How to detect cervicitis

Cervicitis is a common gynecological disease and also a disease that poses a greater health risk to patients. Cervicitis is generally divided into two types: acute cervicitis and chronic cervicitis. Different types of cervicitis have different clinical manifestations, and the specific examination methods and treatment methods are also somewhat different. Below, we will introduce the relevant knowledge about cervicitis in detail.

1. Clinical manifestations

1. Acute cervicitis

The main manifestations are increased vaginal discharge, which is mucopurulent. The irritation of vaginal discharge can cause itching and burning sensation of the vulva. There may be symptoms such as pain during sexual intercourse and lower abdominal pain. If combined with urinary tract infection, urinary urgency, frequent urination and pain may occur. If it is a Neisseria gonorrhoeae infection, due to the involvement of the paraurethral glands and Bartholin's glands, congestion and edema of the urethral and vaginal opening mucosa as well as a large amount of purulent secretions may be seen. It often occurs simultaneously with vaginitis and endometritis. Infections with pyogenic bacteria such as Staphylococcus and Streptococcus can spread upward and cause pelvic connective tissue inflammation.

2. Chronic cervicitis

(1) Increased vaginal discharge: Patients with chronic cervicitis may be asymptomatic. Sometimes, increased vaginal discharge may be the only symptom. The vaginal discharge is light yellow and may sometimes contain blood or contact bleeding. Occasionally, secretions may irritate the vulva and cause itching and discomfort.

(2) Pain in the lower abdomen or lumbosacral region is a common symptom, which worsens during menstruation and bowel movements and may cause pain during sexual intercourse. The pain becomes more severe when the inflammation spreads and forms chronic parauterine connective tissue inflammation.

(3) Urinary tract irritation symptoms When the inflammation spreads to the bladder trigone or the connective tissue around the bladder, urinary tract irritation symptoms such as frequent urination or difficulty urinating may occur.

(4) Other symptoms: Some patients may experience irregular menstruation, dysmenorrhea, and a feeling of heaviness in the pelvis.

2. Inspection

1. Acute cervicitis

(1) Gynecological examination: The cervix may be congested, red and swollen, with cervical mucosal edema and ectropion. The cervix is ​​obviously tender. There is purulent discharge from the cervix.

(2) White blood cell test: Check the white blood cells in the endocervical secretions or vaginal secretions. In patients with acute cervicitis, the neutrophil count in the endocervical purulent secretions is greater than 30/high-power field of view, and the white blood cell count in the vaginal secretions is greater than 10/high-power field of view.

(3) Pathogen detection: Perform a cervical secretion smear or bacterial culture to look for pathogenic bacteria. When chlamydial infection is suspected, an enzyme-linked immunosorbent assay (ELISA) can be performed to detect Chlamydia trachomatis antigen.

2. Chronic cervicitis

(1) Gynecological examination may reveal that the cervix is ​​eroded and bleeds easily when touched. There may be yellow discharge covering the cervical opening or flowing out of the cervical opening, and there may be cervical tenderness. It may also manifest as cervical polyps, cervical gland cysts or cervical hypertrophy.

(2) Colposcopy: When cervicitis is not cured for a long time, there is contact bleeding, and the Pap smear is grade 2 or above, a colposcopy can be performed to detect possible precancerous lesions (such as cervical intraepithelial neoplasia) or early cervical cancer as early as possible.

(3) Pathogen detection: Cervical secretion smear or bacterial culture can detect pathogenic bacteria. Cervical cell smear can also detect gonococci, Trichomonas, and fungi. If necessary, chlamydia, mycoplasma, and human papillomavirus tests should be performed.

(4) Cervical smear and cervical biopsy: Chronic cervicitis should be routinely examined by cervical smear cytology to differentiate it from other diseases such as cervical precancerous lesions, cervical cancer, and cervical tuberculosis. The most accurate examination method is to take tissue from more obvious cervical erosion ulcers or deeper lesions for pathological examination. In case of acute inflammation of the vulva and vagina, or during menstruation or pregnancy, the procedure should be postponed.

3. Diagnosis

1. Acute cervicitis

The presence of purulent or mucopurulent secretions visible to the naked eye on the cervical canal or cervical canal cotton swab specimens, or when the cervical canal is wiped with a cotton swab, it is easy to induce intracervical bleeding. The presence of either of these two characteristic signs, coupled with an increased white blood cell count in microscopic examination of cervical or vaginal secretions, can make a preliminary diagnosis of acute cervicitis. After the diagnosis of cervical inflammation, further examination is required to identify the pathogen.

2. Chronic cervicitis

Based on the clinical manifestations and results of gynecological examinations, a preliminary diagnosis of chronic cervicitis can be made, but care should be taken to differentiate the positive signs found in the gynecological examination from the common pathophysiological changes of the cervix (cervical precancerous lesions or early cervical cancer).