Cervicitis

Acute cervicitis is usually caused by a sexually transmitted infection Overview of Sexually Transmitted Infections Sexually transmitted infection (STI) refers to infection with a pathogen that is transmitted through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with... read more ; the most common infectious cause of cervicitis is Chlamydia trachomatis Chlamydia and Mycoplasmal Mucosal Infections Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis (that are not due to gonorrhea) are caused predominantly by chlamydiae and less frequently by mycoplasmas. Chlamydiae... read more , followed by Neisseria gonorrhea Gonorrhea Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent... read more . Other causes include herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Common severe infections include encephalitis... read more (HSV), Trichomonas vaginalis, and Mycoplasma genitalium. Often, a pathogen cannot be identified.

The cervix may be inflamed but not infected as part of vaginitis (eg, bacterial vaginosis Bacterial Vaginosis (BV) Bacterial vaginosis is a dysbiosis, a complex alteration of vaginal flora, in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a yellow-green or gray, thin, malodorous... read more , trichomoniasis Trichomoniasis Trichomoniasis is infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or cause urethritis, vaginitis, or occasionally cystitis, epididymitis... read more ).

Noninfectious causes of cervicitis include gynecologic procedures, foreign bodies (eg, pessaries, barrier contraceptive devices), chemicals (eg, in douches or contraceptive creams or gels), and allergens (eg, latex).

Cervicitis may not cause symptoms. The most common symptoms are vaginal discharge and intermenstrual or postcoital vaginal bleeding. Some women have dyspareunia.

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 a 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 and tested for chlamydia Diagnosis Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis (that are not due to gonorrhea) are caused predominantly by chlamydiae and less frequently by mycoplasmas. Chlamydiae... read more and gonorrhea Diagnosis Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent... read more , bacterial vaginosis Diagnosis Bacterial vaginosis is a dysbiosis, a complex alteration of vaginal flora, in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a yellow-green or gray, thin, malodorous... read more , and trichomoniasis Diagnosis Trichomoniasis is infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or cause urethritis, vaginitis, or occasionally cystitis, epididymitis... read more .

In certain clinical situations, patients with signs and symptoms suggestive of cervicitis should be treated empirically for gonorrhea Treatment Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent... read more and chlamydia Treatment Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis (that are not due to gonorrhea) are caused predominantly by chlamydiae and less frequently by mycoplasmas. Chlamydiae... read more , even before test results are received. This includes settings in which patient follow up is uncertain (eg, emergency department, urgent care clinic) or if the clinical suspicion is high and expediting treatment may benefit the patient. Treatment is the following:

Once the cause or causes are identified based on the results of microbiologic testing, subsequent treatment is adjusted accordingly.

If the cause is the herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Common severe infections include encephalitis... read more , infection usually persists for life. Antiviral medications can control but not cure these infections.

If cervicitis persists despite 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. M. genitalium has been associated with cervicitis, pelvic inflammatory disease, preterm delivery, and infertility and should be investigated in patients with nongonococcal, nonchlamydial cervicitis if polymerase chain reaction (PCR) testing is available.

If the cause is a bacterial STI, sex partners should be tested and treated simultaneously. They should abstain from sexual intercourse until the infection has been eliminated from the patient and all partners.

All women with confirmed chlamydia or gonorrhea, and those diagnosed with trichomoniasis, should be tested 3 months after treatment because reinfection is common.