Cervicitis

ByOluwatosin Goje, MD, MSCR, Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University
Reviewed/Revised Mar 2023
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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.

Acute cervicitis is usually caused by an infection; chronic cervicitis is usually not infectious. Cervicitis may ascend and cause endometritis and pelvic inflammatory disease (PID).

Etiology of Cervicitis

Acute cervicitis is usually caused by a sexually transmitted infection; the most common infectious cause of cervicitis is Chlamydia trachomatis, followed by Neisseria gonorrhea. Other causes include herpes simplex virus (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, trichomoniasis).

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:

Women should be evaluated clinically for PID and tested for chlamydia and gonorrhea, bacterial vaginosis, and trichomoniasis.

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 and chlamydia, 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:

  • N. gonorrhoeae to cephalosporins)

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, infection usually persists for life. Antiviral medications can control but not cure these infections.

If cervicitis persists despite treatment, reinfection with chlamydiae and N. gonorrhoeaeM. 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.

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