Exocervicitis

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

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

Since the formulation of the diagnosis concerning the inflammatory changes in the cervix, featured many similar terms, and sometimes they even refer to one and the same process, the patient often can not understand the nature of his illness. In order to correctly interpret any diagnosed diagnosis, it is necessary to have general ideas about the cervix.

The neck is the lower, considerably narrowed, segment of the uterus. It can be represented 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 cells of a flat shape.

Inside the cervix is ​​a cervical canal that connects the vaginal and uterine cavities. The glandular structures of the cervical canal produce a lot of mucosal secretions. Nodular mucus is biologically active against the infection and is capable of destroying undesirable microorganisms, protecting the upstream structures from inflammation.

Inflammatory changes can affect only the area surrounding the cervix from the outside - exocervix, then the diagnosis includes the term "exocervicitis".However, isolated inflammation of only the surface of the cervix is ​​more likely to last for long, especially if there is a weakened local immunity. Often the inflammation spreads to the mucous membranes of the cervical cavity( endocervix).Inflammatory process with exocervicitis involves mucous vaginas, provoking the development of vaginitis.

Complaints of patients with ekzotservitsitom no different specificity and are similar to symptoms of an infectious inflammation of the external genitalia of any location and nature: vaginal discomfort and abnormal discharge. The severity of symptoms depends on the stage of inflammation. Expressed exocervicitis has a sharp onset and bright symptoms, when the inflammatory process is transformed into a chronic form, active symptoms may be absent.

The presence of inflammation on the surface of the cervix is ​​well visualized during routine examination, but detailed laboratory diagnosis is required to determine the source of the disease. More often at the sources of exocervicitis, a specific microflora is detected( gonococci, trichomonads, less often - chlamydia).Nonspecific inflammation provoked by opportunistic germs that are part of the vaginal microbiocenosis( streptococci, staphylococci, E. coli, Corynebacterium and others).

For a more detailed study of the inflammatory changes in the cervical epithelium, colposcopic examination is performed. It also makes it possible to determine the involvement of the endocervical mucosa in the inflammatory process and to diagnose associated diseases( more often true and false erosions of the cervix).

The volume 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 infection, it is necessary to eliminate provoking factors, stimulate local immunity and restore normal vaginal microbiocenosis.

reasons ekzotservitsita

superficial cervical epithelium is able to resist most of the microbes, so the development of an infectious inflammation requires certain predisposing conditions, namely:

- related infectious-inflammatory process, localized in any part of the urogenital system. Infection on the neck surface can get from cervical or vaginal cavity, so often expressed ekzotservitsit diagnosed in combination with obesity, endotservitsitah, endometritis, adnexitis, cystitis. Quite often, exocervicitis is accompanied by erosion of the cervix.

- Sexual infections( trichomoniasis, gonorrhea, chlamydia and others).More often than other representatives of a specific microflora, the effects of exocervicitis cause trichomonads and gonococci. In every third patient these infections provoke an inflammatory process on the cervix.

- Damage to the cervix of a mechanical nature( abortion, trauma, childbirth, diagnostic traumatic manipulation, frequent douching).Violation of the integrity of the cervical epithelium allows the undesirable microflora to penetrate into the mucous layer and provoke inflammation.

Also corrosive chemical substances( spermicides, non-conforming hygienic agents) are capable of damaging the covering neck of the mucosa.

- Dysbiotic disorders in the vaginal mucosa. The microflora of the vagina is very diverse, but the proportion of its various representatives is always constant. In a healthy vagina, lactoflora predominates( 98%).Lactobacilli maintain a constant level of acidity( pH) and protect mucous membranes from the negative effects of opportunistic and pathogenic microflora. In much smaller amounts( the remaining 2%), the vagina is inhabited by conditionally pathogenic microorganisms( staphylococci, streptococci, corynebacteria, bacteroids and others).Under the unfavorable conditions created by lactobacilli, they are not able to vegetate, but if the normal microbalance is disturbed, their increased reproduction begins, and infectious inflammation occurs.

- The presence of a large number of sexual partners in the absence of adequate protection against genital infections. Exocervicitis is more often found in sexually active and younger ones.

- Severe hormonal dysfunction. Vaginal mucosa and, accordingly, cervix, responsive to hormonal changes, especially changes in the concentration of estrogens. When hypoestrogenic death of lactobacilli occurs, and the number of opportunistic microbes increases.

- Weakening of the mechanisms of immune defense.

Symptoms and signs of exocervicitis

The disease has several clinical forms, usually they are associated with the nature of the causative agent of infectious inflammation. Acute exocervicitis often appears due to a specific infection, especially gonorrhea. Moderate exocervicitis with minimal clinical signs can provoke chlamydia. Chronic exocervicitis does not disturb the patient and is diagnosed only by direct examination.

Acute form of exocervicitis has all the signs of pronounced local inflammation: abundant leucorrhoea, unpleasant sensations in the projection of the vagina( itching, burning), discomfort during urination. Usually, at the end of menstruation, the severity of the symptoms increases.

Moderate exocervicitis has the same features, but they are much less pronounced.

If the acute inflammation is not diagnosed on time and is not treated, the infection penetrates deep into the body( literally "leaves" the surface of the neck) of the epithelium. Symptoms of inflammation subsiding, creating a false idea of ​​"recovery", and on the neck formed a chronic exocervicitis.

Infectious inflammation in exocervicitis consistently goes through three stages: alteration( damage), exudation( production of inflammatory secretion) and proliferation( the formation of new cells).At the stage of damage, the infection penetrates into the cells of the mucous layer and destroys their membrane. In response, the tissues loosen, and the affected glands intensively secrete to "wash" the infection( exudation).The stage of proliferation begins after the infection leaves the surface epithelial layers and penetrates beneath them. The processes of regeneration( restoration) of the damaged mucosa are activated. However, often the healing processes occur incorrectly, and newly formed cells cover the holes of the cervical glands, as a result, they accumulate a secret, and the pseudo-cysts are formed.

If exocervicitis occurs against the background of concomitant pathology, its symptoms will be supplemented by signs of the existing disease, therefore it is impossible to make a reliable diagnosis only on the basis of complaints.

Diagnosis of exocervicitis

Inflammatory changes on the cervix of the uterus are already detected by visual examination, so it is easy to ascertain the presence of exocervicitis. When examining the cervix, reddened and edematous mucosa with small hemorrhages( petechiae) in the form of red speckles are visualized. Acute purulent pronounced exocervicitis often differs in more severe course, when a dense purulent coating forms on the surface of the neck, and ulcers are formed. Moderate exocervicitis is distinguished by an erased clinic, it can provoke a slight reddening and mild edema of the cervix.

Since exocervicitis causes the pathological secretion of the cervical glands, atypical discharge is always present in the vagina during examination. Their nature depends on the "culprit" of inflammation. So, with gonorrhea and trichomonas infection, the vaginal discharge is always dense, abundant, pus-like, and the nonspecific microflora differs in serous or serous-purulent secretions.

Chronic exocervicitis does not have bright inflammatory signs, however long-existing in the thickness of the mucous infection provokes thickening of the cervix and leads to the formation of pseudo-erosion.

Because inflammatory changes on the neck are often combined with other pathologies, and sometimes they cause, for a more detailed study of pathological processes in the mucous layer, colposcopic examination is performed. With a large increase, the signs of an infectious lesion of the mucosa are visualized and its boundaries are determined, the presence of pseudo-erosion is determined.

Valuable information about the disease is provided by the result of a cytological examination( exocervicitis cytogram).With its help, the cellular composition of the pathological site on the cervix is ​​studied. The cytogram of exocervicitis indicates an inflammatory process: the number of leukocytes exceeding 100( instead of 10 permissible), a lot of mucus containing the causative agent of the infection.

It is much easier to diagnose exocervicitis than to find its true cause. To treat the disease successfully, it is necessary to establish which infection triggered the inflammatory process on the cervix. Therefore, a comprehensive laboratory study( smears and bapsides) is required to identify the causative agent of the disease.

Treatment of exocervicitis

Exocervicitis therapy is performed according to the principles of treatment of infectious inflammation and implements several basic goals:

- Elimination of infection. Antibiotic therapy begins only after an accurate laboratory identification of the pathogen. The earlier the exocervicitis is diagnosed, the easier it is to kill the infection. Treatment of chronic exocervicitis is always problematic, since the infection is not localized on the surface, but in the submucosa, and also causes serious structural disturbances.

Symmetric treatment with a sexual partner is performed if a particular inflammation is detected in the patient.

- Elimination of local dysbiotic disorders. If the physiological composition of the vaginal microflora is not restored, it will not be possible to avoid recurrence of the disease. Therefore, at the end of the course of antibiotics, drugs containing bifido- and lactobacilli( Lactagel, Bifidumbacterin, Acilact and the like) are prescribed.

- Restore the ability of mucous to resist infection with immunomodulators and vitamin therapy.

Surgical treatment with exocervicitis is usually used to eliminate the effects of chronic inflammation on the cervix, that is, erosion. After antibiotic therapy, erosion is eliminated by the most appropriate method for a particular patient.