chronic cervicitis
Introduction
Introduction to chronic cervicitis Chronic cervicitis (chroniccervicitis) is the most common type of gynecological disease, and it is more common in women. The main clinical manifestations are increased vaginal discharge, milky white or yellowish, or viscous purulent, sometimes bloody or mixed with blood. Generally, it is not difficult to diagnose by gynecological examination. The local part of the cervix is characterized by erosion, cervical hypertrophy, cervix tuberculosis, cervical gland cyst and cervical squamous metaplasia. Because the symptoms of chronic cervicitis are often masked by other gynecological diseases, it is often found in routine gynaecological examinations that the cervix has a bright red fine-grained erosion zone and a purulent mucoid-like leucorrhea in the cervical canal. A diagnosis can be made. basic knowledge The proportion of illness: 0.02%-0.05% Susceptible population: more common in women Mode of infection: non-infectious Complications: infertility Cervical cancer Vaginitis Urethritis Pelvic inflammatory disease Annex inflammation
Cause
Causes of chronic cervicitis
Cervical erosion (30%):
The appearance of the cervix at the external cervix is a fine-grained red area called cervical erosion. At present, the terminology of cervical erosion is abandoned in Western countries, and it is renamed columnar epithelial ectopic And think that it is not a pathological change, but one of the physiological changes of the cervix, mainly based on the following understanding:
(1) The erosive surface under the microscope is covered by a single columnar epithelium of the cervical canal. Because the columnar epithelium is thin, the lower interstitial is red, so the naked eye looks like erosion, not the epithelial shedding, and the ulcer is truly erosive.
(2) Colposcopy is the external shift of the original scale column junction.
(3) There are lymphocytes in the normal cervical interstitium as immune response, and the infiltration of lymphocytes in the cervical interstitial does not necessarily mean chronic cervicitis.
China's cervical erosion is divided into pathological inflammatory erosion and pseudo-erosive: only in some physiological conditions such as adolescence, pregnant women, due to increased estrogen levels, cervical columnar epithelial hyperplasia and external migration, visible cervical outer mouth is red, thin Granular, for cervical pseudo-erosive, does not belong to pathological cervical erosion; other are inflammatory erosion.
According to the degree of cervical erosion, it is divided into 3 types:
1 simple erosion: in the early stage of inflammation, the erosion surface is only covered by a single layer of columnar epithelium, the surface is flat.
2 granular erosion: followed by hyperplasia of the glandular epithelium with interstitial hyperplasia, the erosion surface is uneven and granular.
3 mastoid type erosion: interstitial hyperplasia is significant, the surface unevenness is more obvious papillary.
According to the size of the cervical erosion area, the cervical erosion can be divided into 3 degrees:
A. Mild: The erosion surface is less than 1/3 of the entire cervical area.
B. Moderate: The erosion surface accounts for 1/3 to 2/3 of the entire cervical area.
C. Severe: The erosion surface accounts for more than 2/3 of the entire cervical area.
Cervical polyps (35%):
The localized lesions formed by cervical mucosal hyperplasia are called cervical polyps. Polyps often protrude from the basal to the external cervix. The mechanism of polyp formation is unclear. It may be related to local chronic inflammatory stimuli. Polyps often occur in 40-60 years old. Prolific women, polyps of one or more, generally about 1cm in diameter, reddish color, tongue-shaped, smooth or lobulated surface, soft and brittle, easy to bleed, slender stalk, roots attached to Outside the cervix, a few in the wall of the cervix, under the light microscope, the polyp center is connective tissue with congestion, edema and inflammatory cell infiltration, the surface is covered with a single layer of high columnar epithelium, the same as the cervical canal epithelium, cervical polyps rarely malignant, The malignant rate is <1%, but it should be noted that uterine malignant tumors can be polypoid-like protruding in the cervix, and attention should be paid to the identification of cervical polyps.
Cervical mucositis (10%):
The lesion is confined to the cervical mucosa and submucosal tissue, the cervix and vaginal part of the appearance is smooth, the cervix can be seen with purulent secretions, sometimes the cervical mucosa hyperplasia protrudes outward, visible cervix hyperemia, redness, due to cervical mucosa and mucosa Lower tissue congestion, edema, inflammatory cell infiltration and connective tissue hyperplasia can make the cervical hypertrophy.
Cervical gland cyst (5%):
During the healing process of cervical erosion, the new squamous epithelium covers the mouth of the cervical gland or extends into the glandular duct, blocking the glandular orifice; the connective tissue around the duct becomes hyperplasia or scar formation compresses the gland, narrowing or even blocking the duct The drainage of glandular secretions is blocked, and cysts are formed by retention. Under the microscope, the single-layer flat cervical mucosal epithelium is covered by the cyst wall. When examining, the surface of the cervix is covered with a number of blue-white small vesicles containing colorless mucus. If the cyst is infected, then Appearance is white or light yellow small vesicles, cervical gland cysts.
Cervical hypertrophy (5%):
Due to the long-term stimulation of chronic inflammation, cervical tissue congestion, edema, glandular and interstitial hyperplasia, there may be mucus retention in the deep part of the gland to form cysts, so that the cervix is hypertrophied to different degrees, up to 2 to 3 times the normal cervix, hardness Increased, but the surface is smooth, sometimes visible to the cyst of the cervical gland.
Prevention
Chronic cervicitis prevention
The main points should be noted:
1. Pay attention to sexual hygiene, properly control sexual life, resolutely put an end to extramarital sex and avoid menstrual sexual intercourse.
2. Timely and effective use of contraceptive measures to reduce the incidence of induced abortion and induction of labor to reduce the chance of human trauma and bacterial infection.
3, where the menstrual cycle is too short, the menstrual period lasts longer, should be actively treated.
4, to prevent damage to the cervix during childbirth.
5, postpartum findings of cervical laceration should be sutured in time.
6, regular gynecological examination, in order to find cervical inflammation in a timely manner, timely treatment.
Complication
Chronic cervicitis complications Complications infertility cervical cancer vaginitis urethritis pelvic inflammatory disease annex inflammation
1. Due to a large amount of secretions filling the cervix, the sperm can not pass smoothly, causing infertility.
2. Long-term inflammatory stimuli lead to malignant transformation and cause cervical cancer.
3. Due to inflammatory irritation, causing sexual pain and discomfort, unable to normal activity orgasm, thus affecting the quality of sexual life.
4. Secondary vaginal infection, urethritis, pelvic inflammatory disease, annex inflammation and other genitourinary infections.
Symptom
Chronic cervicitis symptoms Common symptoms Itching with bloody secretions nausea urinary frequency vaginal discharge increased dysmenorrhea pelvic heavy uterine polyps cervical mucus less cervical cyst
(A) increased vaginal discharge: sometimes the only symptom of chronic cervicitis, usually sticky mucus or purulent mucus, sometimes with bloodshot or a small amount of blood in the secretions, but also contact bleeding, due to leucorrhea stimulation Causes genital itching.
(2) Pain: Pain often occurs in the lower abdomen or lumbosacral region. Sometimes pain can occur in the upper abdomen, thighs and hip joints. Every time during menstrual period, defecation or sexual life is aggravated, especially when the inflammation is posterior along the uterine ligament. Spread or spread along the bottom of the broad ligament, forming chronic paragangular connective tissue inflammation, the pain of the main ligament of the cervix is thicker. Whenever the cervix is touched, it immediately causes axillary fossa, lumbosacral pain, and some patients may even cause nausea. , affecting sex life.
(C) bladder and intestinal symptoms: chronic cervicitis can spread through the lymphatics or directly spread to the bladder triangle or connective tissue around the bladder, so the bladder has urine, there is a feeling of frequent urination or dysuria, but Urine is clear, urine routine examination is normal, in some cases, inflammation continues to spread or through the cervix and bladder triangle, the ureteral lymphatic pathway, secondary urinary tract infection, the incidence of chronic pyelonephritis in adult women is more than the male May be related to this situation.
Intestinal symptoms appear less than bladder symptoms, and some patients feel pain during bowel movements.
(D) other symptoms: such as irregular menstruation, dysmenorrhea, pelvic weight, infertility and so on.
Examine
Chronic cervicitis examination
Enzyme-linked immunosorbent assay (ELISA) and nucleic acid detection, secretion examination, pathogen culture and bacterial sensitivity test, cervical smear for lymphocyte classification.
Vaginal B-mode ultrasound, colposcopy local biopsy.
Diagnosis
Diagnosis and diagnosis of chronic cervicitis
diagnosis
Because the symptoms of chronic cervicitis are often masked by other gynecological diseases, it is often found in routine gynaecological examinations that the cervix has a bright red fine-grained erosion zone and a purulent mucoid-like leucorrhea in the cervical canal. A diagnosis can be made.
Chronic cervicitis in the clinical, there may be cervical erosion, cervical hypertrophy, cervical polyps, cervical gland cysts and cervical tube inflammation, of which cervical erosion is the most common, according to the size of the cervical erosion surface, can be divided into light, medium, severe three Situation:
Mild: the erosion area accounts for 1/3 of the cervical area;
Moderate: the erosion area accounts for 1/3 to 2/3 of the cervical area;
Severe: The erosion area accounts for more than 2/3 of the cervical area.
Differential diagnosis
With vaginal examination, various types of lesions can be seen. The severely erosive tissue is brittle and easy to hemorrhage. It must be differentiated from early cervical cancer.
The latter is generally hard and brittle, and is highly prone to bleeding. The cervical erosion is soft and lubricated. Although there is a tendency to hemorrhage, blood stains are applied to the finger sleeve only after the test is touched. However, most early cervical cancers are clinically not differentiated from cervical erosion by other diagnostic methods. Therefore, anyone with cervical erosion should be routinely used for cervical smear examination to find cancer cells, if necessary, under biopsy under colposcopy (detailed gynecological disease diagnosis).
