Cervicovaginal inflammation – Vaginal discharge

During colposcopic examination, the character of the discharge in the vagina and that covering the cervix gives a fair indication of the nature and cause of infection.

CANDIDA infection is characterized by curdy or cheesy and often sticky white discharge.

TRICHOMONAS VAGINALIS infection is detected by frothy greenish or yellowish foul-smelling discharge.

Greyish discharge with fishy smell is commonly seen in BACTERIAL VAGINOSIS

An inflamed cervix (cervicitis) that appears red (beefy) and swollen with pus coming out of the external os is commonly seen in chlamydia or gonococcal infections. The columnar epithelium becomes oedematous and friable. Visualization of the endocervical canal becomes difficult because of profuse purulent discharge.

However, excessive normal vaginal discharge should not be confused with infection. Normal discharge will not be associated with symptoms or foul smell or any inflammation of the cervix or vagina. The amount and the consistency of normal vaginal discharge change with the phase of the menstrual cycle, age, pregnancy status, and use of oral contraceptive pills

Cervico-Vaginal inflammation – Inflamed cervix

The infected cervix is often tender on movement and is congested with prominent but normal branching blood vessels. Inflammation of the columnar epithelium can give the cervix a beefy-red appearance

Sometimes staghorn-like small capillaries or prominent vessels are seen on the infected cervix.

Infection with TRICHOMONAS VAGINALIS may produce a “strawberry” appearance of the cervix because of focal round patches of dilated capillaries on the surface.

An inflamed cervix may have diffuse white patches after application of acetic acid. The white patches are thin with indistinct or irregular margins. Inflamed areas may bleed on contact because the epithelium is thinned out.

Inflammation is followed by repair of the damaged epithelium. During the reparative process, glycogen may be absent from the epithelium. As a result, patchy iodine -negative areas are seen after inflammation.

Application of Lugol’s iodine to an inflamed cervix sometimes produces the typical “leopard-skin” appearance because of multiple iodine-negative spots. Such changes are more commonly seen in trichomoniasis.

Sometimes follicular (chronic) cervicitis is detectable as multiple small raised whitish areas on the squamous epithelium.

Condyloma and subclinical papillomavirus infection (SPI)

Genital condylomata (warts) are caused by infection with low-risk (non-oncogenic) types of human papillomavirus (HPV). Condylomata can be detected on the external genitalia, vagina, or cervix and are frequently multiple.

Clinically detectable cervical condyloma may appear as single or multiple distinct, lumpy, irregular lesions on the cervix. The colour is usually bright white, and the surface is irregular, pitted, or spiky. The location of condylomata can be anywhere on the cervix. Unlike neoplastic lesions, they are not confined to the TZ.

When there are multiple lesions, the lesions away from the SCJ are called ‘satellite’ lesions. Satellite lesions are typically seen in condylomata.

Some of the condylomata have finger-like projections on the surface (papilliferous condyloma) with a central capillary loop in each of the projections. Such a condyloma near the SCJ can be confused with prominent villi of the columnar epithelium.

Condylomata as multiple discrete raised white lesions can be seen in the vagina with or without associated cervical lesions.

Vulvar condylomata can be a few discrete papillary lesions or multiple exophytic lesions with spiky or finger-like projections on the surface.

The majority of condylomata of the cervix are not visible before application of acetic acid. Acetowhite patches with irregular, geographical margins and multiple satellite lesions, often away from the SCJ, are characteristic of these subclinical papillomavirus infections (SPI). The lesions may be milky or thin acetowhite and may have fine mosaics on the surface.