Cervicitis
Introduction
Introduction to cervicitis Cervicitis is a common gynecological disease in gynecology, and it occurs mostly in women of childbearing age. Older people also have symptoms with vaginitis. Cervicitis mainly manifests as increased vaginal discharge, purulent, or abnormal bleeding such as inter-menstrual bleeding, bleeding after sexual intercourse. Often accompanied by backache and lower abdominal discomfort. There are two kinds of acute and chronic, acute cervicitis often coincides with acute endometritis or acute vaginitis, but it is more common in chronic cervicitis. The occurrence of cervicitis is related to sexual life. Natural or artificial abortion, diagnostic curettage and childbirth can cause cervical damage and lead to inflammation. The treatment strategy is mainly antibiotic drug treatment. For those who have acquired the pathogen, select sensitive antibiotics for the pathogen. Empirical treatment should include treatment for a variety of possible pathogenic microorganisms, including aerobic bacteria, anaerobic bacteria, chlamydia (and or gonococcus), mycoplasma, and the like. basic knowledge The proportion of illness: 1% Susceptible population: more women of childbearing age Mode of infection: non-infectious Complications: dystocia
Cause
Causes of cervicitis
Mechanical stimulation or injury (25%):
The occurrence of cervicitis is related to sexual life. Natural or artificial abortion, diagnostic curettage and childbirth can cause cervical damage and cause inflammation. Adult women should pay attention to contraception, avoid or reduce abortion, pay attention to postpartum hygiene, and avoid postpartum infection. .
Pathogen infection (25%):
The most common ones at home and abroad are gonococcus, Chlamydia trachomatis and Mycoplasma genitalium, followed by common bacteria such as Staphylococcus, Streptococcus, Escherichia coli, and Trichomonas and fungi.
Chemical stimulation (20%):
Washing the vagina with a potassium permanganate solution or placing a suppository into the vagina can cause cervicitis.
Vaginal foreign body infection (15%):
Vaginal foreign body infection causes cervicitis.
Prevention
Cervicitis prevention
1. Do a good job in family planning, avoid unplanned pregnancy, and do less or not to do artificial abortion.
2, pay attention to hygiene after abortion and puerperium, to prevent infection.
3, chronic cervicitis and cervical cancer have a certain relationship, it should be actively treated.
4. Keep the vulva clean.
5, to minimize the damage caused by artificial abortion and other gynecological surgery on the cervix.
6. Suspension of cervical cervix during menstruation, banned during the treatment period.
7. Rational use of antibiotics.
Complication
Cervicitis complications Complications
There is a certain correlation between cervical erosion and infertility, but there is no absolute necessity. As long as the correct treatment, it is very possible to wait for the cervical erosion to heal or improve the pregnancy. If there is a narrowing of the cervical canal, it can cause dystocia.
Symptom
Symptoms of cervicitis common symptoms leucorrhea increased squamous cell septic bloody vaginal discharge cervical congestion cervical erosion abdominal discomfort lower abdominal pain leucorrhea odor acid acid cervical edema
1, acute cervicitis: increased vaginal discharge, purulent, with low back pain, lower abdominal discomfort. Consciously low back pain, lower abdomen pain, genital itching or tingling; urinary frequency, tingling when urinating, etc.
2, chronic cervicitis: more vaginal discharge, milky white, mucus or vaginal discharge with bloodshot, or sexual intercourse bleeding, with genital itching, lumbosacral pain, menstrual aggravation.
3, signs: acute cervicitis, gynecological examination, cervical congestion, edema, tenderness; chronic cervicitis, gynecological examination, different degrees of cervix erosion, hypertrophy or polyps.
Examine
Cervicitis examination
Hysteroscopy
Interpretation: is a new minimally invasive gynecological diagnosis and treatment technology, a fiber light source endoscope for intrauterine examination and treatment, including hysteroscopic energy system light source system perfusion system and imaging system; it uses the lens body The anterior part enters the uterine cavity and has a magnifying effect on the observed part to visually and accurately become the first choice for gynecological hemorrhagic diseases and intrauterine lesions; in the case of completely painless, it can be used to directly observe the patient's palace in gynecological patients. Intracavitary conditions, understanding the pathogenic factors and surgical treatment of abnormal conditions.
Indications: diagnosis and treatment of various diseases in the uterine cavity, the etiology of various types of abnormal uterine bleeding infertility patients and the differential diagnosis of abnormal intrauterine imaging, submucosal fibroids, endometrial polyps, etc.; can also be used Uterine malformation correction can also be used for the diagnosis of early endometrial cancer if necessary.
Advantages: large angle of view, high resolution, clear image and good sealing, is an ideal way to treat benign lesions in the uterine cavity. It directly displays the physiological and pathological changes in the uterine cavity through a large-screen high-resolution color display, and can perform some intrauterine therapeutic operations under the speculum; it has small trauma, less bleeding, quick recovery, and does not affect the function of ovarian secretion. Does not harm the uterus and other advantages.
2. Pap stain
Cervical grading is a simple and effective way to detect cervical cancer early. It is a fixed staining microscope for cervical epithelial cells. It is usually divided into five levels:
Grade I cells are normal;
Grade II has inflammatory manifestations;
Class III has suspected malignant cells;
Grade IV has cancer cells to be confirmed;
Class V has cancer cells.
The accuracy is very high.
TCTHPV-DNA virology test
1. Membrane liquid-based ultrathin cytology detection system (TCT)
TCT detection is a leading international cervical cancer prevention technology. It adopts high-precision filtration membrane core technology and micro-computer automatic control system. The cell membrane made by the method has the advantages that traditional smears can not match. The principle is Use advanced liquid-based cell preservation techniques and computer-controlled filtration techniques to collect cells from the sampler for smear to diagnose mold infections, bacterial infections, human papillomavirus infections, and herpes virus infections, etc. It is recommended to go to the specialist The hospital allows experienced doctors to help diagnose the diagnosis, so as not to cause misdiagnosis and affect the treatment effect.
Brush it in the cervix with a small brush, take a few seconds to sample, no pain, then use the "cell preservation solution" to separate the impurities in the sample to form a clear cell smear, you can detect whether you have HPV infection .
2.HPV-DNA virology test
The collected cell sample is divided into two parts, one for detecting suspicious cells and one for detecting HPV infection by special instruments. This test can not only detect whether you are infected with HPV but also detect the amount of virus.
3. Colposcopy positioning "biopsy"
After the suspicious cells are found, the doctor needs to make a pathological section for diagnosis. The doctor will observe the lesions on the surface of the cervix through a colposcope, and use the small "cervical biopsy forceps" and "cervical tube scraping spoon" to take a few pieces from the cervix. The tissues were placed in small bottles and pathologically examined for therapeutic measures.
test result
Positive: 1. Only 20% to 30% of HPV viruses cause disease, and 60% to 70% of people are only HPV-positive without cervical lesions. This is equivalent to antigen-positive hepatitis B virus carriers and does not necessarily cause abnormal liver function. Some people have strong body resistance and the virus can be multiplied, so although it does not cause cervical lesions or cervical cancer, this situation does not require treatment, as long as HPV virus screening is performed once a year.
Negative: If the HPV infection test results are negative in women over 30 years old and the cells do not have any lesions, that is to say, there is no problem in the first two tests, and no similar examination is needed in the next 3 to 5 years.
note:
1. Do not screen during menstruation.
2. Do not have sex within 24 hours before screening.
3. Do not rinse the vagina or use intravaginal medication for 3 days before the test.
Diagnosis
Diagnosis and diagnosis of cervicitis
The first step is to ask the patient what clinical manifestations are: the main symptoms of cervicitis patients are increased vaginal discharge, and some patients show the only symptoms. In addition, there are slight differences in the symptoms of acute and chronic cervicitis. Usually, acute cervicitis vaginal discharge is purulent, patients often accompanied by lower abdomen and lumbosacral pain, or frequent urination, urgency, dysuria and other bladder irritation. Chronic cervicitis vaginal discharge is milky white, mucous, or pale yellow, purulent. Some patients with severe symptoms may also have bleeding symptoms, which are mostly aggravated after defecation and sexual intercourse.
The second step , the routine gynecological examination: Because cervicitis is a local inflammation of the cervix, usually the patient has more purulent discharge under the genital genital, most of these secretions are discharged from the cervical canal. In addition, when the gynecological examination touches the cervix, the patient may feel pain. If accompanied by cervical erosion or polyps, there may be contact bleeding.
The third step , smear examination of cervical secretions: for patients with cervicitis, a large number of pus cells can be seen when examining and culturing smear, bacteria can be found when Gram staining; secretion culture can produce pathogenic bacteria. The main operation is to wipe off the secretion of the outer surface of the cervix, insert a small cotton swab into the cervical canal to remove the appropriate amount of secretions, and then smear the secretions for Gram stain, to determine which pathogen caused by cervicitis.
The fourth step , the pathological examination of cervical tissue: According to gynecological experts, cervicitis is caused by cervical squamous epithelial shedding, endometrial gland secretion hypersecretion, and a large amount of neutrophil infiltration in the interstitial and gland. In patients with severe cervicitis, neutrophils can invade the surface and even reach the glandular epithelial cells. The results of the examination indicate tissue edema, vasodilatation and hyperemia. Clinically, pathological examination is generally not performed during the acute inflammatory phase.
