Chronic nonspecific cervicitis

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.