A Review of the Cervix for the Physician Assistant Exam
Problems with the cervix often occur in younger women. It’s important to know the basics for the Physician Assistant Exam. Examples include cervical incompetence during pregnancy, cervicitis, cervical dysplasia, and cervical cancer. For cervical incompetence, prompt diagnosis and management is important. For the latter conditions, especially cervical cancer, routine screening is vital to detect the problem early. Convincing a younger person of the importance of screening is sometimes hard.
How to deal with an incompetent cervix
Cervical incompetence refers to the cervix’s dilating and effacing prematurely before a pregnant woman’s expected due date. Risk factors for cervical incompetence include a history of prior cervical surgeries or a history of miscarriages.
If the condition isn’t corrected, the baby can be born much sooner than he or she is supposed to be. The treatment is a surgical intervention known as a cerclage. It’s usually performed around the 13-week mark of pregnancy. With a cerclage, the cervix is sewn shut to prevent premature birth.
How to treat an inflamed cervix
Cervicitis refers to an inflamed cervix, usually caused by the same organisms that cause a sexually transmitted infection (STI). Other causes include instruments used for birth control and foreign objects that may be placed in the vagina, such as tampons.
Initial symptoms can be nonspecific and include dysuria, dyspareunia, pelvic irritation, and pruritus in the affected area. Left untreated, cervicitis can lead to pelvic inflammatory disease (PID).
You diagnose cervicitis by doing a pelvic examination. You’re assessing for cervical motion tenderness (the “chandelier sign”). You also do a Pap smear to assess for cervical cancer, and test for Chlamydia/Gonococcus and other causes of STIs. As always, you need to assess for high-risk behaviors and keep HIV in the back of your mind.
Sexually transmitted infections
Vaginitis, urethritis, and cervicitis can all be symptoms of a sexually transmitted infection. Additionally, each STI has symptoms that are unique to the specific condition. Realize that STIs can be a cause of pelvic inflammatory disease if left untreated. This can manifest in several forms, including salpingitis and tubo-ovarian abscess. Pelvic inflammatory disease increases the risk of infertility big time. Here are some STIs to know for the test.
Trichomoniasis is caused by the single-celled protozoa Trichomonas vaginalis, a bacterium that can also cause cervicitis, vaginitis, and urethritis. The classic description of trichomoniasis is the presence of a frothy, yellowish-green vaginal discharge. Punctate hemorrhages may be visible on the vagina and cervix. The treatment is metronidazole. Both the affected woman and her partner should be treated, even if the partner isn’t exhibiting any symptoms.
Gonorrhea and chlamydia
Gonorrhea is a common STI that can produce symptoms in both men and women. Common symptoms include burning, a vaginal discharge, and cervicitis or an inflamed penile area. There also can be the urinary symptoms of dysuria, urgency, and frequency.
The key to diagnosis is to obtain a urethral swab in men or a cervical culture in women. A Gram stain is often done, although you can also do specialized DNA testing to test for Neisseria gonorrhea. The high-yield test-taking phrase is “Gram-negative intracellular diplococci.” The treatment for gonorrhea is usually 1 g of ceftriaxone, which can be given intramuscularly.
Many people who have gonococcus also have concomitant infection with Chlamydia trachomatis. In addition to ceftriaxone, there two treatment regimens that are used for Chlamydia: a single 1 g dose of azithromycin or a 7-day course of doxycycline, taken twice a day.
Gonococcus can affect other areas of the body as well, especially if left untreated. These conditions can include gonococcal pharyngitis and arthritis. A person may also have a disseminated gonococcal infection, which in rare cases can be a cause of meningitis.
Human papillomavirus is associated with unprotected sexual relations. Complications of cervical dysplasia occur in young women, and rectal cancer may occur in both men and women. The virus is a cause of genital warts.
You need to be aware of certain serotypes because some types of HPV put the affected woman at increased risk of developing cervical cancer. Here are the serotypes commonly asked about on tests:
HPV serotypes 6 and 11 increase the formation of condyloma acuminata, or genital warts.
HPV serotypes 16, 18, and 31 increase the risk of developing cervical cancer.
Gardasil is a vaccination that women and men can get in their early teen years to mid-20s to help prevent acquiring certain cancer-causing HPV serotypes. The diagnosis of human papillomavirus can be confirmed by Pap smear.
Cervical dysplasia and carcinoma
You need to be aware of cervical cancer screening as well as the cancer’s evaluation and management. Cervical dysplasia refers to premalignant changes that require very close follow-up. Cervical dysplasia and Cervical cancer usually occurs in younger women. Risk factors for the development of cervical cancer include multiple sexual partners, sex at a younger age, and HIV.
cervical cancer are caused by the human papillomavirus.
Diethylstilbestrol is a synthetic estrogen used years ago to prevent miscarriage. Women who were exposed to DES in-utero have a dramatically increased risk of developing cervical or vaginal cancer. The histology is clear cell adenocarcinoma. Given the number of women in the 1950s–1970s who were given this medication, you’ll likely see a test question on this aspect.
Many times, the woman has no symptoms to signal that cervical cancer may be present. Some symptoms are nonspecific and can include vaginal discharge and vaginal bleeding.
Here are the screening recommendations for cervical cancer:
All women should get a Pap smear every 3 years, starting at age 21.
Women over the age of 65 don’t need to be tested anymore if their three most recent Pap smear results were normal.
Order a colposcopy if the Pap smear gives you concern for dysplasia or atypical cells. After the colposcopy, depending on the results of the biopsy findings, additional procedures may be necessary. One option includes the loop electrosurgical excision procedure (LEEP).