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Цервицит у беременных: комплексный подход к диагностике и терапии
Цервицит у беременных: комплексный подход к диагностике и терапии
Доброхотова Ю.Э., Боровкова Е.И., Залесская С.А. Цервицит у беременных: комплексный подход к диагностике и терапии. Consilium Medicum. 2018; 20 (6): 31–36. DOI: 10.26442/2075-1753_2018.6.31-36
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Аннотация
Цервицит – это воспалительный процесс, локализованный в цилиндрическом или многослойном плоском неороговевающем эпителии шейки матки, может быть инфекционной и неинфекционной природы, протекать остро и хронически. Острый цервицит ассоциирован со специфическими возбудителями, передающимися половым путем, а также с бактериальным вагинозом. Клиника цервицита неспецифична и характеризуется обильными гноевидными белями и контактной кровоточивостью. Эластография является дополнительным методом диагностики и оценки эффективности терапии цервицита. Препаратом первого выбора в терапии неспецифического цервицита у беременных является клиндамицин.
Ключевые слова: острый цервицит, хронический цервицит, бактериальный вагиноз, внутриутробное инфицирование плода, преждевременные роды, клиндамицин, эластография, эластометрия, бутоконазол, клиндамицин.
Ключевые слова: острый цервицит, хронический цервицит, бактериальный вагиноз, внутриутробное инфицирование плода, преждевременные роды, клиндамицин, эластография, эластометрия, бутоконазол, клиндамицин.
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Cervicitis is an inflammatory process localized in columnar or stratified squamous non-keratinized epithelium of cervix uteri which can be infectious or non-infectious, acute or chronic. Acute cervicitis is associated with specific sexually transmittable causative pathogens as well as with bacterial vaginosis. Cervicitis clinical manifestations are non-specific and are characterized by plentiful puslike leucorrhea and contact bleeding. Elastography is an additional method for cervicitis diagnostics and treatment effectiveness evaluation. Clindamycin is the first-line drug for non-specific cervicitis treatment.
Key words: acute cervicitis, chronic cervicitis, bacterial vaginosis, intrauterine fetus infection, preterm delivery, clindamycin, elastography, elastometry, butoconazole, clindamycin.
Key words: acute cervicitis, chronic cervicitis, bacterial vaginosis, intrauterine fetus infection, preterm delivery, clindamycin, elastography, elastometry, butoconazole, clindamycin.
Полный текст
Список литературы
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2. Samantaray S, Parida G, Rout N et al. Cytologic detection of tuberculous cervicitis: a report of 7 cases. Acta Cytol 2009; 53: 594.3. Rodrigues MM, Fernandes PÁ, Haddad JP et al. Frequency of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis and Ureaplasma species in cervical samples. J Obstet Gynaecol 2011; 31: 237.
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6. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.
7. Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015; 61: 418.
8. Paraskevaides EC, Wilson MC. Fatal disseminated intravascular coagulation secondary to streptococcal cervicitis. Eur J Obstet Gynecol Reprod Biol 1988; 29: 39.
9. Manhart LE, Critchlow CW, Holmes KK et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 2003; 187: 650.
10. Marrazzo JM, Wiesenfeld HC, Murray PJ et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis 2006; 193: 617.
11. Nugent RP, Hillier SL. Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. Sex Transm Dis 1992; 19: 198.
12. Paavonen J, Critchlow CW, DeRouen T et al. Etiology of cervical inflammation. Am J Obstet Gynecol 1986; 154: 556.
13. Marrazzo JM, Handsfield HH, Whittington WL. Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. Obstet Gynecol 2002; 100: 579.
14. Koelle DM, Benedetti J, Langenberg A, Corey L. Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes. Ann Intern Med 1992; 116: 433.
15. Huppert JS, Mortensen JE, Reed JL et al. Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women. Sex Transm Dis 2008; 35: 250.
16. Short VL, Totten PA, Ness RB et al. Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis 2009; 48: 41.
17. Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis 2007; 44 (Suppl. 3): S102.
18. Kirkcaldy RD, Kidd S, Weinstock HS et al. Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006-June 2012. Sex Transm Infect 2013; 89 (Suppl. 4): iv5.
19. Whittington WL, Kent C, Kissinger P et al. Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicenter cohort study. Sex Transm Dis 2001; 28: 117.
20. Chandeying V, Sutthijumroon S, Tungphaisal S. Evaluation of ofloxacin in the treatment of mucopurulent cervicitis: response of chlamydia-positive and chlamydia-negative forms. J Med Assoc Thai 1989; 72: 331.
21. Schwebke JR, Weiss HL. Interrelationships of bacterial vaginosis and cervical inflammation. Sex Transm Dis 2002; 29: 59.
22. Nyirjesy P. Nongonococcal and Nonchlamydial Cervicitis. Curr Infect Dis Rep 2001; 3: 540.
23. Dunlop EM, Garner A, Darougar S et al. Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis. Genitourin Med 1989; 65: 22.
24. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis 2009; 48: 1649.
25. Schwebke JR, Rompalo A, Taylor S et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis 2011; 52: 163.
26. Jensen JS, Cusini M, Gomberg M Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016; 30: 1650.
27. Jensen JS, Bradshaw CS, Tabrizi SN et al. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis 2008; 47: 1546.
28. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS One 2008; 3: e3618.
29. Bissessor M, Tabrizi SN, Twin J et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2015; 60: 1228.
30. Manhart LE, Jensen JS, Bradshaw CS et al. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. Clin Infect Dis 2015; 61 (Suppl. 8): S802.
31. Braam JF, van Dommelen L, Henquet CJ et al. Multidrug-resistant Mycoplasma genitalium infections in Europe. Eur J Clin Microbiol Infect Dis 2017. [Epub ahead of print] PMID: 28361246. https://doi.org/10.1007/s10096-017-2969-9
32. Li Y, Le WJ, Li S et al. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS 2017: 956462416688562.
33. Mattson SK, Polk JP, Nyirjesy P. Chronic Cervicitis: Presenting Features and Response to Therapy. J Low Genit Tract Dis 2016; 20: e30.
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2. Samantaray S, Parida G, Rout N et al. Cytologic detection of tuberculous cervicitis: a report of 7 cases. Acta Cytol 2009; 53: 594.
3. Rodrigues MM, Fernandes PÁ, Haddad JP et al. Frequency of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis and Ureaplasma species in cervical samples. J Obstet Gynaecol 2011; 31: 237.
4. Gaydos C, Maldeis NE, Hardick A et al. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis 2009; 36: 598.
5. Bjartling C, Osser S, Persson K. Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol 2012; 206: 476.e1.
6. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.
7. Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015; 61: 418.
8. Paraskevaides EC, Wilson MC. Fatal disseminated intravascular coagulation secondary to streptococcal cervicitis. Eur J Obstet Gynecol Reprod Biol 1988; 29: 39.
9. Manhart LE, Critchlow CW, Holmes KK et al. Mucopurulent cervicitis and Mycoplasma genitalium. J Infect Dis 2003; 187: 650.
10. Marrazzo JM, Wiesenfeld HC, Murray PJ et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis 2006; 193: 617.
11. Nugent RP, Hillier SL. Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. Sex Transm Dis 1992; 19: 198.
12. Paavonen J, Critchlow CW, DeRouen T et al. Etiology of cervical inflammation. Am J Obstet Gynecol 1986; 154: 556.
13. Marrazzo JM, Handsfield HH, Whittington WL. Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. Obstet Gynecol 2002; 100: 579.
14. Koelle DM, Benedetti J, Langenberg A, Corey L. Asymptomatic reactivation of herpes simplex virus in women after the first episode of genital herpes. Ann Intern Med 1992; 116: 433.
15. Huppert JS, Mortensen JE, Reed JL et al. Mycoplasma genitalium detected by transcription-mediated amplification is associated with Chlamydia trachomatis in adolescent women. Sex Transm Dis 2008; 35: 250.
16. Short VL, Totten PA, Ness RB et al. Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis 2009; 48: 41.
17. Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis 2007; 44 (Suppl. 3): S102.
18. Kirkcaldy RD, Kidd S, Weinstock HS et al. Trends in antimicrobial resistance in Neisseria gonorrhoeae in the USA: the Gonococcal Isolate Surveillance Project (GISP), January 2006-June 2012. Sex Transm Infect 2013; 89 (Suppl. 4): iv5.
19. Whittington WL, Kent C, Kissinger P et al. Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicenter cohort study. Sex Transm Dis 2001; 28: 117.
20. Chandeying V, Sutthijumroon S, Tungphaisal S. Evaluation of ofloxacin in the treatment of mucopurulent cervicitis: response of chlamydia-positive and chlamydia-negative forms. J Med Assoc Thai 1989; 72: 331.
21. Schwebke JR, Weiss HL. Interrelationships of bacterial vaginosis and cervical inflammation. Sex Transm Dis 2002; 29: 59.
22. Nyirjesy P. Nongonococcal and Nonchlamydial Cervicitis. Curr Infect Dis Rep 2001; 3: 540.
23. Dunlop EM, Garner A, Darougar S et al. Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis. Genitourin Med 1989; 65: 22.
24. Mena LA, Mroczkowski TF, Nsuami M, Martin DH. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin Infect Dis 2009; 48: 1649.
25. Schwebke JR, Rompalo A, Taylor S et al. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. Clin Infect Dis 2011; 52: 163.
26. Jensen JS, Cusini M, Gomberg M Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016; 30: 1650.
27. Jensen JS, Bradshaw CS, Tabrizi SN et al. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis 2008; 47: 1546.
28. Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS One 2008; 3: e3618.
29. Bissessor M, Tabrizi SN, Twin J et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2015; 60: 1228.
30. Manhart LE, Jensen JS, Bradshaw CS et al. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. Clin Infect Dis 2015; 61 (Suppl. 8): S802.
31. Braam JF, van Dommelen L, Henquet CJ et al. Multidrug-resistant Mycoplasma genitalium infections in Europe. Eur J Clin Microbiol Infect Dis 2017. [Epub ahead of print] PMID: 28361246. https://doi.org/10.1007/s10096-017-2969-9
32. Li Y, Le WJ, Li S et al. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int J STD AIDS 2017: 956462416688562.
33. Mattson SK, Polk JP, Nyirjesy P. Chronic Cervicitis: Presenting Features and Response to Therapy. J Low Genit Tract Dis 2016; 20: e30.
Авторы
Ю.Э.Доброхотова, Е.И.Боровкова*, С.А.Залесская
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*katyanikitina@mail.ru
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*katyanikitina@mail.ru
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Yu.E.Dobrokhotova, E.I.Borovkova*, S.A.Zalesskaya
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*katyanikitina@mail.ruN.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
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