Cervicitis

An inflammation of the cervix mainly due to an infection is Cervicitis. The infected cells of the cervix become irritated and may become red, swollen and ooze mucus and pus. They could bleed easily when touched. The most important cause of Cervicitis is sexually transmitted disease although many women do not test positive for any type of infection though contracted with Cervicitis.

Symptoms of Cervicitis

Many women do not exhibit any symptoms and if tested may be positive for Cervicitis. If present, the signs and symptoms include:

• Vaginal discharge which could be grayish or pale yellow.
  
• Abnormal vaginal bleeding or bleeding after sex, between periods.
  
• Pain during sexual intercourse.
  
• Pelvic or abdominal pain, fever in some cases.
  
• Vaginal irritation
  
• Pain in the vagina
  
• Pressure or heaviness in the pelvis.
  

Serious symptoms might indicate a life-threatening condition and immediate medical care should be sought. If Cervicitis is suspected during pregnancy, there could be life-threatening symptoms including - high fever, severe nausea and vomiting and severe pelvic pain.

Causes of Cervicitis

Cervicitis is most often caused by an infection caught during sexual activity. Some sexually transmitted diseases include gonorrhea, Chlamydia, Herpes Virus and Trichomoniasis. Other possible causes for Cervicitis are:

• Use of a diaphragm or cervical cap insertion into the pelvic area.
  
• Allergy to condoms and latex
  
• Chemical exposure
  
• Many sexual partners
  
• High risk sexual behavior
  
• Sex at an early age.

When the vagina is overwhelmed by unhealthy and harmful bacteria, it can cause Cervicitis. Hormonal imbalance with relatively low estrogen or high progesterone may interfere with the body's ability to maintain healthy cervical tissue. Cancer treatment and radiation therapy can also cause Cervicitis.

Diagnosing Cervicitis

A doctor first gets a closer look at the cervix when Cervicitis is suspected. Then the doctor will swab the cervix, collect vaginal fluid and see how it bleeds. The patient's sexual history is noted. A routine examination of the cervix is conducted if you are pregnant or the doctor thinks that there is high risk for sexually transmitted disease like gonorrhea or Chlamydia. Inspection of the discharge under a microscope may show Trichomoniasis or Bacterial Vaginosis. Pap smear is also done. Rarely, colposcopy and biopsy of the cervix is necessary to rule out cancer.

Reducing risk of Cervicitis

You can reduce or lower the risk of Cervicitis by:

• Avoiding known allergens.
  
• Avoiding sexual intercourse.
  
• Monogamous sexual partner.
  
• Following instructions while using diaphragm or cervical cap.
  
• Getting tested for STD infections annually.
  
• Getting vaccinated against human papilloma virus.
  
• Using condoms during sexual intercourse.
  

Treatment

If sexually transmitted infection is not the cause, then you do not need treatment for Cervicitis. If an infection is suspected, the main goal would be to eliminate the infection and prevent it from spreading to the uterus and fallopian tubes, in case of pregnancy.

In case of bacterial infections such as Chlamydia, Gonorrhea and others, antibiotics are used for treatment. Antiviral drugs may be used to treat herpes infections. Hormonal therapy with estrogen and progesterone may be used in women who have reached menopause. When such treatments fail, and Cervicitis is still present for a long time, then cryosurgery, electro cauterization and laser therapy are adopted.

The doctor would prescribe the line of treatment depending upon the cause of infection. The doctor may advice antibiotics, antifungal medications and antiviral medications. The doctor may also recommend treating the partner to rule out chances of infection again. It is recommended to avoid sexual contact till the partner has finished treatment.

If medications such as Antibiotics do not work in some cases, there are other options available recently:
Loop Electro surgical Excision Procedure (LEEP)
Cryotherapy, Electrocoagulation or Laser to cauterize the affected tissue.

Tips to prevent Cervicitis

Avoid chemical irritants such as deodorant tampons. When inserting any foreign objects into the vagina, make sure that they are properly placed. Be in a monogamous sexual relationship. Use latex condom every time of sex to lower the risk of getting sexually transmitted infections. A condom must be properly used every time.

Mycoplasma Genitalium

Mycoplasma Genitalium refers to a sexually transmitted disease (STD) that is caused by a pathogenic bacteria of the same name. It affects both men and women. These organisms live in the urinary and genital tracts of humans and attach themselves to the surface of the genital tract and attack the tissue of the host. Though the presence of Mycoplasma genitalium was known 30 years ago, it has been recently identified as STD and extensive research is being carried out to establish the connection between risky sexual behavior and development of Mycoplasma Genitalium. It is also proven that the risk of infection increases for those with multiple sexual partners.

Often, Mycoplasma genitalium in men is associated with urethritis and bacterial vaginosis in women. Cervicitis, pelvic inflammatory disease and Endometriosis are some of the other conditions associated with Mycoplasma genitalium in women. This condition is also known to cause infertility in women. Urethritis in men could also be caused by conditions like gonorrhoea or Chlamydia and hence these conditions are primarily ruled out before probing for Mycoplasma genitalium. Mycoplasma Genitalium Urine Test is recommended for people who have tested negative for other bacterial infections such as Chlamydia and Gonorrhea but continue to experience symptoms.

Mycoplasma genitalium does not cause symptoms at the initial stage. It usually takes 1 to 3 weeks for the symptoms to show up. And also, it often occurs in conjunction with other sexually transmitted infections. As the symptoms start to surface, it is advisable to get tested for Mycoplasma genitalium separately along with other STD related diagnostic tests.

Symptoms in men may include

• Burning sensation while urinating
  
• Discharge from the penis
  
• Inflammation of urethra

Symptoms in women

Most often, Mycoplasma genitalium in women causes infection in cervix. Bleeding after sex is the most common symptom associated with Mycoplasma genitalium in women. Some of the other symptoms include:

• Abnormal discharge
  
• Cervicitis or inflamed cervix
  
• Pain during intercourse
  
• Bleeding in between periods

Mycoplasma organisms are difficult to culture and identify. Diagnosis of infection is performed using nucleic acid amplification tests (NAATs). In case of men, the first passed urine and in case of women endocervical/ vaginal swab are collected to conduct test. Polymerase Chain Reaction (PCR) is a popularly followed NAAT test to detect Mycoplasma genitalium.

Treatment

Mycoplasma genitalium is treated with antibiotics. The antibiotic azithromycin has been generally successful against Mycoplasma genitalium infection. But there are instances where mycoplasma genitalium has developed resistance to azithromycin. Antibiotics like moxifloxacin and doxycycline are also widely recommended to treat the condition.

Precautions

• Mycoplasma genitalium is sexually transmitted; hence abstinence from sex should be strictly followed during the course of treatment.
  
• Both the partners involved should be treated at the same time to avoid recurrence.
  
• Test of cure is normally advised after six weeks to assess if the infection has cleared.
  
• Usage of condoms is the best practice to prevent not only Mycoplasma genitalium but also other STDs.

Pyometra

Pyometra is an uterine condition that involves accumulation of pus in uterine cavity, caused by interference with natural drainage of uterus. It is a rare disorder that normally occurs in post-menopausal woman with concurrent medical conditions. Most pyometra cases are associated with malignant disease of the uterus. Other causes include:

• Foreign bodies
  
  
• Puerperal infections or Postpartum infections
  
  
• Uterine anomalies
  
  
• Fibroid degeneration
  
  
• Senile Cervicitis
  
  
• Uterine compression sutures used for postpartum hemorrhage to avoid hysterectomy
  
  
• Genital tuberculosis.
  

Symptoms

Most often, Pyometra does not present with any symptoms and the condition could be incidentally found through imaging performed for different purpose. Some of the symptoms of Pyometra include

• Blood-stained purulent vaginal discharge
  
  
• Symmetrical uterine enlargement
  
  
• Post menopausal bleeding
  
  
• Lower abdominal pain
  
  
• Nausea and vomiting
  
  
• Diarrhea
  
  
• Pyrexia (rarely)
  

Very rarely, pyometra leads to spontaneous perforation. It is a medical emergency and requires an immediate attention and treatment.

Diagnosis

Diagnostic tests are planned and performed on the lines of underlying condition that has resulted in Pyometra. If prevailing tuberculosis is causing symptoms of pyometra, diagnosis can be confirmed by tuberculin testing, histology, Hysterosalpingogram or PCR. Ultrasound scan, CT scan and MRI are generally recommended to diagnose the condition. Doppler scanning is used when pyometra has occurred due to endometrial cancer. X-ray shows the presence of spontaneous perforation of the uterus.

Treatment

Dilatation of the cervix and pus drainage is the treatment of choice, and it is important to rule out the possibility of cancer and differentiate the malignancy. However regular monitoring is necessary to look for recurrence. In few cases, Hysterectomy may be advised to avoid future complications. Medicine therapy with antibiotics becomes necessary if there is an infection. Tubercular pyometra should is treated with appropriate anti-tubercular chemotherapy.