Cervicitis and endocervical polyps
- Lesion
Some inflammation of the cervix is almost universal; infections such as Chlamydia matter because they climb higher. Polyps are benign but bleed.
What it is
The cervix is a meeting point of squamous and glandular epithelium, and the transformation zone between them is constantly remodelled by squamous metaplasia. Mild chronic inflammation here is almost universal and harmless. Infectious cervicitis, mostly from Chlamydia, gonococcus, herpes, Trichomonas and Mycoplasma genitalium, matters because it can ascend to cause pelvic inflammatory disease, pass to the newborn or alter a Pap test. Endocervical polyps are benign outgrowths that present with spotting.
Structure
- Chronic nonspecific cervicitis: lymphocytes and plasma cells in the stroma, reactive epithelial changes, and metaplasia.
- Acute cervicitis: neutrophils in the epithelium and glands, erosion of the surface and mucopurulent discharge.
- Follicular cervicitis: germinal centres in the stroma, typical of chlamydial infection.
- Endocervical polyp: smooth, glistening, soft mass protruding from the os; glands lined by mucinous columnar cells, sometimes with squamous metaplasia or surface ulceration.
Step by step
- Under estrogen, the columnar epithelium everts onto the ectocervix (ectropion) and meets the acidic vaginal environment.
- Reserve cells beneath it proliferate and form squamous metaplasia, closing gland openings into Nabothian cysts.
- Sexually transmitted organisms infect the columnar and metaplastic cells and cause acute or chronic cervicitis.
- Untreated infection can ascend to the endometrium and tubes, or be passed to the baby at birth.
Clinical notes
- Mucopurulent discharge, contact bleeding and pain with intercourse; many infections are found only on screening.
- Chlamydial or gonococcal cervicitis in pregnancy can cause neonatal conjunctivitis and pneumonia.
- Inflammation can produce reactive atypia on cytology, which is why infections are treated and the smear repeated when needed.
- Polyps are removed and examined; carcinoma within an endocervical polyp is rare.
Test yourself
Think of the answer, then tap the question to see it.
What is a Nabothian cyst?
An endocervical gland whose opening is covered by squamous metaplasia, so mucus accumulates; it is harmless.
Which organism most often causes infectious cervicitis, and what histologic clue may suggest it?
Chlamydia trachomatis; follicular cervicitis with lymphoid germinal centres is a clue.
How does an endocervical polyp usually present?
With irregular or postcoital spotting from a soft, smooth mass protruding through the os.
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Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Chlamydia trachomatis Infection (StatPearls (NCBI Bookshelf), 2026); Prevalence of Chlamydia trachomatis in an asymptomatic female population attending cervical cytology services of three healthcare centers in Medellín, Colombia (Biomedica : revista del Instituto Nacional de Salud, 2020).
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Representative model, for educational purposes only.