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Cervicitis +sur-vu-!sI-tus

by David E. Soper, MD

Cervicitis is inflammation of the cervix (the lower, narrow part of the uterus that opens into the vagina). It may be caused by an infection or another condition.

  • Cervicitis is often caused by a sexually transmitted disease but may result from other conditions.

  • The most common symptoms are an unusual discharge from the vagina and vaginal bleeding between menstrual periods or after sexual intercourse, but women may not have any symptoms.

  • If symptoms suggest a cervical infection, doctors use a swab to obtain a sample from the cervix to be tested for microorganisms that can cause infection.

  • Women are often first given antibiotics that are effective against chlamydial infections and gonorrhea (the most common causes).

Cervicitis may spread upward from the cervix and affect the lining of the uterus (causing endometritis) and other reproductive organs (causing pelvic inflammatory disease).

Causes of Cervicitis

If cervicitis appears suddenly, it is usually caused by an infection. If it has been present for a long time (is chronic), it is usually not caused by an infection.

Infections that commonly cause cervicitis include sexually transmitted diseases such as

  • Chlamydial infections due to the bacteria Chlamydia trachomatis (most common)

  • Gonorrhea due to the bacteria Neisseria gonorrhea (second most common)

  • Genital herpes due to the herpes simplex virus

  • Infection with the bacteria Mycoplasma genitalium

Infections of the vagina (such as bacterial vaginosis and Trichomonas vaginitis) may also affect the cervix. Often, the microorganism that causes cervicitis cannot be identified.

Conditions other than infections can cause cervicitis. They include

  • Gynecologic procedures

  • Objects (such as diaphragms) that are left in the vagina too long

  • Chemicals in douches or contraceptive creams

  • If women are allergic to latex, latex condoms

Symptoms of Cervicitis

Cervicitis may not cause any symptoms. When it does, the most common are an unusual (sometimes yellow-green and puslike) discharge from the vagina and vaginal bleeding between menstrual periods or after sexual intercourse. Some women have pain during intercourse, urination, or both. The area around the opening to the vagina may be red and irritated, as may the vagina.

Women may have other symptoms depending on what is causing cervicitis. For example, if the cause is pelvic inflammatory disease or herpes simplex infection, women may have a fever and pain in the lower the abdomen.

Diagnosis of Cervicitis

  • A doctor's evaluation

  • Tests on a sample taken from the cervix

A woman should see her doctor if she has a persistent, unusual vaginal discharge, vaginal bleeding other than during menstrual periods, or pain during sexual intercourse. However, because cervicitis often causes no symptoms, it may be diagnosed during a routine pelvic examination.

If symptoms suggest cervicitis, doctors do a pelvic examination. They check for a discharge from the cervix and touch the cervix with a swab to see whether it bleeds easily. If a puslike discharge is present and if the cervix bleeds easily, cervicitis is likely.

If symptoms suggest pelvic inflammatory disease, doctors use a swab to obtain a sample from the cervix to be tested for microorganisms that can cause sexually transmitted diseases (such as gonorrhea or a chlamydial or Trichomonas infection) or bacterial vaginosis.

Treatment of Cervicitis

  • Usually antibiotics at first

  • If infection is caused by the herpes simplex virus, antiviral drugs

If cervicitis appeared suddenly, most women are given antibiotics that are effective against chlamydial infections and gonorrhea, particularly if they have risk factors for sexually transmitted disease (such as being younger than 25, having new or several sex partners, or not using protection during sex).

Treatment consists of the following:

  • For chlamydial infection: Azithromycin or doxycycline, taken by mouth

  • For gonorrhea: Ceftriaxone, given one time by injection into a muscle, plus azithromycin, taken once by mouth

These drugs are continued until test results are available. Once the cause is identified, doctors adjust the drugs accordingly.

If the cause is a sexually transmitted disease caused by bacteria, 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.

If the cause is the herpes simplex virus, infection usually persists for life. Antiviral drugs can control but not cure these infections.

After being treated for 3 to 6 months, all women are tested again to determine whether the infection has been eradicated or is under control.

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