Cervicitis is infectious or noninfectious inflammation of the cervix. Findings may include vaginal discharge, vaginal bleeding, and cervical erythema and friability. Women are tested for infectious causes of vaginitis and pelvic inflammatory disease and are usually treated empirically for chlamydial infection and gonorrhea.
Acute cervicitis is usually caused by an infection; chronic cervicitis is usually not caused by an infection. Cervicitis may ascend and cause endometritis and pelvic inflammatory disease (PID).
Etiology of Cervicitis
The most common infectious cause of cervicitis is Chlamydia trachomatis, followed by Neisseria gonorrhea; they are sexually transmitted. Other causes include herpes simplex virus (HSV), Trichomonas vaginalis, and Mycoplasma genitalium. Often, a pathogen cannot be identified. The cervix may also be inflamed as part of vaginitis (eg, bacterial vaginosis, trichomoniasis).
Noninfectious causes of cervicitis include gynecologic procedures, foreign bodies (eg, pessaries, barrier contraceptive devices), chemicals (eg, in douches or contraceptive creams), and allergens (eg, latex).
Symptoms and Signs of Cervicitis
Cervicitis may not cause symptoms. The most common symptoms are vaginal discharge and vaginal bleeding between menstrual periods or after coitus. Some women have dyspareunia, vulvar and/or vaginal irritation, and/or dysuria.
Examination findings can include purulent or mucopurulent discharge, cervical friability (eg, bleeding after touching the cervix with a swab), and cervical erythema and edema.
Diagnosis of Cervicitis
- Clinical findings
- Testing for vaginitis and sexually transmitted diseases (STDs)
Cervicitis is diagnosed if women have cervical exudate (purulent or mucopurulent) or cervical friability.
Findings that suggest a specific cause or other disorders include the following:
- Fever: pelvic inflammatory disease (PID) or HSV infection
- Cervical motion tenderness: PID
- Vesicles, vulvar or vaginal pain, and/or ulceration: HSV infection
- Punctate hemorrhages (strawberry spots): Trichomoniasis
Women should be evaluated clinically for PID and tested for chlamydial infection and gonorrhea (eg, with polymerase chain reaction [PCR] or culture), bacterial vaginosis, and trichomoniasis.
Treatment of Cervicitis
- Usually empiric treatment for chlamydial infection and gonorrhea
At the first visit, most women with acute cervicitis should be treated for chlamydial infection empirically, particularly if they have risk factors for STDs (eg, age < 25, new or multiple sex partners, unprotected sex) or if follow-up cannot be ensured. Women should also be treated empirically for gonorrhea if they have risk factors for STDs, if local prevalence is high (eg, > 5%), or if follow-up cannot be ensured.
Treatment of cervicitis consists of the following:
- Chlamydial infection: Azithromycin 1 g orally once or with doxycycline 100 mg orally twice a day for 7 days
- Gonorrhea: Ceftriaxone 500 mg IM once for patients weighing < 150 kg (300 lb) or 1g IM once for patients weighing > 150 kg ( > 300 lb) plus azithromycin 1 g orally once (due to emerging resistance of N. gonorrhoeae to cephalosporins)
Once the cause or causes are identified based on the results of microbiologic testing, subsequent treatment is adjusted accordingly.
If cervicitis persists despite this treatment, reinfection with chlamydiae and N. gonorrhoeae should be ruled out, and empiric treatment with moxifloxacin 400 mg orally once a day for 7 to 14 days (eg, for 10 days) should be started to cover possible M. genitalium infection.
If the cause is a bacterial STD, sex partners should be tested and treated simultaneously. Women should abstain from sexual intercourse until the infection has been eliminated from them and their sex partners.
All women with confirmed chlamydial infection or gonorrhea should be tested between 3 and 6 months after treatment because reinfection is common.
- Acute cervicitis is usually caused by an STD and can presage PID.
- Infection may be asymptomatic.
- Test women for chlamydial infection, gonorrhea, bacterial vaginosis, and trichomoniasis.
- Treat most women for chlamydial infection and gonorrhea at the first visit.
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