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).
The most common infectious cause of cervicitis is Chlamydia trachomatis, followed by Neisseria gonorrhea. Other causes include herpes simplex virus (HSV), Trichomonas vaginalis, and Mycobacterium tuberculosis. 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
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.
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:
Women should be evaluated clinically for PID (see see Diagnosis) and tested for chlamydial infection (see see Diagnosis) and gonorrhea (eg, with PCR or culture—see see Diagnosis), bacterial vaginosis (see see Diagnosis), and trichomoniasis (see see Diagnosis).
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.
Other causes, if identified, should be treated. Chlamydial infection is treated with azithromycin 1 g po once or with doxycycline 100 mg po bid for 7 days. Gonorrhea is treated with ceftriaxone 250 mg IM once. Subsequent treatment should be directed by the results of microbiologic testing.
All women should be tested between 3 and 6 mo after treatment to determine whether the infection is eradicated.
Last full review/revision March 2013 by David E. Soper, MD
Content last modified September 2013