Cervicitis

Cervicitis is the most common of all gynecologic disorders. Over 60 per cent of parous women have cervicitis, usually as a result of pre or postpartum infections. Gonorrhea and mixed infections frequently cause acute and chronic cervicitis in nonpregnant women. Chronic cervical infection is the most common cause of leukorrhea and a major etiologic factor in infertility, dyspareunia, abortion, and intrapartum infection. Chronic cervicitis may even predispose to cervical cancer. At least three-fourths of all women have cervicitis at some time during their adult lives.

Vaginitis or cervical instrumentation and laceration may initiate cervicitis.

Cervicitis is characterized by erosion (a transient ulceration of the endo and ectocervix) and eversion (ectropion), which is due to outward growth of endo- cervical cells.

The characteristics of cervical mucus vary with the menstrual cycle. In the absence of infection, the cervical mucus is thin, clear, and acellular at the time of ovulation or after moderate estrogen stimulation. In cervicitis the mucus is mucopurulent, even blood streaked, and may be tenacious and viscid at midcycle. Microscopic examination of a smear of cervical mucus from a patient with clinical cervicitis or bleeding never shows the normal "fern" formation. The acidity of the mucus and the presence of bacteria are noxious to sperm.

The symptoms include leukorrhea, low back pain, hypogastric pain, dyspareunia, dysmenorrhea, dysuria, urinary frequency and urgency, metrorrhagia, and cer-vical dystocia.

Cervical cancer, venereal infections, and cervical tuberculosis must be ruled out.

Treatment

A. Acute Cervicitis:

Treat acute infections with appropriate antibiotics. Avoid instrumentation and vigorous topical therapy during the acute phase and before the menses, when an upward spread of the infection may occur.

B. Chronic Cervicitis:

Replace and retain a free retroverted uterus (which both aggravates and predis-poses to cervicitis) with a vaginal pessary to reduce chronic passive congestion of the cervix and corpus. l. For mild cervicitis, cauterize the ecto and endocervix during the midcycle with 5 per cent silver nitrate solution or 2 per cent sodium hydroxide solution.

2. In more severe or resistant cases, give diethyl-stilbestrol, 0.1 mg orally, and sulfisoxazole (Gantri-sin®), 0.5 gm orally twice daily for 15 days, beginning with the first day of menstruation.

3. In deep hypertropMc chronic cervicitis, cauter-ize the cervix with the galvanocautery ("hot" or nasal tip cautery) or by means of cryosurgery or diathermy (high frequency or "cold" cautery), coagulating lightly with radial strokes of the instrument.

Treat only portions of the canal and portio at any one visit, preferably during the first half of the cycle. Treatment may be repeated monthly if necessary.

Immediately after cauterization, prescribe warm saline douches or furazolidonenifuroxime (Tricofuron®) or sulfonamide cream or suppositories locally for 3-4 days to suppress infection. Sound and dilate the cervical canal periodically to prevent stenosis.

4. Trachelorrhaphy (cervical repair), conization, and hysterectomy are justified only occasionally for intractable cervicitis.

Prognosis

Mild chronic cervicitis usually responds to local therapy in 4-8 weeks; more severe chronic cervicitis may require 2-3 months of treatment. The prognosis for acute cervicitis is excellent if an accurate diagnosis by means of smears and cultures is made and appropriate antibiotic treatment given.

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