Chronic cervicitis

Epidemiology and classification

Inflammatory diseases of the female pelvic organs rank 1st in the structure of gynecological pathology, accounting for 60–65% of all visits to women's health clinics. The actual number of cases is significantly higher, as many patients do not seek medical attention due to mild forms of the disease. The rise in incidence is associated with changes in the sexual behavior of youth, environmental deterioration, and decreased immunity.

The anatomical boundary between the parts of the genital tract is the internal os. Cervicitis and endocervicitis belong to inflammations of the lower genital tract. According to the clinical course, the process is considered chronic if its duration exceeds 2 months or is not precisely established. The disease proceeds with alternating stages of exacerbation and remission.

Etiology: pathogens of inflammation

Inflammation occurs under the influence of various factors, but the most significant is infectious. The main route of pathogen transmission is sexual (household transmission is rare, mainly in girls when sharing personal hygiene items).

Depending on the type of pathogen, the following are distinguished:

• Specific infections: gonorrhea, tuberculosis, diphtheria.
• Nonspecific infections: caused by streptococci, staphylococci, enterococci, Escherichia coli (E. coli), klebsiella, proteus, Candida fungi, viruses, and actinomycetes.

In pathogenesis, a key role is played by absolute pathogens: gonococci, chlamydia, trichomonads, and Mycoplasma genitalium. Opportunistic microorganisms often act as microbial associations. The current trend shows that inflammation is increasingly caused by mixed microflora with a predominance of anaerobic non-spore-forming microorganisms.

Pathogenesis and clinical presentation

The process often begins as acute endocervicitis — inflammation of the mucosa of the cervical canal. In the acute stage, patients complain of purulent or mucopurulent discharge, and sometimes dull aching pain in the lower abdomen.

As the process becomes chronic, the inflammation spreads deeper, involving the muscular layer of the cervix, leading to true cervicitis.

The clinical picture changes:

• The pain syndrome gradually subsides.
• Complaints of itching and pus-like genital discharge come to the fore.
• Upon objective examination, the physician reveals compaction and hypertrophy of the cervix.
• Nabothian cysts (ovulae Nabothii) form within the thickness of the tissues.

Chlamydial infection deserves special attention. Chlamydia has a high tropism for the columnar epithelium of the endocervix. Chlamydial cervicitis in most cases is asymptomatic or accompanied by scanty seropurulent discharge, which greatly complicates timely diagnosis.

Diagnostic methods

Since symptoms are often mild, the diagnosis is made based on a comprehensive examination:

1. Speculum examination and colposcopy: reveal edema, mucosal hyperemia around the external os, possible erosions, and seropurulent discharge from the cervical canal.
2. Bacterioscopy and bacteriological culture: allow determining the composition of the discharge microflora and its antibiotic sensitivity.
3. Cytological examination: smears from the cervix reveal cells of stratified squamous and columnar epithelium without signs of atypia, but with a pronounced inflammatory leukocyte reaction.
4. PCR diagnostics: used to identify the specific nature of the inflammation (e.g., chlamydia).
5. Microscopy with Romanowsky-Giemsa staining: used to examine scrapings from the cervical canal (allows detecting chlamydia in 25–30% of cases).

Complications and principles of therapy

The main danger of chronic cervicitis is the risk of developing an ascending infection. Pathogens can penetrate into the upper compartments, causing endometritis, salpingo-oophoritis, pelvioperitonitis, and parametritis.

Prolonged inflammation (especially of chlamydial etiology) leads to the formation of cicatricial-adhesional processes. This causes severe consequences: infertility and ectopic pregnancy. In addition, with inadequate therapy, chlamydia are able to transform into L-forms or alter their antigenic structure, hiding from the immune system.

Treatment should include antibiotics based on pathogen sensitivity. Important rule: in the acute phase of inflammation, local treatment is strictly contraindicated due to the high risk of generalization of the process and the development of ascending infection.

Class and exam questions

What else to study on this topic

• Acute endometritis: etiology, clinical features, and ultrasound findings
• Ascending infection: salpingo-oophoritis and pelvioperitonitis
• Urogenital chlamydia and Reiter's syndrome
• Clinical forms of specific vulvovaginitis (trichomonal, mycotic, herpetic)
• Methods of laboratory diagnosis of pelvic inflammatory diseases (PCR, bacteriological culture, cytology)

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