An inflamed cervix

Dear Dr Mitchell,

I went to see my gynaecologist in September of last year because I was having symptoms of a vaginal infection. While examining me he told me that my cervix was red and inflamed and that that was the reason why I was having a heavy, yellowish, stretchy discharge. I also did my first Pap test that day. My results came back and my Pap test was normal. The problem is that I’m still having the symptoms as before. Shouldn’t it have cleared up after treatment (MetroGel-Vaginal)? Can an inflamed cervix lead to cancer of the cervix and will it affect my chances of having a baby in the future?

The symptom of a persistent yellow discharge does suggest that you still have a problem. The fact that this discharge has persisted does not mean that the treatment did not work. If you are sexually active your partner should have been treated since this could be an infection that has recurred because of re-exposure from your partner. If your partner has other partners, then this could also be the source of the persistent infection.

You will need to be seen again by your gynaecologist and have a vaginal swab done to try to identify the underlying organism that is causing the problem so that specific treatment can be prescribed based on the findings of the culture done on the vaginal swab.

A culture for chlamydia and gonorrhoea should also be done since these two bacteria can cause an inflamed cervix, and Metrogel (metronidazole) would not treat the problem. If the swab confirms that you have one of these infections then it means there is a third-party involvement and without resolving this you will be faced with recurrent infections in addition to the risk of contracting a more significant sexually transmitted infection such as HIV.

A normal Pap smear does not rule out underlying abnormal changes in the cervix. The presence of an infection can mask underlying abnormal changes that can lead to cervical cancer. If you have a persistent vaginal discharge with an abnormal-looking cervix then you should have a special examination done called a colposcopy. This allows the doctor to look at the cervix in detail and identify any underlying abnormal changes in the cervix that would not normally be picked up with the naked eye. If abnormal cells are present then a biopsy can be done and treatment undertaken to remove the abnormal area on the cervix.

If the problem is purely an inflamed cervix and there is no infection with the Human Papilloma Virus (HPV), then your risk of cervical cancer is insignificant at this point. However, all women are at risk of cervical cancer once they are sexually active. Chronic infection of the cervix can also be associated with ascending infection which can cause an inflammation in the Fallopian tubes resulting in blockage of the tubes and subsequent inability to conceive. It can also increase your chance of having an ectopic pregnancy, which is a surgical emergency.

You should also discuss the option of vaccination against cervical cancer with your doctor. There are vaccines now widely available to prevent cancer of the cervix. This is affordable and gives you over 90 per cent chance of prevention of cervical cancer which is caused by the HPV. This vaccine should be given to all women aged 10 to 55. It is administered in three doses. The first is given, followed by the second dose one month later and the last dose is given five months after the second dose. Screening for cervical cancer should still be continued by doing regular Pap smears to detect early abnormal changes in the cervix caused by HPV sub-types which are not covered by vaccination. Consult your doctor who will advise you further.

Best wishes

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER: The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.