammatory process with exocervicitis also involves the vaginal mucosa, provoking the development of vaginitis.

Complaints from patients with exocervicitis are not specific and are similar to signs of infectious inflammation of the external genitalia of any location and nature: vaginal discomfort and pathological discharge. The severity of symptoms depends on the stage of inflammation. Severe exocervicitis is characterized by an acute onset and vivid symptoms; when the inflammatory process transforms into a chronic form, active symptoms may be absent.

The presence of inflammation on the surface of the cervix is clearly visualized during a routine examination, but detailed laboratory diagnostics are required to determine the source of the disease. More often, at the origins of exocervicitis, specific microflora is found (gonococci, trichomonas, less often - chlamydia). Nonspecific inflammation is provoked by opportunistic microbes that are part of the vaginal microbiocenosis (streptococci, staphylococci, Escherichia coli, corynebacteria and others).

For a more detailed study of inflammatory changes in the cervical epithelium, a colposcopic examination is performed. It also allows you to determine the involvement of the endocervical mucosa in the inflammatory process and diagnose concomitant diseases (usually true and false erosions of the cervix).

The scope of treatment depends on the source of infection, the form of the disease, the involvement of surrounding tissues and the presence of concomitant pathology. In addition to eliminating the infection, it is necessary to eliminate provoking factors, stimulate local immunity and restore normal vaginal microbiocenosis.

Exocervicitis - what is it?

Due to the specific features of the female anatomy, and in particular the genitourinary system, pathogenic organisms can very easily penetrate the body. As a result, they can cause cervical exocervicitis. What it is? These are inflammatory processes in the mucous membrane of the cervix, which are accompanied by pain in the lower abdomen and discharge uncharacteristic for a woman.

The inflammatory process - exocervicitis - is most often observed in women aged 25 to 35 years who lead an active and disordered sex life.

Cytogram

A cytogram of exocervicitis is changes observed in a smear that indicate the presence of inflammation in the cervical area. Cytological examination examines the cellular composition of the resulting sample. This analysis makes it possible:

Determine the number of leukocytes, eosinophils and other blood cells;
Study in detail the shape of epithelial cells;
Clarify the location of chromatin in the nucleus;
Determine reactive changes in tissue;
Identify the presence of pathological microorganisms that could presumably be the cause of inflammation.

As a rule, such indicators are characteristic of all layers of the epithelium. They are important for calculating important indices:

Maturation;
Karyopyknotic;
Eosinophilicity.

After analysis, it can be revealed that the cytogram corresponds to exocervicitis, which means the presence of an inflammatory process occurring in the area of the cervix. With this diagnosis, you need to take another smear to determine the sensitivity of the microflora to antibacterial agents.

After treatment of the disease with a previous diagnosis of exocervitis, the cytogram is repeated.

What is a “cytogram corresponding to exocervicitis” and how to prepare for the study?

In order for the cytogram result to be as reliable as possible, you need to follow simple rules for preparing for analysis:

There should be no sexual intercourse two days before taking a smear;
It is necessary to avoid douching and inserting medications into the vagina;
Taking hormonal medications should also be stopped;
Cytological examination is not done immediately after or before menstruation. The best time for analysis is the middle of the cycle;
Inflammatory diseases of the cervix or vagina must be treated first, since when taking a smear, the risk of inflammation and pus spreading to other layers of tissue is very high. Based on this risk, a smear for cytology is taken in the absence of an active inflammatory process.

It is not possible to understand what the cytogram means corresponds to exocervicitis during pregnancy, since this cytological study is not carried out. This exception can be explained by the fact that in pregnant women the cervical canal is tightly closed with a plug of mucus. If you neglect this, the risk of damage to this plug will be very high.

You can take a smear for cytology after childbirth, when the birth canal and uterine tone are restored.

The cytogram corresponds to the inflammatory process of exocervicitis - what does this conclusion mean?

The most common conclusion of such a study is considered to be an inflammation cytogram. In fact, such a conclusion is not very dangerous.

Against the background of inflammation, cytological examination may reveal koilocytes, which indicate the presence of human papillomavirus. If such cells are detected, the woman will need to undergo additional examination to confirm the presence of such a disease.

The result of a cytological examination may also show cervical leukoplakia. This pathology can be detected even by taking a smear based on external signs. The doctor can see white areas of keratosis, which stands out perfectly against the background of the pink cervix.

Cytological analysis also reveals such atypical cells. As a result of their division, cells of irregular shape and size appear. If such cells are detected, the analysis is repeated to exclude an erroneous result. The presence of such cells indicates the development of a precancerous condition of the cervix. Once the diagnosis is confirmed, the woman should undergo urgent treatment.

Causes of exocervicitis

There are several factors that can trigger the onset of the disease:

Promiscuous sex, unprotected sex.
Decreased immunity due to renal or liver failure, HIV infection, diabetes.
Abortion, childbirth, as well as the presence of injuries caused to the internal genital organs as a result of these processes.
Prolapse of the cervix.
Inflammatory processes in the genitourinary system (colpitis, cystitis, etc.).
The presence of diseases during which microbes are spread throughout the body along with the blood (tonsillitis, various inflammations, etc.).
Improper use of internal contraceptives (coils, vaginal suppositories) or frequent douching with aggressive drugs to protect against pregnancy.
Hormonal imbalances in the body. Most often this occurs in postmenopausal women, when the production of female hormones significantly decreases and because of this, atrophic inflammation begins to develop in the mucous membrane. Another cause of hormonal imbalance may be improper use of oral contraceptives (birth control pills).
Ignoring personal hygiene rules.

Prevention

Inflammation of the cervix is a very serious disease, which in an advanced stage can cause the development of various kinds of complications. To prevent such a situation, the following prevention of exocervicitis is required:

You should visit a gynecologist twice a year;
After birth, uterine ruptures are sutured;
Abortion is not recommended;
You should refrain from frequently changing sexual partners and sex without condoms;
It is worth treating infectious and other sexual diseases in a timely manner;
You need to periodically do exercises to strengthen the vaginal muscles;
During menopause, hormone replacement therapy can be performed.

To eliminate the risk of developing the disease, it is also important to strengthen your immune system and lead a healthy lifestyle.

Exocervicitis of the cervix: what is it and what are its symptoms

The question of what cervical exocervicitis is has been sorted out - these are inflammatory processes in its mucous membrane. What symptoms accompany these processes? It depends on the stage of the disease. While at the initial stage a woman may not even suspect the presence of infections and inflammatory processes in the reproductive system, in the event of an exacerbation some specific symptoms will appear, by which one can judge the disease:

feeling of discomfort and pain in the lower abdomen;
pain during sex and spotting immediately or a short period of time after it;
discomfort, pain or burning during urination;
change in the nature of the discharge - it can become bloody, mixed with pus or mucus.
itching in the external genital area.

In addition to the main symptoms, drowsiness, general malaise, and increased body temperature may occur.

Pathogenic organisms causing cervicitis

Among the infectious agents that cause inflammation of the cervix are:

Specific microorganisms. These are chlamydia, ureaplasma, trichomonas, amoebas, tuberculosis bacilli, gonococci, genital herpes. In the presence of this infection, the process is acute and requires urgent treatment with antibiotics and anti-inflammatory drugs, that is, chronic cervicitis of a high degree of activity is observed;
Nonspecific. Candida fungus, gardnerella, E. coli. These microorganisms provoke chronic cervicitis of moderate activity.

In both cases, inflammation develops – this is how the body’s protective reaction to microbes manifests itself.

Bacterial nature of cervicitis

Bacterial cervicitis can occur against the background of an existing viral infection, which weakens the defenses. In this case, chronic active cervicitis occurs with periodic relapses and remissions, which is difficult to treat until the immune system is restored and the viral agent is eliminated.

Carefully! Against the background of viral infections, bacteria can transform into inactive forms, which, under favorable conditions, restore their activity. In this case, the woman will be a source of infection without even knowing it. Similar cases with Trichomonas are described in the medical literature.

Viral nature of cervicitis

With a low immune status, there is a high probability of developing sexually transmitted viral infections. These are:

herpes virus;
ureaplasma (intermediate microorganisms between bacteria and viruses)
human papillomavirus;
AIDS virus.

These pathogens weaken the body and create a favorable environment in which bacteria and fungi thrive, while actively reproducing.

Reasons contributing to the formation of a focus of inflammation

An exacerbation of a chronic infection can cause:

abortion;
hormonal disorders;
damage to the cervix during childbirth;
installation of an IUD;
diagnostic examinations and microdamage to the epithelium;
scars on the cervix.

When several factors are combined - infection, mechanical damage, low immunity - there is a high probability of an inflammatory process in the cervix.

Classification of the disease

Depending on the nature of the disease, exocervicitis is divided into two groups:

1. Acute exocervicitis.

This type of disease is characteristic of a healthy cervix. It is caused by a fungal infection or gonorrhea. Characteristic signs of acute exocervicitis are the appearance of purulent or mucopurulent discharge from the vagina, severe pain and fever.

2. Chronic exocervicitis.

In most cases, it develops in case of improper treatment of acute exocervicitis. This type of disease is characterized by increased pain, hardening of the cervix, severe inflammation and cyst formation, and rejection of the epithelium.

Signs of chronic cervicitis

Highly active cervicitis is manifested by the following symptoms:

yellow-green purulent discharge in large quantities;
presence of a specific odor;
dysuria – painful urination;
nagging pain in the lower abdomen;
the presence of ulcerative lesions on the vaginal part of the cervix;
painful sexual intercourse.

Chronic cervicitis is characterized by:

cloudy mucous discharge;
mild pain during sexual intercourse;
There may be itching or a burning sensation in the vagina.

Important! Chronic inflammatory process on the cervix much more often develops into malignant tumors and poses a great danger to women of reproductive age.

Diagnosis of the disease

In order for treatment to take place as quickly as possible and without unnecessary effort, it is important to notice the symptoms of the disease in time and consult a doctor to confirm the diagnosis of exocervicitis. What it is and what its symptoms are was described above, so now it’s worth learning in more detail about how to diagnose the disease.

A visit to the gynecologist begins with a short survey. The doctor asks questions about the nature and duration of abdominal pain, the presence or change of vaginal discharge, characteristics of the menstrual cycle, previous infectious diseases, and so on.

The second stage of diagnosis is examination in a gynecological chair. First of all, the external genitalia are examined, after which the doctor moves on to the vagina and cervix. Already during the examination, the gynecologist determines the nature and type of the disease: acute or chronic exocervicitis.

For a more accurate diagnosis and prescription of the correct and effective method of treatment, in addition to examination, the following procedures are also carried out:

Taking a smear of vaginal flora.
Diagnosis of possible sexually transmitted viral diseases (including HIV, hepatitis B).
Ultrasound of the pelvic organs (ovaries, uterine appendages).
General blood and urine tests.
Colposcopy.
Carrying out a cytological examination. It helps to definitively confirm the diagnosis of exocervicitis. A cytogram will help the doctor once again verify the presence of inflammatory processes and obtain information about changes in the vaginal flora. Particular attention is paid to the nature of changes in the epithelium.

If the cytogram corresponds to exocervicitis, the gynecologist prescribes the necessary course of treatment. In this case, treatment is selected exclusively on an individual basis based on the characteristics of the patient’s body.

Mkb

Cervicitis is a disease of the cervix in which inflammation develops. There are two similar concepts - exocervicitis and endocervicitis.

The first disease is inflammation of the vaginal area of the cervix;
The second is inflammation of the mucous membrane of the cervical canal of the cervix.

A disease such as exocervicitis according to ICD 10 refers to paragraph No. 72, which indicates inflammatory diseases of the cervix.

This diagnosis is made to women who seek medical help in 70% of cases.

Exocervicitis code according to ICD 10 No. 72 can be of different forms, these are:

Acute;
Chronic.

Exocervicitis ICD 10 – how is this diagnosis confirmed?

To make an accurate diagnosis, the doctor prescribes a number of diagnostic procedures to the patient, which include:

Microscopic examination;
Bacteriological research;
Cytological examination;
Polymerase chain reaction or enzyme immunoassay.

To obtain an accurate description of the disease, a woman needs to have a colposcopy. The results of such a study will make it possible to evaluate the following characteristics:

The consistency of the discharge, which may differ depending on the type of pathogen;
The presence of bright red dots on the surface of stratified squamous epithelium;
The presence of an inflammatory process can be detected using the Schiller test. The lesions will be visible as light dots on a brown background;
A purulent coating is visible on eroded surfaces.

To confirm or exclude oncological formations, an OMT ultrasound is performed.

The diagnosis of exocervicitis - ICD 10 code No. 72 is made after laboratory and instrumental studies

Before making a diagnosis, you need to undergo laboratory and instrumental studies.

Through microscopic examination, it is possible to identify the exact number of microorganisms, as well as determine what type they belong to.

With the help of bacteriological examination, it is possible to determine to what genus or species microorganisms belong. Their sensitivity to antibiotics is also determined.

Using the cytological method of research, it is possible to determine the structure and cellular level of tissue damage. It can also help you understand whether a particular treatment is effective.

Using colposcopy, you can also identify the type of pathogen and determine which treatment will be more effective.

In addition to laboratory diagnostics, an extensive examination of the cervix and instrumental examination of the pelvic organs are carried out. This should be done to exclude oncology.

Treatment of the disease

The next stage after diagnosis of exocervicitis is treatment. It can be of a different nature, depending on the severity of the disease and its causative agents.

If the inflammation was caused by bacteria, a course of antibiotic therapy is prescribed. In this case, only a doctor can prescribe the drug and dosage!

In the case of a viral nature of the disease, treatment is carried out with a course of antiviral therapy. The most popular drugs in this case are Valtrex and Acyclovir. Just as in the previous case, the required dosage is calculated individually.

If exocervicitis was caused by a fungus, then, accordingly, antifungal drugs are prescribed.

After the course of treatment, medications are necessarily prescribed to restore the vaginal microflora. These can be various ointments or suppositories, which are also selected individually.

If the disease was diagnosed too late and caused complications, surgical interventions are possible. Their goal is to remove the damaged layer of epithelium using laser radiation.

Differences between exocervicitis and endocervicitis

Cervical exocervicitis, as mentioned earlier, is an inflammation of the vaginal segment of the cervix. It is characterized by the following signs:

Ulceration of the mucous membrane.
Visually noticeable hyperemia of the external pharynx of the cervical canal.
Detection of microabscesses.
Swelling of the mucous lining.
Copious discharge.
Leukocyte infiltration of the cervix in the form of multiple periglandular infiltrates.

Endocervicitis of the cervix is manifested by symptoms of inflammation of the cervical canal. More often it develops as a result of invasive procedures and diseases of nearby organs of the reproductive system. The pathology is characterized by rapid progression and a high probability of chronicity and a blurred clinical picture. There is not as much discharge as with exocervicitis, and the intensity of the pain syndrome can vary.

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During the examination, the gynecologist may note swelling of the mucous membrane of the cervical canal, its hyperemia, a large number of small ulcers, and pathological discharge in the cervix. Cervical endocervicitis is dangerous due to its complications. Often, an erased clinic plays a negative role: despite apparent well-being, the disease spreads and manifests itself in a more severe form.