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Cervical infection in women

Cervicitis

Cervicitis is an inflammation of the cervix (the end of the uterus). Cervicitis often does not cause symptoms, but if they do happen, they may include abnormal vaginal discharge, painful intercourse, or vulvar or vaginal irritation. Antibiotics successfully treat cervicitis in most cases. For other cases, laser therapy or surgery may be required.

What is cervicitis?

Cervicitis is an inflammation of the cervix (the end of the uterus). This inflammation may be acute or chronic in nature. Cervicitis might not have symptoms, or a woman with cervicitis may have abnormal vaginal discharge.

Who gets cervicitis?

Cervicitis is very common. It has been projected that more than half of all adult women will have cervicitis at some point. Women who engage in high-risk sexual behaviors and have multiple partners are at a higher risk for cervicitis. Women who have had sexually transmitted diseases, or who have partners who have had sexually transmitted diseases, are also at a higher risk for cervicitis. Sexual practices are far from the only cause of the condition, however.

What are the causes of cervicitis?

There are many causes of cervicitis. Acute cervicitis is usually caused by an infection. Chronic cervicitis is more likely from a noninfectious cause.
Infections can result from the introduction of staphylococcus or streptococcus bacteria into the uterus. The sexually transmitted diseases chlamydia and gonorrhea are also significant causes of cervicitis. It has been estimated as much as 40 percent of cases of cervicitis are related to chlamydia. Herpes simplex virus, trichomonas and mycoplasma genitalium are also sometimes a cause.

Noninfectious causes of cervicitis include exposure to chemicals or

mechanical irritation. These include:

• Chemical irritation from spermicides or douches or the latex used in condoms
• Reaction to diaphragms, cervical caps, tampons or pessaries inserted
• Radiation therapy or systemic inflammatory diseases

What are the symptoms of cervicitis?

Symptoms of cervicitis can include:

• Abnormal vaginal discharge that may be yellow, white, or gray and have an unpleasant odor. This may persist for a long period of time.
• Sexual intercourse may become painful.
• Vulvar or vaginal irritation.

Cervicitis often does not have any symptoms, however. This is one reason why women should have regular gynecological appointments. It is especially important to seek an exam if you notice any of the above symptoms and/or have had chlamydia or another sexually transmitted disease in the past.

How is cervicitis diagnosed?

If you have any of the above symptoms, or if you have engaged in high-risk sexual practices, you should see your Gynecologist for a full pelvic exam. At this exam, your Gynecologist may perform tests including a Pap smear. In this test, a swab is used to collect cells from the cervix and uterus to look for abnormalities.

Your Gynecologist will also take a sample of any vaginal discharge to test for bacteria, such as bacterial vaginosis under a microscope. Tests for the sexually transmitted diseases gonorrhea and chlamydia will also be done.

Your Gynecologist also perform a full manual pelvic exam, looking for:

• Any redness on the cervix
• Discharge
• Blood on the vagina or cervix
• Inflammation of the vaginal walls
You will lay down on an examination table with your feet in stirrups for these tests.

How is cervicitis treated?

If your Gynecologist determines that you have cervicitis, you will usually be prescribed an antibiotic to treat any bacterial infections that may be causing the condition. Women under age 25 or who engage in high-risk behaviors may be treated with antibiotics even if bacteria are not detected in the diagnosis. Some bacteria can be hard to detect but may still be present. You should abstain from intercourse until treatment is done.

Antibiotics successfully treat cervicitis in most cases. If cervicitis is not successfully treated by antibiotics, laser therapy or surgery may be required. Your Gynecologist can best determine the treatment for your cervicitis based on your age, habits, diagnostic tests, and the length of the condition.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including cervical and vaginal infections .

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Can Pelvic or uterine adhesions cause infertility?

Pelvic adhesions, sometimes referred to as “scar tissue”, are a common cause of both infertility and pelvic pain.

Pelvic adhesions can occur as a result of a variety of different conditions including endometriosis, pelvic infection, and previous abdominal or pelvic surgery. It is well known that pelvic adhesions develop over 90% of the time following major abdominal surgery. The most common types of surgery that predispose to the development of pelvic adhesions include the removal of uterine fibroids (myomectomy), treatment of endometriosis, removal of ovarian cysts, and the repair of obstructed fallopian tubes.

Many complications can occur as a result of pelvic adhesions. For example, it is thought that adhesions may be a significant factor in as much as 40% of cases of infertility. They are also thought to be responsible for up to 50% of cases of chronic pelvic pain. In addition, adhesions are typically responsible for 50-75% of cases of bowel obstruction. Although more recent data are lacking, the treatment of pelvic adhesions accounted for 3% of all surgical procedures performed in the United States in 1998, as well as 1% of all hospital admissions and 2% of all patients admitted for surgeries around that time.

How do pelvic adhesions occur?

Adhesions typically develop in response to injury, as part of the normal healing process. Immediately following injury, cells that cause healing (inflammatory cells) migrate to the site of the injury. Within seven days following injury, the scaffold for healing or adhesion formation has already developed. As a result, it appears that no new adhesions form more than seven days after an injury. Rather, the character of the adhesion changes, progressing from thin, filmy adhesions to more dense, vascular adhesions. The earlier in this process that adhesions can be removed, the less likely it is that they will recur and cause long-term problems.

Adhesion formation that occurs following surgery can be of two types; de novo adhesion formation or adhesion reformation. De novo adhesion formation means the formation of adhesions at a site that did not have any adhesions affecting it prior to surgery. This would include the formation of adhesions around the uterus following the removal of a fibroid tumor or the formation of adhesions around an ovary following removal of an ovarian cyst.

Adhesion reformation refers to the recurrence of adhesions following a procedure designed to remove pre-existing pelvic adhesions. This difference is important, as the techniques described below may be very effective at preventing de novo adhesion formation, while they appear to be somewhat less effective at preventing adhesion reformation

What types of surgeries can increase my risk of adhesions?

In most cases of adhesions, they form in the majority of women after gynaecologic pelvic surgery. Studies have shown that adhesions formed in 55-100% of patients who had reproductive pelvic surgery, whether open or laparoscopic.

For example:

• myomectomy (surgery to remove fibroids)
• tubal surgery (to remove an ectopic pregnancy)
• surgery on the ovary (to remove cysts)
• surgery for endometriosis
Even surgery to remove adhesions can lead to new adhesions. It can be a vicious cycle.
• Laparoscopic surgery (surgery done through several small incisions using a camera) has been known to cause less adhesion formation than laparotomy (surgery through one larger incision without use of a camera).
• Microsurgery (surgery using a microscope or magnifying glass, and special surgical technique) leads to less tissue damage and has a lower incidence of adhesion development than the traditional approach.
• Diagnostic procedures, which only involve a visual inspection of the organ(s), such as a diagnostic hysteroscopy or diagnostic laparoscopy, rarely lead to adhesions.

How can I reduce my risk of adhesions?

It starts with talking to your doctor and explaining your concerns about adhesions. There are techniques which can be used at the time of surgery to reduce the risk of developing adhesions. In addition to using microsurgery or laparoscopic techniques, prevention of infection is essential.

During surgery, various products are used to inhibit adhesion formation, known as adhesion barriers. These include gauze-like materials placed over the tissue which dissolve to become a gelatinous layer to reduce the incidence of post-operative adhesions. This material is eventually absorbed by the body.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including infertility and high risk Pregnancies.

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COVID vaccine in women healthcare

Who should be vaccinated first?

As with all COVID-19 vaccines, health workers at high risk of exposure and older people should be prioritized for vaccination.

As more vaccine becomes available, additional priority groups should be vaccinated, with attention to people disproportionately affected by COVID-19 or who face health inequities.

Who else can take the vaccine?

The vaccine is safe and effective in people with known medical conditions associated with increased risk of severe disease, such as hypertension, diabetes, asthma, pulmonary, liver or kidney disease, as well as chronic infections that are stable and controlled.

Although further studies are required for immunocompromised persons, people in this category who are part of a group recommended for vaccination may be vaccinated after receiving information and counselling.

Persons living with HIV are at higher risk of severe COVID-19 disease. Known HIV-positive vaccine recipients should be provided with information and counselling.

Vaccination can be offered to people who have had COVID-19 in the past. But individuals may wish to defer their own COVID-19 vaccination for up to six months from the time of SARS-CoV-2 infection.

The vaccine can be offered to a breastfeeding woman who is part of a group recommended for vaccination (e.g. health workers); discontinuing breastfeeding after vaccination is currently not recommended.

Should pregnant women be vaccinated?

While pregnancy puts women at higher risk of severe COVID-19, very little data are available to assess vaccine safety in pregnancy.

Nevertheless, based on what we know about this kind of vaccine, we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.

For this reason, those pregnant women at high risk of exposure to SARS-CoV-2 (e.g. health workers) or who have comorbidities which add to their risk of severe disease, may be vaccinated in consultation with their health care provider.

Who should not take the vaccine?

Individuals with a history of severe allergic reaction to any component of the vaccine should not take this or any other mRNA vaccine.

While vaccination is recommended for older persons due to the high risk of severe COVID-19 and death, very frail older persons with an anticipated life expectancy of less than 3 months should be individually assessed.

The vaccine should not be administered to persons younger than 18 years of age pending the results of further studies.

What’s the recommended dosage?

SAGE recommends the use of the Moderna mRNA-1273 vaccine at a schedule of two doses (100 µg, 0.5 ml each) 28 days apart. If necessary, the interval between the doses may be extended to 42 days.

Compliance with the full schedule is recommended and the same product should be used for both doses.

Is it safe?

While this vaccine has yet to be approved by WHO for an Emergency Use Listing, it has undergone review by the European Medicines Agency (EMA) and consequently meets WHO’s criteria for SAGE consideration.

The EMA has thoroughly assessed the data on the quality, safety and efficacy of the Moderna COVID-19 vaccine and authorized its use across the European Union.

SAGE recommends that all vaccinees be observed for at least 15 minutes after vaccination. Those who experience an immediate severe allergic reaction to the first dose should not receive additional doses.

Longer-term safety assessment involves continued follow up of clinical trial participants, as well as specific studies and continued surveillance of secondary effects or adverse events of those being vaccinated in the roll out.
The Global Advisory Committee on Vaccine Safety, a group of experts that provides independent and authoritative guidance to the WHO on the topic of safe vaccine use, receives and assesses reports of suspected safety events of potentially international impact.

How efficacious is the vaccine?

The Moderna vaccine has been shown to have an efficacy of approximately 92 per cent in protecting against COVID-19, starting 14 days after the first dose.

Does it work against new variants?

Based on the evidence so far, the new variants of SARS-CoV-2, including the B.1.1.7 and the 501Y.V2, do not alter the effectiveness of the Moderna mRNA vaccine. The monitoring, collection and analysis of data on new variants and their impact on the effectiveness of COVID-19 diagnostics, treatments and vaccines continues.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including high risk Pregnancy.