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Cervicitis, Ectropion & True Erosion

Description of Medical Condition

Cervicitis, Ectropion & True Erosion
  • Cervicitis — inflammatory changes due to infections
  • Ectropion — eversion of the cervix in pregnancy
  • True erosion — loss of overlying vaginal epithelium due to trauma, e.g., forceful insertion of vaginal speculum in patient with atrophic mucosa

System(s) affected: Reproductive

Genetics: N/A

Incidence/Prevalence in USA:

  • Cervicitis — very common in sexually active women
  • Ectropion — with oral contraceptive use; very common in pregnant women
  • True erosion — occasionally seen in postmenopausal women

Predominant age: Sexually active women

Predominant sex: Female only

Medical Symptoms and Signs of Disease

  • Cervicitis — metrorrhagia, post-coital bleeding, vaginal discharge
  • Ectropion — red cervix due to color of the columnar epithelium
  • True erosion — vaginal bleeding, sharply defined ulcers of cervix

What Causes Disease?

  • Cervicitis — Chlamydia trachomatis, Trichomonas vaginalis
  • Ectropion — hormonal changes with oral contraceptive use (especially with progesterone) or during pregnancy
  • True erosion — injury to atrophic epithelium due to estrogen deficiency in menopause

Risk Factors

    • Cervicitis — sexual contact with infected partner(s). recurrence due to inadequate therapy
Cervicitis, Ectropion & True Erosion
  • Ectropion — pregnancy
  • True erosion — estrogen deficiency, trauma

Diagnosis of Disease

Differential Diagnosis

  • Cervical dysplasia
  • Carcinoma of the cervix

Laboratory

  • Saline and potassium hydroxide preparation of cervical/vaginal smears
  • Chlamydiazyme or chlamydia cell culture, gonorrhea culture
  • Papanicolaou (Pap) smear of the cervix
  • Chlamydia DNA probe
  • Gonorrhea DNA probe

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

Pathological Findings

  • Cervicitis — acute and chronic inflammatory changes, presence of infective organisms
  • Ectropion — none/squamous metaplasia
  • True erosion — sharply defined ulcer borders, loss of epithelium

Special Tests

None

Imaging

None

Diagnostic Procedures

Colposcopy

Treatment (Medical Therapy)

Appropriate Health Care

Outpatient

General Measures

N/A

Activity

No restrictions

Diet

No special diet

Patient Education

Provide printed material about sexually transmitted diseases and about estrogen deficiency and estrogen replacement therapy

Medications (Drugs, Medicines)

Drug(s) of Choice

  • Trichomoniasis — metronidazole 500 mg bid for 7 days or 2 g once or 1 g bid for 2 doses
  • Chlamydial infection — for non-pregnant women, doxycycline 100 mg bid po for 7 days; for pregnant women, erythromycin base 500 mg qid po for 7 days, or erythromycin ethylsuccinate 800 mg qid for 7 days
  • Ectropion — none
  • True erosion — estrogen, conjugated vaginal cream daily for 2 weeks, followed by estrogen replacement therapy

Contraindications:

  • Metronidazole — first trimester of pregnancy
  • Doxycycline — pregnancy or lactation
  • Estrogen — see extended list of contraindications to estrogen use in standard texts

Precautions:

  • Metronidazole — possible fetal harm if used in first trimester of pregnancy, disulfiram reaction with alcohol
  • Doxycycline — possible fetal harm if used during pregnancy, staining of the infant’s teeth if used during breast-feeding, allergy, photosensitization
  • Erythromycin — nausea or vomiting
  • Estrogens — history of estrogen dependent neoplasms, history of thromboembolic diseases, see extended list of contraindications to estrogen therapy in standard texts

Significant possible interactions:

  • Metronidazole and alcohol
  • Doxycycline and dairy products, iron preparations, warfarin, and oral contraceptives (use backup contraceptive method)
  • Erythromycin with astemizole — may increase latter’s levels with subsequent ECG changes
  • Erythromycin and theophylline (elevated theophylline level)
  • Estrogen — N/A

Alternative Drugs

  • Metronidazole — sulfanilamide-aminacrine-allantoin cream (AVC cream)
  • Doxycycline — erythromycin or azithromycin
  • Erythromycin — clindamycin
  • Estrogen — lubricant, same as that used for vaginal speculum
  • Azithromycin 1 g for one dose only (pregnancy category B)
  • Ofloxacin 300 mg bid x 7 days
  • Amoxicillin-clavulanate (Augmentin) 250 mg po q8h for 7 days

Patient Monitoring

  • Trichomoniasis — repeat vaginal smear until infection is cleared
  • Chlamydial infection — repeat chlamydial culture post antibiotic therapy
  • Estrogen deficiency — re-examine in one month to confirm healing

Prevention / Avoidance

  • Trichomoniasis or chlamydial infection — treatment of sexual partners and use of condom during coitus
  • Estrogen deficiency — estrogen replacement therapy

Possible Complications

N/A

Expected Course / Prognosis

  • Cervicitis — excellent healing once infection is eradicated
  • Ectropion — spontaneous regression postpartum, cessation or oral contraceptive use
  • True erosion — spontaneous healing

Miscellaneous

Associated Conditions

  • Gonorrhea
  • Bacterial vaginosis

Age-Related Factors

Pediatric: N/A

Geriatric: Menopause

Pregnancy

  • Ectropion
  • Azithromycin should be used with caution
  • Doxycycline should not be used in pregnancy

International Classification of Diseases

616.0 Cervicitis and endocervicitis

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