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

chronic cervicitis

cervix uteri

ultrasound cavitation

cavitated solutions

excision of the cervix uteri

Full text (in Russian)

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Received 04.10.2022

Accepted 28.06.2023

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

Chronic nonspecific cervicitis

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

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