About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2023№7
Chronic nonspecific cervicitis

Chronic nonspecific cervicitis

DOI
https://dx.doi.org/10.18565/aig.2022.233

Firichenko S.V., Popova E.O., Smirnova S.O.

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
Objective: To evaluate the efficiency of treatment for chronic nonspecific cervicitis (CNSC) by ultrasound cavitation and altered tissue radiowave excision compared to empirical antibacterial treatment. Materials and methods: Based on standardized included criteria, 50 reproductive-aged patients with CNSC were enrolled in the investigation and were available for analysis. They were equally divided into 2 groups: a study and a comparison group. After colposcopic examination, each group was divided into subgroups A (in terms of the presence of cervical deformity) and B (in terms of its absence). At the first stage, all the study patients (n=25) underwent 5 sessions of treatment of the cervix with 0.05% chlorhexidine solution cavitated by ultrasound. The comparison group patients (n=25) received only empirical treatment with a single dose of 1.0 g azithromycin. After 3 months, the study group patients (n=17) who had impaired cervical histoarchitectonic abnormalities as old ruptures, the consequences of destructive treatment or ectropion, and who did not meet the criteria for cure by the time cutoff of 3 months, an additional intervention (electrosurgical (radiowave) excision of the altered cervical tissue) was performed. No additional interventions were done in the control group patients. The effect of therapeutic interventions was evaluated following 1, 3, and 6 months according to the criteria: satisfaction with treatment (a subjective effect) and the criterion of cure (an objective one). Results: After a month, the disappearance of the main symptoms of CNSC according to the objective criteria was noted in most patients, in both patients with normal (1B, 2B) and in those with the impaired cervical (1A, 2A) histoarchitectonics, in both the study (cavitation) group and control (azithromycin) groups. Antibiotic therapy with azithromycin showed no statistically significant differences in efficiency compared with ultrasound cavitation, neither in the patients with the normal cervical histoarchitectonics (1B and 2B) after 1, 3, and 6 months (p=0.55; 0.262; 0.3, respectively), nor in the patients with the impaired cervical histoarchitectonics after 1 and 3 months (p=0.29; 0.06, respectively). Ultrasound cavitation for the treatment of CNSC was not inferior in the effectiveness of antibacterial therapy in the short term. However, there was a resumption of the symptoms of CNSC after 3 and 6 months, which was especially pronounced in patients with the impaired histoarchitectonics of the cervix uteri. Additional surgical excision of its altered tissue in patients with the impaired cervical histoarchitectonics (1A) led to the cure criteria in 15/16 (93,8%) patients compared with the identical (azithromycin) group 2A, where after 6 months only 1/18 (5,6%) met the cure criteria (OR 157.7 [11.5; 10051.4]; p<0.001). There was a high treatment satisfaction on average 4 [3; 4] scores when evaluating after 1 month in all the groups, with its subsequent decrease, except for Group 1A (cavitation, then excision following 3 months), in which at the cut-off of 6 months, there was a higher treatment satisfaction than that in Group 2A (4 [4; 4] vs 2 [2; 2]; p<0.001; 0.676 [0.5; 0.817]). Conclusion: The main reason supporting the chronic inflammatory process is the impaired cervical histoarchitectonics. Empirical antibiotic therapy is not effective in treating CNSC in the long term, having only a temporary effect. Ultrasound cavitation therapy has a positive permanent effect in patients with the normal cervical histoarchitecnonics, but most patients with the impaired cervical exhibited a resumption of the symptoms of CNSC. Only additional surgical removal of the altered cervical tissue after ultrasound cavitation therapy in patients with the impaired cervical histoarchitectonics can achieve the cure of CNSC in most cases. Authors' contributions: Firichenko S.V. – concept, hypothesis, and design of the investigation, final edition of the manuscript for publication; Popova E.O. – concept, hypothesis, and design of the investigation, collection of material and its statistical analysis, writing the manuscript; Smirnova S.O. – search for and review of publications of the studies on the topic of the investigation, analysis of the material. Conflicts of interest: The authors declare that there are no possible conflicts of interest. Funding: The investigation has not been sponsored. Ethical Approval: The investigation has been approved by the Ethics Committee, A.I. Yevdokimov Moscow State Medical University of Medicine and Dentistry, Ministry of Health of Russia (Report No. 06-20 dated June 18, 2020). Patient Consent for Publication: All patients have signed an informed consent form to the publication of their data. Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator. For citation: Firichenko S.V., Popova E.O., Smirnova S.O. Chronic nonspecific cervicitis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (7): 135-146 (in Russian) https://dx.doi.org/10.18565/aig.2022.233

Keywords

chronic cervicitis
cervix uteri
ultrasound cavitation
cavitated solutions
excision of the cervix uteri
Full text (in Russian)

References

  1. Серов В.Н., Сухих Г.Т., Прилепская В.Н., Радзинский В.Е., ред. Руководство по амбулаторно-поликлинической помощи в акушерстве и гинекологии. М.: ГЭОТАР-Медиа; 2018. 1136с. [Serov V.N., Sukhikh G.T., Prilepskaya V.N., Radzinsky V.E., eds. Guide for outpatient help in obstetrics and gynecology. Мoscow: GEOTAR-Media; 2018. 1136p.(in Russian)].
  2. Peipert J.F., Ness R.B., Soper D.E., Bass D. Association of lower genital tract inflammation with objective evidence of endometritis. Infect. Dis. Obstet. Gynecol. 2000; 8(2): 83-7. https://dx.doi.org/10.1002/(SICI)1098-0997(2000)8:2<83::AID-IDOG4>3.0.CO;2-4.
  3. Jayakumar N.K.B. Cervicitis: how often is it non-specific! J. Clin. Diagn. Res. 2015; 9(3): EC11-2. https://dx.doi.org/10.7860/JCDR/2015/11594.5673.
  4. Nugent R.P., Hillier S.L. Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. Sex. Transm. Dis. 1992; 19(4): 198-202. https://dx.doi.org/10.1097/00007435-199207000-00003.
  5. Lusk M.J., Garden F.L., Rawlinson W.D., Naing Z.W., Cumming R.G., Konecny P. Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics. Sex. Transm. Infect. 2016; 92(3): 175-81. https://dx.doi.org/10.1136/sextrans-2015-052332.
  6. Gaydos C., Maldeis N.E., Hardick A., Hardick J., Quinn T.C. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex. Transm. Dis. 2009; 36(10): 598-606. https://dx.doi.org/10.1097/OLQ.0b013e3181b01948.
  7. Lusk M.J., Pam Konecny. Cervicitis: a review. Curr. Opin. Infect. Dis. 2008; 21(1): 49-55. https://dx.doi.org/10.1097/QCO.0b013e3282f3d988.
  8. Глухов Е.Ю., Дикке Г.Б. Применение и клинические эффекты низкочастотной ультразвуковой кавитации в акушерстве и гинекологии. Акушерство и гинекология. 2016; 1: 109-16. [Glukhov E.Yu. Dikke G.B. The use and clinical effects of low-frequency ultrasound cavitation in obstetrics and gynecology: A review of literature. Obstetrics and Gynecology. 2016; (1): 109-16. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.1.109-116.
  9. Хабаров С.В., Горская О.С., Русанова Г.П. Опыт применения ультразвуковой кавитации у пациенток с хроническим эндометритом перед проведением программы ЭКО. Акушерство и гинекология. 2020; 11: 197-204. [Khabarov S.V., Gorskaya O.S., Rusanova G.P. Experience with ultrasonic cavitation in patients with chronic endometritis before IVF. Obstetrics and Gynecology. 2020; (11): 197-204. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.11.197-204.
  10. Глухов Е.Ю., Дикке Г.Б., Нефф Е.И., Рощина М.О. Подготовка к хирургическому лечению пациенток с тяжелыми формами пролапса тазовых органов, осложненного трофическими нарушениями. Фарматека. 2020; 6: 54-60. [Glukhov E.Yu., Dikke G.B., Neff E.I., Roshchina M.O. Preparation for surgical treatment of patients with severe forms of pelvic organ prolapse complicated by trophic disorders. Farmateka. 2020; (6): 54-60. (in Russian)]. https://dx.doi.org/10.18565/pharmateca.2020.6.54-60.
  11. Аполихина И.А., Саидова А.С., Арустамян А.Р. Оценка эффективности применения низкочастотной ультразвуковой кавитации лекарственных растворов в комплексном лечении инфекционно-воспалительных урогенитальных заболеваний. Медицинский оппонент. 2020; 2(10): 40-6. [Apolikhina I.A., Saidova A.S., Arustamyan A.R. Evaluation of the effectiveness of the use of low-frequency ultrasonic cavitation of medicinal solutions in the complex treatment of infectious and inflammatory urogenital diseases. Medical Opponent. 2020; 2(10): 40-6. (in Russian)].
  12. Kataoka Y., Kunimitsu M., Nakagami G., Koudounas S., Weller C.D., Sanada H. Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: a scoping review. Int. Wound J. 2021; 18(2):176-86. https://dx.doi.org/10.1111/iwj.13509.
  13. Caixeta R.C.A., Ribeiro A.A., Segatti K.D., Saddi V.A., Figueiredo Alves R.R., dos Santos Carneiro M.A., Rabelo-Santos S.H. Association between the human papillomavirus, bacterial vaginosis and cervicitis and the detection of abnormalities in cervical smears from teenage girls and young women. Diagn. Cytopathol. 2015; 43(10): 780-5. https://dx.doi.org/10.1002/dc.23301.
  14. Nyirjesy P. Nongonococcal and nonchlamydial cervicitis. Curr. Infect. Dis. Rep. 2001; 3(6): 540-5. https://dx.doi.org/10.1007/s11908-001-0092-6.
  15. Taylor S.N., Lensing S., Schwebke J., Lillis R., Mena L.A., Nelson A.L. et al. Prevalence and treatment outcome of cervicitis of unknown etiology. Sex. Transm. Dis. 2013; 40(5): 379-85. https://dx.doi.org/10.1097/OLQ.0b013e31828bfcb1.
  16. Власов В.В. Эпидемиология. М.: ГЭОТАР-Медиа; 2021. 496с. [Vlasov V.V. Epidemiology. Moscow: GEOTAR-Media; 2021. 496p. (in Russian)].
  17. Marrazzo J.M., Martin D.H. Management of women with cervicitis. Clin. Infect. Dis. 2007; 44(Suppl. 3): S102-10. https://dx.doi.org/10.1086/511423.
  18. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. 2021.
  19. Young C., Argáez C. Management and treatment of cervicitis: a review of clinical effectiveness and guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Sep. 21.
  20. Marrazzo J.M., Handsfield H.H., Whittington W.L.H. Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. Obstet. Gynecol. 2002; 100(3): 579-84. https://dx.doi.org/10.1016/s0029-7844(02)02140-3.
  21. Одыванова А.А., Межевитинова Е.А., Прилепская В.Н., Донников А.Е., Уруйгмагова А.Т., Абакарова П.Р. Современные представления об этиологии, патогенезе, диагностике и лечении хронического неспецифического цервицита. Медицинский cовет. 2022; 16(14): 178-84. [Odyvanova A.A., Mezhevitinova E.A., Prilepskaya V.N., Donnikov A.E., Uruymagova A.T., Abakarova P.R., Nazarova N.M., Dovletkhanova E.R., Gusakov K.I., Kepsha M.A. Modern ideas about the etiology, pathogenesis, diagnosis and treatment of chronic nonspecific cervicitis. Medical Council. 2022; 16(14): 178-84. (in Russian)]. https://dx.doi.org/10.21518/2079-701X-2022-16-14-178-184.
  22. Taylor S.N. Cervicitis of unknown etiology. Curr. Infect. Dis. Rep. 2014; 16(7): 409. https://dx.doi.org/10.1007/s11908-014-0409-x
  23. Paavonen J., Roberts P.L., Stevens C.E., Wølner-Hanssen P., Brunham R.C., Hillier S. et al. Randomized treatment of mucopurulent cervicitis with doxycycline or amoxicillin. Am. J. Obstet. Gynecol. 1989; 161(1): 128-35. https://dx.doi.org/10.1016/0002-9378(89)90249-4.
  24. Chandeying V., Sutthijumroon S., Tungphaisal S. Evaluation of ofloxacin in the treatment of mucopurulent cervicitis: a response of chlamydia-positive and chlamydia-negative forms. J. Med. Assoc. Thai. 1989; 72(6): 331-7.
  25. Амирханян А.С., Прилепская В.Н., Байрамова Г.Р., Бурменская О.В., Костава М.Н., Асатурова А.В. Хронический цервицит: современные возможности диагностики и лечения. Акушерство и гинекология. 2018; 4: 22-7. [Amirkhanyan A.S., Prilepskaya V.N., Bairamova G.R.,Burmenskaya O.V., Kostava M.N., Asaturova A.V. Chronic cervicitis: current opportunities for diagnosis and treatment. Obstetrics and Gynecology. 2018; (4): 22-7. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.4.22-27.
  26. Мелкозерова О.А., Башмакова Н.В., Чистякова Г.Н., Есарева А.В., Барлит О.Г., Гиниятова А.А. Тканевые и молекулярные эффекты кавитированных растворов в восстановлении показателей рецептивности эндометрия у пациенток с маточной формой бесплодия. Проблемы репродукции. 2017; 23(5): 73-83. [Melkozerova O.A., Bashmakova N.V., Chistiakova G.N., Esareva A.V., Barlit O.G., Giniyatova A.A. Tissue and molecular effects of the cavitated solution in the endometrial receptivity rehabilitation of patients with the uterine infertility. Russian Journal of Human Reproduction. 2017; 23(5): 73 83. (in Russian)]. https://dx.doi.org/10.17116/repro201723573-83.
  27. Камалова Е.Ю., Узлова Т.В., Шамаева Т.Н. Оптимизация лечения хронического цервицита. Уральский медицинский журнал. 2017; 5: 135-9. [Kamalova E.J, Uzlova T.V., Shamaeva T.N. What can cavitated water in the treatment of chronic cervicitis? Ural Medical Journal. 2017; (5): 135-9(in Russian)].

Received 04.10.2022

Accepted 28.06.2023

About the Authors

Sergey V. Firichenko, Dr. Med. Sci., Associate Professor at the Department of Obstetrics and Gynecology, Faculty of Medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, +7(910)440-04-52, firichenko@mail.ru, https://orcid.org/0000-0001-8342-8317,
127473, Russia, Moscow, Delegatskaya str., 20/1.
Evgeniya O. Popova, postgraduate student at the Department of Obstetrics and Gynecology, Faculty of Medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, +7(916)070-18-59, evgeniya-surg@yandex.ru, https://orcid.org/0000-0002-0129-486X, 127473, Russia, Moscow, Delegatskaya str., 20/1.
Svetlana O. Smirnova, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Faculty of Medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, +7(916)703-11-69, https://orcid.org/0000-0002-7940-3245, 127473, Russia, Moscow, Delegatskaya str., 20/1.
Corresponding author: Evgeniya O. Popova, evgeniya-surg@yandex.ru

Similar Articles

№6 / 2016
Samodelkin E.I., Kosareva P.V., Vetelina V.V.
Transforming growth factor-β expression in the ectocervical epithelial cells in cervical intraepithelial neoplasia and HPV infection
№11 / 2016
Yusupov K.F., Nedopekina E.V., Vikhareva O.N.
Use of elastography in obstetric and gynecologic practice
№1 / 2019
Omarpashaeva M.I., Dikke G.B., Abusueva Z.A., Khashaeva T.Kh-M.
Endometrial receptivity restoration in women after a missed miscarriage
№2 / 2020
Baev O.R., Babich D.A.
Comparison of the efficiency of labor induction in full term and late term pregnancies
№9 / 2020
Mazitova M.I., Mardieva R.R., Antropova E.Yu.
Preventive therapy for postoperative complications in patients with old ruptures of the cervix uteri
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.