Cervicitis is the general name for a group of diseases that are divided into endocervicitis and exocervicitis. The difference is that exocervicitis is a smaller problem in which only the vaginal part of the cervix becomes inflamed. Endocervicitis is already an inflammation that affects the entire mucous membrane of the cervical canal. Logically, endocervicitis is an untreated exoprocess.

By their nature, these are infectious diseases that are provoked by microorganisms - viruses, bacteria, protozoa. Intrauterine manipulations - scraping, cauterization - can provoke inflammation; There is also a high percentage of infections after birth injuries.

According to statistics, cervicitis is the most common female disease during the childbearing period. The frequency of manifestations depends on the standard of living, social status, number of sexual partners, frequency of abortions and childbirth. Cervicitis is dangerous, since during an acute process infection is transmitted.

Causes of cervicitis

Cervicitis of the cervix - schematic photo

Cervicitis is caused by candida fungi, ureaplasma bacteria, chlamydia, trichomonas, and streptococci. This is one of the most common. In all cases, there is discharge, sometimes itching in the vagina, and with a prolonged process, pain in the lower abdomen.

Candida cervicitis is a disease caused by candida fungi. Symptoms of a fungal disease are white, cheesy vaginal discharge and itching. The reason may be either low immunity and the body’s inability to control the reproduction of its own microflora, or infection through sexual intercourse. The second option is also quite common, because in men candidiasis does not manifest itself in any way and the man may not know that he is carrying an infection.

Bacterial vaginosis begins after the penetration of bacteria into the vagina - chlamydia, gonococci, trichomonas, ureaplasma, gardnerella. Bacterial cervicitis can also occur with genitourinary tuberculosis.

Viral vaginosis is a consequence of low immunity and the presence of cytomegalovirus infection, herpes, and human papillomavirus.

To determine the pathogen and provide quality treatment, it is necessary to take a smear of the vaginal flora. It is impossible to accurately determine the cause by appearance, since there may be several pathogens. Fungal diseases have more noticeable manifestations when there are discharges characteristic of this type of infection.

Important! Candidiasis can begin without sexual activity, for reasons:

• hormone therapy;
• taking strong antibiotics;
• rehabilitation period after viral diseases;
• decreased immunity under the influence of various factors.

If Candida is present, you should be tested for other pathogenic organisms that may accompany thrush - Gardnerella and Ureaplasma. A comprehensive test in specialized diagnostic laboratories will be more informative.

Chlamydia is an intracellular infection transmitted exclusively through sexual intercourse, and not only through genital intercourse, but also through oral and other types. Infection is unlikely when using common hygiene items or visiting public places - saunas, swimming pools. The lifespan of chlamydia is very short and it does not survive well in the environment. If there is a sexual partner, both should be diagnosed. Diagnosing chlamydia is a difficult process that involves several methods, each of which has disadvantages.

Important! Without an accurate identification of the causative agent, the treatment of cervicitis will not be effective and may progress to the chronic stage. Therefore, more time should be devoted to diagnosis and analysis of microflora.

Bacterial vaginosis - trichomonas and gonococcal - are easier to identify. Purulent discharge with a specific odor is almost always present, especially with Trichomonas infection. For diagnosis, bacteriological culture is sufficient.

Attention! Trichomonas is very adapted to survival in the environment: it has several forms - flagellated, flagellated. Non-sexual transmission of infection is possible.

Viral vaginosis - causes endocervicitis in women of childbearing age after viral agents penetrate into a weakened body. The most dangerous is HPV. Therefore, it is necessary to treat the disease for a long time and comprehensively. At the same time, do regular examinations. Herpes and HPV are difficult to treat, since their reproduction depends on the condition of the body as a whole.

Treatment of cervicitis

Treatment of cervicitis of various etiologies involves eliminating the infection. To do this, you must complete a full course of antibiotics or antifungal drugs. After completion of treatment measures, re-examine. The cause of recurrent disease is low body resistance, incorrect diagnosis of vaginosis, and insufficient treatment.

Medication is the most effective for chlamydia, trichomoniasis, and gonorrhea. It allows, with the help of drugs, to shorten the acute manifestation of the disease and minimize complications: inflammatory diseases of the urethra and appendages. This makes it possible for pregnancy and subsequent childbirth to be safe for the fetus. Traditional methods cannot completely remove the infection from the body. There is a risk that inactive forms will manifest themselves later.

Fungal cervicitis can be treated in parallel with traditional methods. The combination of medications will normalize the vaginal microflora, increase immunity and eliminate infection.

Treatment methods for vaginosis

Conservative treatment methods are the main ones for cervicitis. They include the use of antibiotics, antifungal drugs such as fluconazole, immunostimulants, anti-inflammatory drugs in the form of suppositories, creams, and local antiseptics.

Drug therapy is successful in case of early diagnosis of the disease and comprehensive treatment.

In the chronic course of the disease, the patient may be offered a surgical method to solve the problem: diathermocoagulation or conization of the cervix.

Diathermocoagulation is an outdated and painful method of exposure to high-frequency current. Sometimes used in the treatment of erosion.

– removal of defective tissue from part of the cervix. Used for cancer prevention. It can also be recommended after cervical ruptures during childbirth, postpartum scars, and pathology of the cervical canal mucosa.

If it is too late to see a doctor, the question is raised about the need to combine conservative and surgical methods.

Trichomonas cervicitis

Trichomoniasis causes vaginosis in most cases. Both the vaginal part of the cervix and the mucous membrane of the cervical canal are affected. The causative agent is trichomonas vaginalis. Vaginal Trichomonas invades the mucous membrane, releases toxins and causes inflammation. This damages the epithelial tissue, which serves as a barrier to other infections.

Photo – Trichamonas

Trichomonas can reduce immunity even with latent carriage. Therefore, special attention should be paid to the diagnosis and identification of protozoan microorganisms in the genital tract and bloodstream.

The presence of trichomonas in a woman’s body can complicate, cause premature release of water, and also infect the child when passing through the birth canal. It is important to stop the reproduction process of Trichomonas before pregnancy so that exposure to toxic drugs does not affect the development of the fetus.

Treatment of cervicitis after Trichomonas

Treatment of cervicitis should begin with the elimination of microorganisms - Trichomonas. For this purpose, both local remedies are used - vaginal suppositories, as well as injections and oral medications. The most common are metronidazole, ornidazole, and tinidazole. These drugs suppress the reproduction of protozoa - Trichomonas, Giardia, Amoeba.

After treatment, it is advisable to use the Solcotrichovac vaccine, which reduces the risk of re-infection. The action of the drug is aimed at normalizing the pH level in the vagina and promoting the development of normal microflora. Apply according to the scheme.

If the examination reveals cervicitis after Trichomonas, treatment continues. Local remedies become help medications at this stage. The cervix is ​​additionally treated with chlorophyllipt, Dimexide or silver solution. Physiotherapy used:

• magnet;
• ultraviolet irradiation;
• Electrophoresis of magnesium.

The measures are aimed at restoring the vaginal microflora. Sometimes there is a need to use hormonal drugs. Laboratory tests are performed throughout the course of treatment.

To estimate the time required to eliminate vaginosis after trichomonas, it is necessary to take into account the timing of treatment of trichomoniasis itself - this is 10 days of antibacterial therapy. Repeated tests for the presence of infection are done no earlier than 7 to 10 days after the end of antibiotic treatment. If laboratory confirmation is received that there are no trichomonas in the body, then treatment of cervicitis begins. Cervicitis after treatment goes away in 15–20 days, if the process is not started and surgical intervention is not required.

Conclusions

To protect yourself from infection with Trichomonas, you must use personal protective equipment. Demanding an orderly sex life is useless, especially at a young age. Women should remember that in men the infection can be latent and treating only one sexual partner will lead to re-infection.

Video: About the treatment of various diseases with propolis, including cervicitis and trichomonas infection

Video: Treatment of chronic cervicitis using phonophoresis

The term exocervicitis refers to inflammation of the vaginal part of the cervix. Endocervicitis is an inflammation of the mucous membrane of the cervical canal of the cervix.

SYNONYMS

Cervical inflammation, cervical erosion.

ICD-10 CODE

N72 Inflammatory diseases of the cervix.

EPIDEMIOLOGY OF CERVICITES

Due to the trend towards an increase in the frequency of inflammatory diseases of the female genital organs, infectious processes in the cervix are quite common. Exo and endocervicitis are detected in 70% of women visiting outpatient departments.

PREVENTION OF CERVICITIS

It is necessary to examine women for the presence of hidden infections during family planning, during pregnancy, and during medical examinations at work. In the presence of exo and endocervicitis, vaginitis, additional examination is necessary - a cytological examination of a smear from the surface of the cervix for early detection of cervical cancer.

SCREENING

Screening is mandatory among workers of child care institutions (hospitals, orphanages, boarding schools).

CLASSIFICATION OF CERVICITES

Classification of endocervicitis:

I. According to the course: acute and chronic.
II. According to the prevalence of the process: focal and diffuse.

There are:

• acute nonspecific cervicitis and vaginitis;
• chronic nonspecific cervicitis.

ETIOLOGY (CAUSES) OF CERVICITIS

Nonspecific cervicitis and vaginitis are caused by the action of opportunistic microorganisms (E. coli, streptococci, staphylococci, epidermal staphylococcus, bacteroides, corynebacteria, etc.). In healthy women, anaerobic microflora prevails over aerobic microflora in a ratio of 10:1. Normal bacterial microflora prevents the invasion of pathogenic microorganisms, leading to the occurrence of an inflammatory process in the vagina and cervix. Exo and endocervicitis can be caused by STIs (chlamydia, myco and ureaplasma, trichomonas, etc.). With some age-related changes, estrogen deficiency leads to the development of atrophic colpitis and nonspecific cervicitis.

PATHOGENESIS OF CERVICITES

It is known that the cervix is ​​one of the biological barriers that protect the reproductive system from the introduction of pathogens. The combination of anatomical and physiological features of the cervix (narrow cervical canal; the presence of a mucus plug containing secretory IgA, lysozyme and other substances with bactericidal properties) protects against the introduction of pathogens. Protective mechanisms are disrupted by cervical injuries after childbirth, abortion (ectropion), invasive diagnostic procedures, in which the infection freely penetrates the genital tract, and the inflammatory process occurs primarily in the exocervix and endocervix.

The main function of the exocervix is ​​protective, while its mechanical strength is provided by blocks of keratin, and glycogen granules create local immunity of the vaginal biotope.

The main function of the endocervix is ​​secretory. The cervical canal is lined with columnar epithelium, the cracks and depressions in it are called cervical glands. They produce a secretion, the nature of which changes depending on the phase of the menstrual cycle. Depending on the nature of the pathogen and the location of its introduction, the inflammatory process develops in the exo and/or endocervix.

The pathogenesis of exo and endocervicitis is based on three stages of inflammation: alteration, exudation and proliferation. At the alteration stage, damage and desquamation of the epithelium of the exo and endocervix occurs, and the basement membrane is exposed. In this case, the glands secrete a mucous secretion, which is the result of pathogen invasion.

The exudation process leads to tissue loosening, activation of macrophages, release of histiocytes, plasma cells, lymphocytes, and fibroblasts.

Proliferation (formation of cells and their organelles) promotes tissue regeneration. The regenerative process may be slow. It may be accompanied by the formation of nabothian cysts (the result of blocking the openings of the cervical glands). Due to the fact that the vagina and cervix represent a single anatomical, physiological and biological system, inflammatory processes, as a rule, are common in the form of inflammation of the vagina - vaginitis, exo and endocervicitis.

Endocervicitis is accompanied by pseudo-erosion of the cervix, ectropion, colpitis, endometritis, and salpingitis. The duration of the disease is associated with the penetration of microbes into the branching glands (crypts, canals) of the mucous membrane of the cervical canal, which is facilitated by cervical injuries during childbirth, abortion, and diagnostic uterine curettage.

Histologically revealed: hyperemia of the mucous membrane, its swelling; desquamation of the surface epithelium, formation of infiltrates in the subepithelial layer and stroma. Infiltrates consist of segmented leukocytes, lymphocytes, and plasma cells. Periglandular abscesses may form. In the chronic stage, hyperemia and swelling are less pronounced, regeneration of areas of the mucous membrane occurs in places where the integumentary epithelium is rejected, during which epithelial metaplasia and partial replacement of columnar epithelium with flat epithelium can occur.

CLINICAL PICTURE (SYMPTOMS) OF CERVICITIS AND VAGINITIS

Acute nonspecific cervicitis and vaginitis are characterized by copious mucous or purulent discharge, itching in the vagina, and sometimes dull pain in the lower abdomen. When examined in the speculum, petechial hemorrhages, mucosal hyperemia, and edema are visualized in the vagina and cervix. In severe cases, there may be ulcerations. With chronic cervicitis and vaginitis, the discharge is insignificant, but the cervix is ​​edematous.

Endocervicitis clinic

Acute endocervicitis: patients complain of mucopurulent vaginal discharge, sometimes nagging pain in the lower abdomen and lower back.

When examining the cervix with the help of mirrors and colposcopy, the following is detected: hyperemia around the external opening of the cervical canal (slight protrusion of hyperemic, edematous mucosa), abundant mucopurulent or purulent discharge, eroded surface.

Chronic endocervicitis results from undiagnosed or untreated acute endocervicitis. It is characterized by the transition of the inflammatory reaction to the underlying connective tissue and muscle elements. Pseudo-erosion forms on the vaginal part of the cervix. This is facilitated by pathological discharge from the cervical canal (maceration and rejection of the epithelium, secondary infection). Infiltrates occur with the subsequent development of hyperplastic and dystrophic changes. The cervix thickens and hypertrophies, which is facilitated by cysts formed as a result of the healing of pseudo-erosions.

Gonorrheal endocervicitis develops in the mucous membrane of the cervical canal, affecting the columnar epithelium of the endocervix and the glands of the mucous membrane. When epithelial cells are damaged and desquamated, gonococci penetrate into the subepithelial layer and stroma of the mucous membrane, where infiltrates are formed, which consist of neutrophils, lymphocytes and plasma cells.

The inflammatory reaction (hyperemia, exudation, swelling) is pronounced. Multiple periglandular infiltrates and microabscesses may form.

DIAGNOSIS OF CERVICITIS

Currently, the diagnosis of exo and endocervicitis is not difficult thanks to laboratory research methods.

• Microscopic.
• Bacteriological.
• Cytological.
• pHmetry of vaginal discharge.
• PCR and enzyme immunoassay.
• Extended colposcopy.

Mandatory studies:

Microscopy of discharge from the cervical canal, vagina and urethra for bacterial flora, including Trichomonas, Gardnerella, gonococci and fungi;
- bacteriological culture of native material with isolation of the pathogen and determination of its sensitivity to antibiotics;
- smear for oncocytology.

Additional research:

General blood test; general urinalysis; blood test for RW, HIV; culture for gonococcus;
- diagnosis of sexually transmitted infections (herpetic, papillomavirus, chlamydial, mycoplasma, ureaplasma);
- colposcopy: detection of altered areas in the form of separate, different in diameter (0.1-0.5 cm) formations protruding above the surface of the epithelium, yellow-red in color and surrounded by a whitish border characteristic of the inflammatory process; location on the surface of altered areas of thin, deformed vessels; in some patients, the lesions merge, affecting large areas where loops of dilated vessels are visible, as well as pinpoint bleeding vessels; focal or diffuse hyperemia.

HISTORY AND PHYSICAL EXAMINATION

In menopausal women, the disease is often determined by the presence of atrophic colpitis.

LABORATORY RESEARCH

To confirm the diagnosis, several laboratory tests should be performed. Microscopic examination allows us to establish the total number of microbial associates and their belonging to obligate anaerobic species or lactobacilli.

Bacteriological research allows us to determine the genus and species of microorganisms and their sensitivity to antibiotics.

The cytological method makes it possible to assess the structure and cellular level of tissue damage and evaluate the effectiveness of treatment over time.

Extended colposcopy makes it possible to evaluate the effectiveness of treatment based on the specificity of the colposcopic picture of inflammation for various pathogens.

According to V.I. Krasnopolsky et al., during colposcopy of the cervix with nonspecific inflammation, several features can be identified.

• Depending on the nature of the pathogen, the discharge has a different type and consistency.
• Cylindrical and stratified squamous epithelium in the form of bright red dots, which are the tips of the capillaries.
• The Schiller test is a good indicator of the inflammatory process (foci in the form of light specks on a brown background or in the form of rounded iodine-negative areas).
• True erosions with a typical picture have a pus-like coating on the surface.

INSTRUMENTAL RESEARCH

An extended colposcopy of the cervix and an ultrasound of the pelvis are mandatory. This is necessary to confirm the presence or absence of a combined oncological process.

DIFFERENTIAL DIAGNOSTICS

Exo and endocervicitis are differentiated from cervical ectopia, cervical cancer, and specific cervicitis (gonorrhea, syphilis, tuberculosis).

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

Consultations with a dermatovenerologist, oncogynecologist, phthisiogynecologist during differential diagnosis with venous diseases (gonorrhea, syphilis), cervical cancer, tuberculous cervicitis.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Nonspecific endocervicitis, acute form. Nonspecific vulvovaginitis.

TREATMENT OF CERVICITIS

TREATMENT GOALS

• Relief of the inflammatory process by etiotropic treatment.
• Elimination of predisposing factors (neuroendocrine and other functional disorders).
• Treatment of concomitant diseases.

NON-DRUG TREATMENT

Can be restorative: physical exercise, fitness therapy, regulation of the regime.

DRUG TREATMENT

Includes the use of antibacterial, antitrichomoniacal, antifungal, antichlamydial and other drugs.

I. At the first stage, etiotropic therapy is carried out.

• For candidal cervicitis and vaginitis, the drug fluconazole is used at a dose of 150 mg orally (a class of triazole compounds with a specific effect on the synthesis of fungal sterols).
• Use econazole (from the group of imidazoles) intravaginally, 1 suppository at night, for 3–4 days, or isoconazole, 1 suppository in the vagina.
• Natamycin (antifungal polyene antibiotic of the macrolide group); Prescribe 1 tablet 4 times a day in combination with suppositories - into the vagina at night.
• For chlamydial cervicitis, along with tetracycline antibiotics (tetracycline, doxycycline, metacycline), macrolides (josamycin), quinols (ofloxacin), the drug azithromycin is used. It is combined with local treatment: treatment of the cervix with solutions of chlorophyllipt © or dimethyl sulfoxide.
• For atrophic cervicitis and vaginitis, a drug containing a natural female hormone - estriol - is used locally.
• For nonspecific cervicitis, local combination drugs are used: terzhinan ©, which includes ternidazole (acts on anaerobic flora), nystatin (suppresses the growth of yeast fungi), neomycin (action is aimed at gram-positive and gram-negative bacteria), prednisolone in the acute stage (quickly relieves pain , itching), etc.

II. At the second stage, the goal of treatment is to restore normal vaginal microbiocenosis. Eubiotics are used: acylact© stimulates the growth of the vagina’s own lactoflora, helps reduce the frequency of relapses; Prescribe 1 suppository in the vagina for 10 days.

*Local treatment: douching, treatment of the vagina and cervix, instillation into the endocervix, introduction of vaginal suppositories and tampons with subsequent restoration of the natural biocenosis of the vagina is carried out according to the principles described in the section “Colpitis”, depending on the type of pathogen (section genitourinary infections). Often It is also necessary to perform diathermopuncture or opening nabothian cysts (they often contain microorganisms); in the presence of cervical deformities after anti-inflammatory treatment, plastic surgery of the cervix is ​​indicated.

III. Immunotherapy (application).

IV. Herbal medicine.

V. Physiotherapy.

Acute stage

1. UV treatment of the panty zone according to Zhelokovtsev: 2-3 biodoses + + 1 biodose, daily, No. 8.
2. Exposure to the UHF electric field on the uterine area - 20-30 W, 10 minutes, daily, No. 5-8.

Subacute and chronic stages

1. UHF therapy for the uterine area. Intensity - 8-12 W, 10 min. daily, No. 10-15.
2. High-frequency magnetic therapy of the uterus. Low-heat dose, 10 min., daily, No. 15-20.
3. Low-frequency magnetic therapy of the uterus. Magnetic induction 35 mT, pulse mode, 20 min, daily, No. 10-15.
4. Diadynamic currents to the uterine area. Current strength - until a pronounced painful vibration is felt, daily, No. 12-15.
5. SMT on the uterine area. In operating mode with a change in polarity in the middle of exposure to each current: IPP - 4 min., modulation frequency 150 Hz, depth 50-75%, NPP - 6 min, modulation frequency - 60 Hz, depth 50-75-100%, duration sending 2-3 s, current strength - until a pronounced painful vibration is felt, daily, No. 12-15.
6. Magnesium electrophoresis on the uterine area. The duration of the procedure is 20 minutes, daily, No. 10-15.
7. Local darsonvalization using a vaginal electrode.
8. Vaginal laser therapy - 10 min, daily, No. 10-12.
9. Aku and laser puncture on the points: he-gu, izian-shi, mei-guan, izu-san-li.
10. Vaginal mud tampons, 10 min., daily, No. 10.

SURGICAL TREATMENT

Can only be used when exocervicitis and endocervicitis are combined with other diseases of the cervix (dysplasia, cervical cancer, elongation, cicatricial deformity, etc.).

APPROXIMATE DURATION OF DISABILITY

Exemption from production activities is not required.

FOLLOW-UP

Carry out under the control of colposcopic and laboratory research methods for the prevention and treatment of possible relapses.

INFORMATION FOR THE PATIENT

Patients with exo- and endocervicitis are at risk for STIs and cervical cancer. They must be registered with a doctor at the antenatal clinic and periodically examined using cytological, colposcopic and microbiological methods. If a relapse or STI is detected, the partner must be examined.

is an inflammation of the cervical tissue caused by bacteria, viruses or other pathogens, which can occur in acute or chronic form. Clinical symptoms are often absent; discharge, itching, burning, and pain are possible. For diagnosis, a smear from the external pharynx, simple and extended colposcopy are used. Bacteriological methods and PCR diagnostics help to identify the pathogen; the condition of the cervix is ​​additionally assessed using ultrasound. Treatment is carried out with medications; destructive and surgical methods are used according to indications.

General information

Cervicitis is more often detected in women 19-45 years old who are sexually active. Inflammation rarely occurs in isolation. The cervix forms a single system with the vagina and vulva, so cervicitis is combined with vulvitis and vaginitis. The pathology is found in 70% of women of reproductive age; the exact prevalence has not been established due to the possible asymptomatic course of the disease. Chronic cervicitis, combined with infection with the human papillomavirus (HPV), increases the risk of developing neoplastic processes of the cervix.

Causes of cervicitis

In healthy women, mucus from the cervical canal acts as a protective factor that prevents the growth of pathogenic microflora. Infection prevents normal vaginal biocenosis and the production of lactic acid by Dederlein's bacilli. If their content decreases, conditions arise for the proliferation of opportunistic flora or the penetration of pathogens. The following types of infection lead to symptoms of cervicitis:

• Opportunistic microorganisms. They are the main cause of the disease. More often, gram-negative flora (Klebsiella, Escherichia coli, enterococci), non-clostridial anaerobes (Proteus, Bacteroides) are detected. Staphylococci and streptococci may be detected.
• Viruses. In women with symptoms of chronic cervicitis, HPV is diagnosed in 80% of cases. A viral infection is characterized by a subclinical or latent form; sometimes the pathogen is detected only during an in-depth examination. Cytomegalovirus, herpes virus, and less commonly adenovirus can also act as a pathogenic agent.
• Chlamydia. They are the causative agent of acute cervicitis. Found in 45% of patients. In its pure form, chlamydial infection is not typical for the symptoms of chronic inflammation; its association with obligate flora is more common.
• Trichomonas. They are detected in 5-25% of women who visit a gynecologist with symptoms of inflammation. Cervicitis often occurs with minimal signs of infection. The peak incidence occurs at the age of 40 years.
• Gonococci. They cause acute vaginitis and cervicitis, which can be combined with symptoms of urethritis. In chronic infections, they are detected in 2% of patients. They often spread to the overlying parts of the reproductive system, which causes a combination of symptoms of cervicitis with manifestations of chronic endometritis and adnexitis.
• Candida. A fungal infection develops when immune factors are reduced and the vaginal biocenosis is disrupted. Candidal cervicitis is complemented by symptoms of colpitis. Exacerbations can be provoked by chronic diseases, antibacterial therapy, and hormonal changes.

The cause of the disease may be pathogens such as syphilis and tuberculosis. Sometimes there is a combination of several infections. Risk factors for the development of cervicitis are abortions and any traumatic manipulations that damage the cervix. The likelihood of pathology increases with cervical ectopia or ectropion. The spread of sexually transmitted infections is facilitated by low sexual culture, frequent changes of sexual partners, and refusal of barrier contraception.

Pathogenesis

The exocervix performs a protective function. Its cells contain lumps of keratin, which provide mechanical strength, and glycogen is a nutrient substrate for the vaginal microflora. The cylindrical epithelium of the endocervix performs a secretory function; it secretes mucus, the composition of which changes in each phase of the cycle. The peculiarity of the secretion is the content of immunoglobulins.

With a decrease in protective functions and cervical injury, pathogenic microorganisms penetrate the epithelium of the exo- or endocervix. After the alteration stage, desquamation of the surface epithelium begins, the basement membrane is exposed, and the glands are damaged. The composition of the secretion changes, as a result, intercellular contacts are disrupted, and immune cells are activated: macrophages, lymphocytes, histiocytes. The inflammatory reaction leads to a disruption of the nuclear-cytoplasmic ratio in cells.

When acute cervicitis transitions to chronic, the infection penetrates into the deep layers of tissue, and destructive changes are observed in the cells. Cellular regeneration is activated, while apoptosis is slowed down, which leads to the appearance of young undifferentiated cells. When chronic cervicitis is combined with papillomavirus, dysplastic changes occur that can develop into cancer.

Classification

Cervicitis is classified based on the clinical and morphological picture and characteristics of the course of the disease. The duration of the inflammatory process and its prevalence are taken into account. Particular attention is paid to the severity of changes in the stromal and epithelial components of cervical tissue. The type of cervicitis can be determined during colposcopy and using histological examination:

• Acute cervicitis. Characterized by severe symptoms of an inflammatory reaction, serous-purulent discharge. The mucous membrane of the cervix is ​​edematous, prone to bleeding. The pathology can be focal, when delimited round foci appear on the surface of the exocervix, and diffuse, when inflammation spreads to a significant part of the cervix.
• Chronic cervicitis. Cervical hypertrophy is observed, thickened folds of the mucous membrane of the cervical canal are formed. Cells are dystrophically changed. With endocervicitis, there is no hyperemia around the external pharynx, cloudy mucus is secreted, sometimes mixed with pus.

The structure of the outer part of the cervix differs from the mucous membrane of the endocervix. Outside, the epithelium is multilayered flat, in the cervical canal it is cylindrical. The inflammatory reaction may involve one of these areas, then cervicitis is classified as follows:

• Endocervicitis. An inflammatory reaction that occurs in the cervical canal.
• Exocervicitis. The epithelium of the vaginal part of the cervix became inflamed.

The etiological classification of cervicitis is based on the types of pathogens that cause inflammation. It is necessary for choosing a method of therapy, correctly selecting medications and determining the prognosis. The type of infection can be assumed from the colposcopy picture; confirmation is obtained by culture or PCR. The following types are distinguished:

• Nonspecific cervicitis. Symptoms appear when obligate microflora multiply (Escherichia coli, staphylococci, streptococci), as well as during hormonal changes in the body.
• Specific cervicitis. Manifestations of pathology occur after infection with sexually transmitted infections. More often it is chlamydia, trichomoniasis, gonorrhea, HPV. Less commonly, specific cervicitis develops with syphilis and tuberculosis.

Symptoms of cervicitis

Symptoms are often absent; manifestations depend on the nature of the course and the type of pathogen. In acute cervicitis, mucous or purulent discharge appears. Symptoms are more pronounced when cervicitis is combined with colpitis. The discharge is accompanied by itching and burning, discomfort when urinating. Pain during sexual intercourse sometimes bothers me. Pulling or aching pain in the lower abdomen, in the lumbosacral region, is rare.

The signs of chronic cervicitis are similar, but less pronounced. Exacerbation of the process is provoked by menstruation, hypothermia, and a change of sexual partner. Sometimes painful sensations over the womb persist without exacerbation and intensify during intimate relationships. A characteristic symptom of chronic inflammation is contact bleeding. Spotting is observed after sex, examination by a doctor, or taking a smear.

The causative agents of nonspecific cervicitis give approximately the same symptoms; for specific infections, the clinical picture may vary. The chlamydial process is often asymptomatic and quickly becomes chronic. Gonorrheal cervicitis is characterized by striking symptoms: copious purulent discharge, dysuric disorders. When infected with Trichomonas, greenish discharge and an unpleasant odor appear.

There is no deterioration in the general condition with cervicitis. An increase in temperature, abdominal pain, and signs of intoxication indicate the spread of infection to the uterus and appendages. If cervicitis is detected simultaneously with vaginitis, endometritis, salpingitis, the amount of discharge increases and the pain syndrome intensifies. Symptoms of cervicitis are often nonspecific, making it impossible to suspect inflammation of the cervix.

Complications

The danger is posed by severe, protracted course of cervicitis and lack of timely treatment. Severe chronic inflammation provokes ulceration of the cervix; upon healing, scar tissue is formed, which deforms the cervix and leads to stenosis of the cervical canal. This becomes a risk factor for infertility. Cervix stenosis causes complications during childbirth, the cervix loses its ability to open, and ruptures form.

Infection from the endocervix often spreads to the endometrium and further upward to the appendages, causing inflammation of the pelvic organs, which over time leads to menstrual irregularities and infertility. Chronic cervicitis without treatment leads to the development of dysplasia. This is a precancerous disease, which is characterized by the appearance of atypical cells. Of particular danger is the combination of inflammation with the detection of HPV of high oncogenic risk.

Diagnostics

An obstetrician-gynecologist examines women with cervicitis. If gonorrhea is suspected, a dermatovenerologist is involved in diagnosis and treatment. The absence of symptoms in the acute stage often leads to a delayed start of treatment due to untimely examination. To confirm the diagnosis, a combination of several diagnostic methods is used:

• Gynecological examination. In the speculum, in the acute type of cervicitis, an inflamed, hyperemic neck is detected. Petechial hemorrhages may appear on the exocervix. Touching with a tampon causes bleeding. With endocervicitis, the external pharynx protrudes in the form of a bright red rim. Mucopurulent discharge may be noticeable.
• Vaginal smear. The composition of the microflora is examined - with cervicitis, the number of lactobacilli is reduced, cocci are present, gonococci and intracellularly located trichomonas can be detected. The number of leukocytes is increased, there is a lot of mucus.
• PAP test. In a cytological smear from the exo- and endocervix, signs of dyskeratosis may appear, which disappear after treatment - this distinguishes cervicitis from neoplasia. Epithelial cells have signs of cytoplasmic degeneration and hypertrophied nuclei. If symptoms of dysplasia are detected, a biopsy is necessary.
• Colposcopy. After treatment with acetic acid, cervicitis is manifested by whitening of the epithelium and fine red punctures. Treatment with Lugol's solution normally causes brown spots to appear; this does not happen with cervicitis. The epithelium looks embossed. Finely speckled iodine staining may persist.
• Biopsy. For histological examination in patients with chronic cervicitis, a section of the epithelium is taken during colposcopy. Symptoms of acute inflammation are a contraindication for biopsy.
• PCR diagnostics. The DNA of the causative agents of cervicitis is determined. The method is valuable for diagnosis in the absence of pronounced clinical symptoms and minimal changes in the cervix. Using PCR, papillomaviruses are detected and their oncogenic type is specified.

Treatment of cervicitis

The goal of treating pathology is to suppress the inflammatory process using etiotropic antibacterial, antiviral, and antifungal therapy. Immunomodulatory drugs can be used at the same time. Treatment is carried out by local or systemic means with subsequent restoration of the vaginal biocenosis.

Conservative therapy

In an acute process, treatment is selected depending on the type of pathogen. Local exposure is allowed for candidiasis infection and nonspecific inflammation. If there are symptoms of chlamydial, trichomonas or viral cervicitis, systemic therapy is necessary. For etiotropic treatment, the following groups of drugs are used:

• For candidiasis. Clotrimazole, nystatin vaginal tablets, and butoconazole cream can be used locally in the form of suppositories or cream. In some cases, treatment is carried out with fluconazole capsules. For manifestations of candidal colpitis and cervicitis, anti-relapse therapy is carried out more often than 4 times a year after suppressing the acute process.
• With chlamydial cervicitis. Local treatment is ineffective; systemic antibacterial therapy is prescribed. The drug of choice is azithromycin. Alternative agents belong to the groups of tetracyclines, macrolides, and quinolones. After completing the course, monitoring of cure is necessary.
• For trichomonas. Trichomonas are protozoan microorganisms; a drug with antiprotozoal action, metronidazole, is used against them. If trichomonas are resistant, detected in 2-5% of women, tinidazole is prescribed.
• For gonococcal infection. When determining the symptoms of gonorrheal cervicitis, broad-spectrum antibiotics are used. 3rd generation cephalosporins in combination with azithromycin are recommended. The second line drug is doxycycline. Treatment is given to both sexual partners.
• For HPV. A unified antiviral treatment regimen has not been developed. The drug based on inosine pranobex has proven itself well. It is used in long courses simultaneously with immunocorrection using suppositories with interferons.
• For herpes. The main drug that suppresses the activity of the herpes simplex virus is acyclovir. It is used in the acute phase in the presence of clinical symptoms - vesicles with liquid contents on the exocervix. An additional line drug is famciclovir.
• For mixed infection. Most often, during exacerbations of chronic cervicitis, a combination of nonspecific microflora and fungi occurs. Combination drugs are prescribed, including antibiotics of different groups and antimycotics.

Subsequent restoration of the microflora is carried out with local preparations, which include lactobacilli. Treatment results can be improved by eliminating the causes of cervicitis and correcting neuroendocrine changes. Lifestyle changes, dosed physical activity, and proper nutrition help. Treatment is effective using physiotherapy methods: diadynamic currents, magnetotherapy, electrophoresis.

Destructive methods

Methods of destructive treatment of cervicitis are used only when inflammation is combined with other background processes in the cervical area. For symptoms of papillomatosis, polyps, leukoplakia, ectropion, true erosion in nulliparous women, gentle methods are first used. If they are ineffective, additional examination is carried out and the approach is changed. Treatment is allowed in the following ways:

• Chemical cauterization. It is performed with preparations that are solutions of acetic, nitric, and oxalic acid. Medicines are applied to a swab and applied to the lesion. This type of treatment does not lead to the formation of scarring and is well tolerated.
• Cryodestruction. A solution of liquid nitrogen or carbon is used. A prerequisite for treatment is that the size of the lesion must correspond to the diameter of the cooling nozzle, therefore the technique is not indicated for diffuse exocervicitis. After exposure to liquid nitrogen, pathological cells freeze out. The tissues do not scar or deform during healing.
• Laser vaporization. Pathological areas on the cervix are precisely removed using a laser, which heats up the altered cells and leads to their death. The treatment method does not cause severe complications, scar deformation of the cervix, and can be used in nulliparous patients.
• Radio wave treatment. Produced by the Surgitron device. The procedure is painless, and a delicate young epithelium is formed in place of the changed tissues. During treatment, healthy cells remain intact, radio waves affect only the pathological epithelium.
• Argon plasma ablation. It is carried out contactlessly using radio waves amplified by the action of the inert gas argon. The procedure can be prescribed to women of any age, including those planning pregnancy. Healing is fast, rough scars are not formed.

Surgical treatment

Surgical treatment of cervicitis is recommended in case of simultaneous diagnosis of dysplasia, cervical polyps or papillomatosis. The indication for surgery is cicatricial deformity of the cervix. Hospitalization to the gynecology department is required. Cervical polyps are removed and the bed is cauterized with liquid nitrogen. Other treatment methods may also be used:

• Loop electrosurgical excision. It is carried out after relief of acute inflammation of the cervix. Using an electric loop, the altered area of ​​tissue is removed, while the vessels are sealed, which reduces the risk of bleeding. The resulting tissues are examined histologically.
• Knife conization of the neck. Performed using a scalpel. A cone-shaped section of tissue is removed, with its apex directed into the cervical canal. The operation can be complicated by bleeding, and is rarely used today. After manipulation, the resulting tissues are sent for histological analysis.

Prognosis and prevention

With timely treatment, it is possible to eliminate the symptoms of cervicitis and prevent it from becoming a chronic disease and the appearance of complications. Prevention involves preventing infection with STIs. It is necessary to refrain from casual sexual contacts and use barrier contraception. You can prevent cervical injury by not having abortions. If it is necessary to terminate a pregnancy, it is safer to carry out the procedure early with medication.

The term cervicitis, formed by the Latin word “cervicis” - cervix and the ending –itis, indicating inflammation, in gynecology refers to an infectious process in the cervix

This formation is an anatomical continuation of the body of the uterus, which is located between its cavity and the vagina. In the center of the cervix runs the cervical canal, which connects these two hollow organs and contains a mucus plug that protects the uterus and other organs of the reproductive system from the introduction of microorganisms from the vagina. If a woman becomes infected with any sexually transmitted disease (trichomoniasis, gonorrhea, chlamydia, mycoplasmosis, etc.), then the thick mucous secretion liquefies, the mucous membrane of the canal becomes inflamed, which threatens the spread of infection to the stroma - the connective tissue base of the cervix. Due to the disappearance of this protective mucus, microbes can easily ascend to the uterus, appendages, and then the bladder, kidneys, peritoneum, causing a pathological process in the pelvic cavity, pyelonephritis and even peritonitis. In addition, with chlamydial cervicitis, there is a high risk of developing Fitz-Hugh-Curtis syndrome, leading to the formation of adhesions in the abdominal cavity and pelvis, and this in turn threatens infertility. The combination of cervicitis with the presence of a high-oncogenic papillomavirus can provoke the appearance of malignant tumor cells in the cervix, that is, cancer.

Cervicitis in many women is asymptomatic or its clinical picture is erased: a feeling of discomfort in the lower abdomen and scanty mucous discharge from the vagina. All of the above is said to mean that in order to avoid these terrible complications, every representative of the fair sex should visit a gynecologist twice a year for preventive purposes, because cervicitis is very often discovered by chance when examining the cervix in the speculum.

In addition to the most common cause of cervicitis - sexually transmitted diseases, there are a number of predisposing factors that contribute to the development of pathology:

• Irritation of the cervix by mechanical or chemical contraceptives;
• Weakening of the immune system, for example, with other somatic diseases;
• Abortion trauma;
• Unsutured cervical and perineal ruptures after childbirth;
• Prolapse of the genital organs;
• Menopause.

These prerequisites contribute to the rapid proliferation of opportunistic microorganisms, which are normally found in very small quantities in the vaginal microflora - streptococci, staphylococci, and less often - E. coli and enterococci. Thus, some kind of flora, specific or nonspecific, is always involved in the development of cervicitis - aseptic (microbial-free) inflammation of the cervix simply does not exist!

Classification

According to localization they distinguish:

1. Endocervicitis - inflammation of the mucous membrane of the cervical canal;

2. Exocervicitis - damage to the vaginal part of the cervix.

According to the course, cervicitis can be acute and chronic, and according to the type of pathogen it is specific (chlamydia, gonococcal, candidiasis, mycoplasmosis, trichomoniasis, syphilitic, herpetic, tuberculosis, amebiasis) and nonspecific (with bacterial vaginosis - the predominance of opportunistic cocci and rods in the flora) .

Clinical picture of the disease

Cervicitis in most women, as mentioned above, is asymptomatic. However, sometimes the following indirect signs of the disease may be present:

Pain in the lower abdomen, ranging from sharp and cutting (for example, with acute gonorrhea) to dull aching.

Discomfort and pain during and after sexual intercourse.

Postcoital (after intimacy) bleeding.

Frequent urge to urinate, most often of a false nature (you want to, but have nothing to urinate with).

Vaginal discharge of various types: with mycoplasmosis and chlamydia - scanty and transparent or with a whitish, less often yellowish tint, with gonorrheal cervicitis - yellow (purulent), with trichomoniasis - foamy, with candidiasis (thrush) - white, cheesy consistency.

Diagnosis of the disease

Cervicitis is initially diagnosed when a gynecologist examines the cervix in a speculum, which allows one to notice redness and swelling of the organ, increased bleeding when touched, the presence of erosions, pinpoint hemorrhages and purulent discharge from the cervical canal. In doubtful cases, the doctor resorts to colposcopy using a special optical device that magnifies the image of the surface of the cervix several times and allows one to identify the smallest defects and erosions of the mucous membrane.

Mandatory diagnostic measures for cervicitis include:

1. Microscopic examination of vaginal discharge, cervical canal and urethra to identify bacterial flora;

2. Taking smears and culturing native material to determine the type of pathogen and its sensitivity to antibiotics;

3. Smear for oncocytology to exclude cancer.

Additional research:

• General blood and urine analysis;
• Test for HIV, RW (syphilis);
• Microbiological methods, PCR (polymerase chain reaction), RIF (immunofluorescence reactions) to exclude sexually transmitted diseases;
• pH-metry of vaginal discharge;
• Ultrasound of the pelvic organs to confirm the presence or absence of complications (adhesions, inflammatory processes).

Treatment of cervicitis

Drug therapy for cervicitis at the first stage is aimed at eliminating the causative agent of the disease and depends on its type and microbiological research data. Specific cervicitis is treated with appropriate drugs that are effective against a specific microbe. For candidal cervicitis, it is fluconazole, for chlamydial cervicitis, tetracycline antibiotics, macrolides, quinols or azithromycin, for herpes, acyclovir, etc.

The second stage of treatment is the restoration of normal microflora and vaginal pH by using suppositories acylact, bificol, lactobacterin, vagilak or colibacterin intravaginally. In parallel, vitamin therapy (multivitamins, riboflavin, ascorbic acid), immunocorrection, herbal medicine (douching with infusions of bergenia, elderberry, nettle, bittersweet), physiotherapy (magnetic therapy, diathermic currents, SMT, magnesium electrophoresis, darsonvalization, vaginal laser therapy, acupuncture) is carried out. In the presence of cervical deformities after etiotropic treatment, surgical plastic surgery of the organ is indicated.

For chronic cervicitis during menopause, hormonal creams and suppositories are prescribed, for example, the drug Ovestin.

Prevention

To prevent the development of cervicitis it is necessary:

• Undergo regular preventive examinations with a gynecologist once every 6 months;
• Avoid abortion if possible;
• Lead a monogamous lifestyle (one sexual partner) or protect yourself with condoms;
• Treat genitourinary diseases, especially sexually transmitted diseases, in a timely manner;
• When prolapse of the genital organs, you need to master wumbling - the skill of controlling the muscles of the vagina, and do exercises to strengthen the vaginal muscles;
• Strengthen the immune system (taking vitamins, dosed physical activity, hardening);
• Take hormonal medications during menopause.

Content

More than half of women with pathological discharge have vaginal candidiasis. The prevalence of candidiasis is determined by predisposing factors and the mechanism of fungal infection.

Vaginal candidiasis is usually called a fungal infection of the external genital area, including the skin of the anogenital zone. The disease is otherwise called thrush because of the characteristic cheesy-looking discharge, which often has a sour odor.

Vaginal candidiasis occurs at any age in both women and men. However, in women, fungal infections are diagnosed somewhat more often. In men, thrush is usually caused by serious causes.

The causative agent of vaginal candidiasis is Candida fungi. This pathogen belongs to a nonspecific or conditionally pathogenic microflora. Its peculiarity is that it is part of the normal microflora of the vagina. Anaerobic bacteria, streptococci, staphylococci and Candida fungi can be found on the skin and mucous membranes in small quantities. However, with their increased reproduction, an inflammatory process occurs with a characteristic clinical picture.

Reproduction of opportunistic microorganisms associated with immune and endocrine disorders in the body and the presence of external provoking factors.

The growth of opportunistic microflora is restrained by the protective mechanism of the vaginal mucosa. It is known that a significant part of the vaginal microflora is represented by lactic acid bacteria. These lactobacilli break down glycogen, which is formed on the surface of the mucosa under the influence of estrogens. Thus, lactic acid is formed. Thanks to this component, an optimal level of acidity is maintained, which does not allow bacteria to multiply.

A glycocalyx also forms on the surface of the epithelium. This is a protective film that is formed by colonies of lactobacilli together with the products of their vital activity. Glycocalyx prevents the penetration of pathogenic flora into the thickness of the vaginal epithelium.

When the number of lactic acid bacteria and the level of acidity change, the bacteria receive the necessary conditions for reproduction. Candida fungi tend to enter into microbial associations. In this case, the clinical picture can be represented by various symptoms.

However, if a woman’s immune system functions adequately, minor changes in the vaginal microflora will soon stop. Thus, the inflammatory process does not develop.

Reasons

Vaginal candidiasis has many causes and factors of its occurrence. The most common provocateur of vaginal candidiasis is long-term use of antibacterial drugs, which significantly affects the state of the immune system.

Sometimes vaginal candidiasis has physiological causes. It is known that during pregnancy, natural changes occur in a woman’s body:

• the mucous membrane is rebuilt;
• Progesterone levels increase many times;
• The body's defenses are weakened.

These changes are also typical for women during lactation. If there are no other causes of vaginal candidiasis, the symptoms of the disease disappear over time.

The appearance of vaginal candidiasis in women during menopause is physiological. There is a decline in reproductive function, which causes changes in the mucosa, for example, atrophy.

The causes of vaginal candidiasis include:

• poor genital hygiene;
• frequent washing and douching, especially with aggressive agents;
• epithelial trauma;
• immature flora in girls;
• genital infections and inflammatory processes;
• bacterial vaginosis;
• hormonal therapy;
• allergic reactions;
• immunodeficiency states;
• diabetes mellitus;
• intestinal dysbiosis.

Typically, vaginal candidiasis is caused by a complex of different causes. The disease can be cured only by eliminating the provoking factors. Otherwise, candidiasis will recur. However, with adequate therapy, stable remission can be achieved.

Symptoms and diagnosis

The clinical picture depends on many factors. It matters whether the disease occurs in an acute or chronic form, and in what state the immune system is.

Sometimes vaginal candidiasis is present in the body as a carrier. However, weakened immunity provokes relapses.

The acute form is characterized by a limited duration of progression. In particular, the acute form is considered to be the appearance of the first signs of vaginal candidiasis, which can bother the patient for up to two months. If treatment was absent or incorrect, vaginal candidiasis becomes chronic and recurrent. This pathology is characterized by a long course, which is characterized by periods of remissions and exacerbations.

Acute vaginal candidiasis is severe and has the following symptoms:

• burning;
• dry mucous membranes;
• discomfort during sexual intercourse;
• discomfort when performing hygiene procedures;
• increased discomfort at night, when walking;
• pain when urinating;
• curdled discharge with a sour odor;
• rash on the genitals.

With a combination of several infections the clinical picture may include other manifestations. The discharge may vary in consistency and color.

In breastfeeding women, signs of thrush may appear on the nipples. As a rule, this pathology is combined with vaginal candidiasis.

Many women consider vaginal candidiasis a non-serious disease, the symptoms of which can be easily relieved by taking any antifungal drug. In fact, the symptoms of thrush are easily eliminated with modern medications. However, the lack of complete therapy leads not only to the transition of vaginal candidiasis to a chronic form, but also to the resistance of microorganisms. As a result, a specialist is not always able to select effective therapy.

With chronic vaginal candidiasis, the symptoms are less pronounced. The discharge is cloudy in nature. The appearance of signs is possible only during periods of exacerbation.

Thrush can be detected through a gynecological examination and a smear on the flora. However, in order to diagnose the causative agent of a fungal infection and determine sensitivity to drugs, it is necessary to perform a more detailed study.

Determining the specific pathogen of vaginal candidiasis is necessary for recurrent chronic thrush. In this case, it is necessary to undergo an examination to exclude hormonal, immune and infectious factors.

Treatment with fluconazole

In modern gynecology, the antifungal drug Fluconazole is often used to treat vaginal candidiasis. The product is relatively safe and easy to use. Fluconazole is well tolerated and is available in several dosage forms.

Active ingredient

Like any drug, Fluconazole contains active and auxiliary substances. The main active ingredient is fluconazole. The composition of the capsules varies depending on the manufacturer.

Auxiliary components in the tablets include lactose, potato starch, magnesium stearate and others. The solution contains sodium chloride, water for injection and sodium hydroxide.

Dosage forms

Both capsules and tablets are used to treat vaginal candidiasis. The volume of the active substance is 50, 150 or 100 mg. The capsules are colored blue and the contents include a white powder mixture.

In addition to capsules and tablets, other dosage forms are used to treat candidiasis:

• syrup;
• gel;
• solution for parenteral administration;
• candles.

Mechanism of action

Fluconazole is prescribed for fungal infections, in particular vaginal candidiasis. The active substance blocks the enzymatic activity of fungal flora. This leads to improved permeability of cell membranes and inhibition of fungal growth.

It is noteworthy that Fluconazole has selective activity. The active substance does not affect healthy cells.

Fluconazole can be used for both therapeutic and prophylactic purposes. For example, doctors prescribe Fluconazole when treating with antibiotics.

One of the indications for taking Fluconazole is vaginal candidiasis. A high level of fluconazole concentration in secreted secretions is observed after eight hours. The therapeutic required level is maintained throughout the day.

Contraindications

Any medicine, including Fluconazole, has contraindications. Doctors identify the following contraindications to taking Fluconazole:

• increased sensitivity to antifungal drugs;
• complex treatment with terfanadine or astemizole;
• the presence of side effects that are caused by hypersensitivity;
• children up to one year of age.

Fluconazole is prescribed with caution in the presence of liver and kidney pathologies. During the treatment of vaginal candidiasis with Fluconazole, laboratory tests should be performed.

Directions for use

The choice of dosage form is made by the doctor. The dosage recommended for the patient is prescribed according to the severity of vaginal candidiasis.

Typically, the use of Fluconazole for vaginal candidiasis involves a single dose of the drug. However, the treatment regimen is prescribed on an individual basis.

If vaginal candidiasis is chronic, it is recommended to take the drug twice every month. Treatment is long-term, up to a year.

Fluconazole can be taken on any day of the cycle.

Side effects

The drug Fluconazole is well tolerated. However, in some cases, side effects may occur.

Side effects while taking Fluconazole include:

• lack of appetite;
• the occurrence of perversion of taste sensations;
• dyspeptic disorders, for example, flatulence, nausea, vomiting;
• headache;
• pain in the stomach;
• dizziness;
• changes in the general blood test, in particular leukopenia;
• skin rashes;
• kidney dysfunction.

If side effects occur, Fluconazole should be discontinued. As a rule, after discontinuation of Fluconazole, unwanted side effects are eliminated. Usually no additional therapy is required.