Colpitis in gynecology

Etiological factors and pathogenesis

The inflammatory process in the vaginal mucosa is triggered when the balance between the macroorganism's defense forces and the microflora is disrupted. The pathogenesis of the disease is based on the fact that the normal saprophytic vaginal microflora acquires pathogenic properties (its virulence increases) in response to a decrease in immunobiological defense.

The main etiological factors include:

• Microorganisms: opportunistic flora plays a leading role. Primarily these are staphylococci, streptococci, Escherichia coli, as well as various non-spore-forming anaerobes.
• External influences: inflammation can be provoked by chemical, thermal, or mechanical damage to the vaginal mucosa.

Clinical picture: acute and chronic stages

The symptoms of nonspecific vaginitis directly depend on the stage of the inflammatory process. The disease often occurs not in isolation, but in combination with vulvitis, endocervicitis, and urethritis.

Acute stage Patients complain of severe itching and burning in the vagina, and the appearance of abundant purulent or seropurulent discharge. A characteristic symptom is pain during sexual intercourse (dyspareunia).

During an objective gynecological examination, the physician reveals the following changes:

• Pronounced edema and hyperemia of the mucosa.
• Presence of purulent deposits on the vaginal walls.
• Punctate hemorrhages (petechiae) on the mucosal surface.
• Contact bleeding (the mucosa is easily traumatized upon touch).
• In severe cases, epithelial desquamation is observed, leading to the formation of erosions and ulcers.

Chronic stage When the disease becomes chronic, acute complaints (itching and burning) subside and occur only periodically. The leading complaint becomes persistent seropurulent discharge.

The objective picture also changes: mucosal hyperemia and edema significantly decrease. A specific sign of the chronic process is the formation of granular colpitis — a condition in which infiltrates of the papillary layer form at the sites of healed erosions, appearing as punctate elevations above the surface.

Diagnostic methods

To make an accurate diagnosis and select therapy, a set of diagnostic measures is used:

• Colposcopy: acts as an important additional visualization method. It allows the detection of even the mildest signs of the inflammatory process.
• Laboratory diagnostics: aimed at the precise identification of the pathogen. It includes bacteriological and bacterioscopic examination of the discharge. The material for analysis is necessarily collected from three points: the vagina, urethra, and cervical canal.
• Smear microscopy picture: characterized by the presence of a large number of leukocytes, desquamated epithelium, as well as abundant Gram-positive and Gram-negative microflora.

Complex treatment and prevention of recurrences

Colpitis therapy must be strictly comprehensive. It includes combating the infectious agent, eliminating concomitant pathologies, and boosting the patient's general immunity.

Etiotropic (antibacterial) therapy Used both systemically and locally. Local treatment consists of washing or douching the vagina with antiseptic solutions 1–2 times a day. Drugs such as dioxidine, chlorhexidine, betadine, miramistin, or chlorophyllipt are used for this purpose. Important rule: prolonged douching (more than 3–4 days) is strictly not recommended. Excessive washing out of the flora prevents the restoration of the natural biocenosis and normal vaginal acidity.

Therapy of senile (atrophic) colpitis In case of age-related mucosal changes, local application of preparations containing estrogens is advisable. For example, estriol is used (Ovestin preparation in the form of vaginal suppositories or ointments). Estrogens help increase the biological defense of the thinned epithelium.

Criteria for cure The main criterion for complete cure is considered to be the normalization of the vaginal microflora. If the disease stubbornly recurs, the physician needs to actively search for and eliminate hidden pathogenic factors.

Class and exam questions

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