Merck Manual

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Oluwatosin Goje

, MD, MSCR, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University

Reviewed/Revised Mar 2023
Topic Resources

Cervicitis is infectious or noninfectious inflammation of the cervix. Findings may include cervical or vaginal discharge and cervical erythema and friability. Diagnosis is with tests for cervical infection. Women are tested for infectious causes of vaginitis and pelvic inflammatory disease and are sometimes treated empirically for chlamydia and gonorrhea.

Etiology of Cervicitis

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).

Symptoms and Signs of Cervicitis

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.

Diagnosis of Cervicitis

  • Pelvic examination

  • Testing for vaginitis and sexually transmitted infections

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:

Treatment of Cervicitis

  • Usually treatment for chlamydia and gonorrhea

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 Treatment 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 Treatment , 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:

  • Chlamydia: Azithromycin 1 g orally once or doxycycline 100 mg orally twice a day for 7 days

  • Gonorrhea: Ceftriaxone 500 mg IM once for patients weighing < 150 kg or 1g IM once for patients weighing ≥ 150 kg 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 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.

Key Points

  • Acute cervicitis is usually caused by an STI and may develop into PID.

  • Infection may be asymptomatic; symptoms may include vaginal discharge and intermenstrual and postcoital vaginal bleeding.

  • Test women for chlamydia, gonorrhea, bacterial vaginosis, and trichomoniasis.

  • Treat most women for chlamydia and gonorrhea at the first visit.

Drugs Mentioned In This Article

Drug Name Select Trade
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
Ceftrisol Plus, Rocephin
Avelox, Avelox ABC Pack, Avelox I.V., MOXEZA, Vigamox
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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