HEALTH TIPS: INFLAMMATION OF THE CERVIX (CERVICITIS)

Dr Tariq Jagnarine
Fam Medicine, Endocrinology/ Diabetes

The cervix is the lowest part of the uterus. It extends slightly into the vagina. This is where menstrual blood exits the uterus. During labour, the cervix dilates to allow a baby to pass through the birth canal (endocervical canal). Like any tissue in the body, the cervix can become inflamed for a variety of reasons. Inflammation of the cervix is known as cervicitis.

CAUSE
The most common cause of this inflammation is an infection. Infections that lead to cervicitis may be spread during sexual activity, but this isn’t always the case. Cervicitis is either acute or chronic. Acute cervicitis involves a sudden onset of symptoms. Chronic cervicitis lasts for several months.
Acute cervicitis is typically due to a sexually transmitted infection (STI) such as:
* Herpes simplex or genital herpes
* Chlamydia
* Trichomoniasis
* Gonorrhoea
* Mycoplasma
* Ureaplasma
Infection with HPV that has progressed may cause cervical inflammation, which is usually a later sign of cervical cancer or precancer.
Other causes of cervicitis include:
* Allergies: If someone is allergic to spermicides, douches, or latex in condoms, these may cause the cervix to become inflamed.
* Irritation: Inserting tampons, pessaries, or diaphragms may irritate or injure the cervix. Cervicitis may also develop if these items are left in place longer than directed.
* Bacterial imbalance: If harmful bacteria overwhelm the healthful bacteria in the vagina, this may cause bacterial vaginosis. An inflamed cervix may be a symptom of this.
* Pregnancy: This can affect hormone levels and lead to cervicitis, as the cervix is much more sensitive at this time.
* Cancer or cancer treatment: Treatments for cancer, or advanced stages of cervical cancer itself, may affect cervical tissue. This is rare, but may lead to symptoms of cervicitis.
Chronic cervicitis is not typically caused by an infection. Symptoms may be milder, but last longer. Some people may want to treat chronic cervicitis at home, using natural remedies that will complement medical treatments.

SYMPTOMS
Some women with cervicitis experience no symptoms. When symptoms are present, they can include:
* Abnormal vaginal bleeding
* Persistent gray or white vaginal discharge that may have an odour
* Vaginal pain
* Pain during intercourse
* A feeling of pelvic pressure
* Backaches
* Vaginal itching or irritation
* Bleeding between periods
* Bleeding after sex
* Pain during a cervical exam
* Frequent and painful urination
* Lower back pain
* Abdominal pain
The cervix can become very inflamed if cervicitis progresses. In some cases, it can develop an open sore. Pus-like vaginal discharge is a symptom of severe cervicitis.
DIAGNOSIS
Persons with symptoms of cervicitis should consult a healthcare worker for accurate diagnosis, and follow up with a screening test. The symptoms of cervicitis can also signal other vaginal or uterine conditions. Cervicitis may be discovered during a routine exam, even without experiencing any symptoms.

There are multiple ways Cervicitis can be diagnosed.
* Bimanual pelvic exam
For this test, a gloved finger is inserted into the vagina while also applying pressure to the abdomen and pelvis with the other hand. This allows any abnormalities of the pelvic organs to be detected, including abnormalities of the cervix and uterus.
* Pap Smear test
For this test, a swab of cells from the vagina and cervix is obtained and tested for abnormalities.
* Cervical biopsy
This test is performed only if an abnormality is detected in the Pap smear test.
* Cervical discharge culture
Studying the microbe content of the vagina for atypical or increased amounts of micro-organisms that can cause infections.

TREATMENT
There’s no standard treatment for cervicitis. The best course of treatment is determined based on factors that include:
* Overall health
* Medical history
* Severity of symptoms
* Extent of the inflammation
Common treatments include antibiotics to kill any infections, and watchful waiting, especially after childbirth. If the cervicitis is due to irritation from a foreign body (a retained tampon or pessary) or use of certain products (a cervical cap or contraceptive sponge), treatment would involve discontinuing use for a short time to allow for healing.
If the cervical inflammation is due to cervical cancer or precancer, a cryosurgery is performed, in which abnormal cells in the cervix are frozen, which destroys them. Silver nitrate can also destroy abnormal cells.
Treatment for cervicitis is done based on the causes. Without treatment, cervicitis can last for years, causing painful intercourse and worsening symptoms.

NATURAL TREATMENT OPTIONS
Acute cervicitis that is caused by an infection is best treated medically, as it is essential to clear up the infection.
If a woman has chronic cervicitis with mild symptoms, she may choose to use home remedies to help ease the symptoms.
A person should always use home remedies alongside medical treatments, as medical treatments are not intended to replace home remedies.
Home remedies that may help treat cervicitis include:
* Traditional Chinese medicine: A 2014 study found that traditional Chinese medicinal treatments, including specific Chinese herbs, may be effective in the treatment of cervicitis. The herbs were reported to have an anti-inflammatory effect.
* Eating yogurt or taking probiotic supplements: Yogurt contains healthful bacteria, called probiotics. A 2014 study suggests that probiotics may help treat bacterial vaginosis, which is one cause of cervicitis.
* Eating garlic or taking a garlic supplement: Garlic has strong antibacterial properties. Another study found that taking garlic supplements may also help treat bacterial vaginosis.
These alternative treatments need further studies as they are not considered first-line treatments for cervicitis or vaginal infections at this time.
Home remedies that support vaginal and cervical health, and may prevent cervicitis, include:
* Drinking green tea: Studies suggested green tea may have a protective role in reducing the risk of ovarian and endometrial cancers.
* Avoiding irritants: Avoiding douches, tampons, diaphragms, and scented soaps reduces the risk of irritation.
* Wearing loose cotton underwear: Breathable underwear reduces the buildup of moisture and bacteria that can lead to infection.
* Using condoms during sex: This reduces the risk of STIs, one of the leading causes of cervicitis.

COMPLICATIONS
Cervicitis caused by gonorrhoea or chlamydia can move to the uterine lining and fallopian tubes, causing pelvic inflammatory disease (PID). PID causes additional pelvic pain, discharge, and a fever. Untreated PID can also lead to fertility problems.

PREVENTION
There are ways to reduce the risk of developing cervicitis. Using a condom every time in sexual intercourse, especially with new or irregular partners, can reduce the risk of contracting an STI. Avoiding sexual intercourse with multiple sexual partners can also protect persons from cervicitis caused by an STI.
Avoiding products containing chemicals, such as douches and scented tampons, can reduce the risk of an allergic reaction.
Cervicitis is typically treatable. Home treatments and prevention strategies should be used alongside, not instead of, medical treatment. Acute cervicitis caused by infections is best treated medically, to avoid complications.