Chronic tservitsit — is long the current inflammatory process in a mucous vaginal and nadvlagalishchny part of a neck of a uterus which in some cases extends to its soyedinitelnotkanny and muscular layer. During remission the symptomatology is limited to increase in number of vaginal allocations. At an aggravation the volume of allocations increases, they become mucopurulent, the patient notes pains in the bottom of a stomach. At diagnosis consider data of an expanded kolposkopiya, bacteriological, serological and cytologic analyses, gynecologic ultrasonography. For treatment use antibiotics, hormonal medicines, eubiotik, immune means.
Chronic tservitsit — one of the most widespread gynecologic pathologies. More than a half of all cases of the revealed inflammatory diseases of bodies of a small pelvis (IDBSP) falls to its share. According to experts in the sphere of gynecology, suffers from a chronic inflammation of a neck of a uterus to a quarter of women of reproductive age. Taking into account the malosimptomny course of process the incidence can be significantly higher. About 2/3 patients make women aged from 25 up to 45 years, reveal a disease in the period of a perimenopauza less often and is extremely rare at girls before the first periods. Direct correlation between risk of development of an inflammation and sexual activity of the patient is observed.
Reasons of a chronic tservitsit
In most cases the chronic inflammation of a mucous neck of a uterus arises against the background of undertreated sharp inflammatory process, however it can develop and gradually, without bright clinical signs. There are two groups of the reasons of a tservitsit:
- Infectious agents. A disease STD activators — gonokokk cause, hlamidiya, trichomonads, viruses of genital herpes and a papillomatoz. Also tservitsit arises at activization of opportunistic microflora (barmy fungi, stafilokokk, streptococci, colibacillus, etc.).
- Noninfectious factors. The inflammation complicates uterus neck injuries, neoplastic processes, allergic reactions to contraceptives, medicinal and hygienic means. As the reason of development of an atrophic tservitsit serves decrease in level of estrogen during a menopause.
An important role in developing of a disease is played by risk factors. Chronic tservitsit provoke:
- Mechanical damages. The uterus neck inflames at the patients who transferred abortions, difficult childbirth, invasive medical and diagnostic procedures more often.
- Gynecologic diseases. The chronic inflammation can develop against the background of omission of a vagina or extend from other departments of a female reproductive system.
- Chaotic sex life. Frequent change of partners increases risk of infection of STD. At the same time tservitsit is or the only display of an infection, or it is combined with vulvity, vaginity, an endometritis, adneksity.
- Decrease in immunity. The immunodeficiency at women with the heavy accompanying pathology or accepting immunosupressivny medicines promotes activization of opportunistic microorganisms.
- Hormonal imbalance. The inflammation often arises at reception of incorrectly picked up oral contraceptives and diseases with the reduced secretion of estrogen.
- Associated diseases. The chronic current of a tservitsit is noted at patients with Bekhchet's syndrome, urological and other ekstragenitalny pathology.
Development of a disease is defined by a combination of several pathogenetic links. Signs of inflammatory process are expressed moderately and localized mainly in an endotserviksa. Mucous the tservikalny channel becomes edematous, reinforced, folded. It is noted polnokrovy vessels, limfogistiotsitarny inflammatory infiltrates are formed, cages of an epithelium emit more slime. In ekzo-and an endotserviksa regenerative processes are slowed down and there are dystrophic changes. In the lower layers of mucous soyedinitelnotkanny elements expand. Output openings of glands are blocked by a flat epithelium with formation of nabotovy (retentsionny) cysts. In process of development of a disease connecting fabric and muscles of a neck of a uterus are involved in an inflammation.
Cellular and humoral immune system function defectively: the quantity decreases In - and T-lymphocytes, T-dependent immune reactions are oppressed, fagotsitarny activity is broken. As a result causative agents of an infection have an opportunity to persistirovat both in a cervical epithelium, and in cages of immune system. In tservikalny slime the level of G and M immunoglobulins against the background of the increased maintenance of IgA decreases. Autoimmune processes with the phenomenon of "a molecular mimicry" between alien proteins and proteins of own fabrics develop.
Chronic tservitsit classify taking into account etiologichesky factors, degree of prevalence and a stage of inflammatory process. On the basis of these criteria distinguish the following forms of a disease.
On an etiology:
- Chronic specific tservitsit, caused by STD activators.
- Chronic nonspecific tservitsit, arisen owing to activation of opportunistic flora or action of noninfectious factors.
- Chronic atrophic tservitsit which is shown by an inflammation endo-and an ekzotserviksa against the background of their thinning.
On prevalence of an inflammation:
- Diffusion — with involvement in process of all mucous membrane.
- Ekzotservitsit — with defeat of a vaginal part of a neck.
- Endotservitsit — with defeat mucous the tservikalny channel.
- Makulyozny — with formation of the separate centers of an inflammation.
On an inflammation stage:
- The aggravation period with the expressed symptomatology.
- Remission with the minimum clinical manifestations.
Symptoms of a chronic tservitsit
Usually the disease proceeds asymptomatically. During remission the woman notes poor mucous or mucopurulent allocations from a vagina which become more plentiful before periods or right after monthly. The pain syndrome, as a rule, is absent. Clinical signs in the period of an aggravation are more noticeable. The number of the mucous vaginal allocations which are growing turbid or turning yellow due to emergence of pus increases. The patient is disturbed by discomfort and dull nagging pains in the lower part of a stomach which amplify during an urination and at sexual intercourse. After sex there are smearing bloody allocations. If tservitsit it is combined with a colpitis, the woman complains of an insignificant itch and burning to a vagina.
At untimely or wrong treatment chronic tservitsit is complicated by a uterus neck hypertrophy, emergence of erosion and her mucous membrane ulcers, polipozny growths. Inflammatory process can extend on mucous vaginas, gland bartolinova, endometrium, uterine tubes, ovaries, other pelvic bodies. At a chronic current of an inflammation arise a dysplasia more often and the risk of development of cancer of neck of a uterus increases. Change of composition of the slime produced by an epithelium of the tservikalny channel, and anatomic violations owing to an inflammation can lead to cervical infertility.
As clinical manifestations of a chronic tservitsit are not specific and usually poorly expressed, a leading role in diagnostics is played by data of fizikalny, tool and laboratory researches. For diagnosis are most informative:
- Survey on a chair. Small puffiness mucous is defined, the neck of a uterus looks condensed and a little increased. In the field of an ekzotserviks erozirovanny sites and papillomatozny growths come to light.
- Expanded kolposkopiya. Survey under a microscope allows to specify a state mucous, in time to reveal precancer changes and malignant regeneration of an epithelium.
- Laboratory etiologichesky researches. Dab on flora and crops from antibiotikogrammy are directed to detection of the activator and assessment of its sensitivity to etiotropny medicines. It is possible to define a type of the specific infectious agent by PTsR, RIF, IFA authentically.
- Cytomorphological diagnostics. At a research of scrape of a neck of a uterus the nature of changes and a condition of cages ekzo-and an endotserviksa is estimated. The histology of a bioptat is carried out according to indications for timely detection of signs of a malignization.
- Gynecologic ultrasonography. During an ekhografiya the neck of a uterus, a cyst nabotova deformed, thickened and increased in sizes come to light, it is excluded .
In addition to the patient analyses for determination of level of female sex hormones and a condition of immunity can be appointed. Differential diagnostics is carried out with tuberculosis, cancer, an ektopiy neck of a uterus. For specification of the diagnosis can be attracted , , the dermatovenerologist.
Treatment of a chronic tservitsit
Correctly picked up complex therapy allows not only to stop aggravation signs, but also to achieve permanent remission. Within a medical course to the patient appoint:
- Etiotropny drug treatment. At infectious genesis of a tservitsit antibacterial and antiviral medicines are used. At selection of antimicrobic means consider sensitivity of the activator. Hormonal medicines (estrogen) apply in therapy of an atrophic tservitsit at women in the period of a menopause.
- Restoration of vaginal microflora. After a course of antibiotic treatment eubiotik locally (in the form of candles, tampons, vaginal irrigations) and inside are recommended.
- Auxiliary therapy. For acceleration of processes of regeneration mucous, strengthenings of immunity and the prevention of a possible recurrence are shown immune and phytotherapy, physiotherapeutic procedures.
In the presence of retentsionny cysts appoint a radio wave diatermopunktura. When conservative treatment is inefficient, or chronic tservitsit is combined with a dysplasia, elongation, cicatricial deformation and other diseases of a neck of a uterus, apply operational techniques — krio-or laser therapy, a trakheloplastika other.
Forecast and prevention
Forecast of a disease favorable. For timely detection of a possible tservikalny dysplasia the patient after course treatment needs to pass twice a year a kolposkopiya, to hand over cytologic dabs and . Prevention of a chronic tservitsit includes regular surveys of the gynecologist, adequate treatment of inflammatory diseases of a female genital, reasonable purpose of invasive procedures. It is recommended to follow rules of intimate hygiene, to order sex life, to use condoms (especially at sexual contacts with unfamiliar partners), to exclude sex during monthly. For prevention of a recurrence courses all-strengthening and immunotherapies, observance of the mode of a dream and rest, protection against overcooling of legs and area of a basin are effective.