3.2.1: Cervicitis
- Page ID
- 98210
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Inflammation of the ectocervix that could be acute (mainly infectious) or chronic (mainly noninfectious).22
3.2.1.2 Etiology
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Infectious Causes
- Sexually transmitted organisms (Chlamydia trachomatis, Ureaplasma urealyticum, T. vaginalis, Neisseria gonorrhoeae, HSV-2, and certain types of HPV)
- Bacterial vaginosis23
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Noninfectious causes
These are mainly chemical and mechanical irritants. Chemical irritants include soaps, laundry products, spermicides, latex, vaginal douches, and contraceptive creams; they result in allergic reactions. Mechanical irritants include condoms, diaphragms, cervical caps, or tampons)24
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Other inflammatory conditions
Cervicitis can also be a part of systemic inflammatory diseases such as lichen planus and Behcet syndrome.25
3.2.1.3 Clinical Presentation
Clinically, it can be asymptomatic or present with mucopurulent vaginal discharge (i.e., leukorrhea), post-coital bleeding, and dyspareunia. It is usually associated with pelvic inflammatory disease and presents with abdominal pain and adnexal tenderness. If associated with inflammation of the urethra (urethritis), it presents with urinary symptoms. On pelvic examination, a yellowish mucoid discharge can be seen coming from the cervical os. The cervix appears swollen with small red spots indicating punctate hemorrhages (strawberry cervix); is usually associated with trichomonas infections. Cervical vesicles and ulcers are seen in cervicitis caused by HSV. Systemic symptoms of inflammation, such as high fever, can also be detected.26
3.2.1.4 Diagnosis
Nucleic acid amplification testing (NAAT) is the most sensitive and specific test for identifying the causative organisms in infectious cervicitis. Both vaginal discharge and urine samples are used for this test.27
3.2.1.5 Treatment
Treatment mainly targets the causative agents. Administration of empiric antibiotics is indicated whenever a causative pathogen is not detected on testing and for women at higher risk of sexually transmitted disease (less than 25 years of age, having a partner with STD, new partner, or multiple partners). These antimicrobials mainly target chlamydia and gonorrhea.28
For more details on cervical abnormalities secondary to cervicitis, please refer to World Health Organization (WHO) "VIA procedure - Examination before application of acetic acid," Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment.
For more details on specific treatments based on detected pathogens, please refer to National Library of Medicine (NLM) "Cervicitis," StatPearls (2023).
Glossary Terms
- Adnexal
- of the uterine appendages (ADNEXA UTERI) including diseases involving the OVARY, the FALLOPIAN TUBES, and ligaments of the uterus (BROAD LIGAMENT; ROUND LIGAMENT)
- Behcet syndrome
- Rare chronic inflammatory disease involving the small blood vessels. It is of unknown etiology and characterized by mucocutaneous ulceration in the mouth and genital region and uveitis with hypopyon. The neuro-ocular form may cause blindness and death. SYNOVITIS; THROMBOPHLEBITIS; gastrointestinal ulcerations; RETINAL VASCULITIS; and OPTIC ATROPHY may occur as well
- Cervical os
- neck portion of the UTERUS between the lower isthmus and the VAGINA forming the cervical canal
- Chlamydia
- A genus of the family CHLAMYDIACEAE whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen
- Dyspareunia
- genital pain before, during, or after intercourse
- Ectocervix
- neck portion of the UTERUS between the lower isthmus and the VAGINA forming the cervical canal
- Gonorrhea
- acute infectious disease characterized by primary invasion of the urogenital tract
- Leukorrhea
- clear or white discharge from the VAGINA, consisting mainly of MUCUS
- Lichen planus
- inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized; characterized by distinctive purplish, flat-topped papules having a predilection for the trunk and flexor surfaces
- Mucoid
- resembling mucus
- Mucopurulent
- containing both mucus and pus
- Trichomonas
- genus of parasitic flagellate EUKARYOTES distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum
- Vaginosis
- abnormal condition of the vagina
Footnotes
- Groetsch, Stefan and James W. Keck. “Cervicitis,” Clinics in Family Practice 7, no. 1 SPEC. ISS. (September 4, 2023): 43–56. doi.org/10.1016/j.cfp.2005.01.002
- Groetsch and Keck, 2023
- Groetsch and Keck, 2023
- Groetsch and Keck, 2023
- Groetsch and Keck, 2023
- Groetsch and Keck, 2023
- Groetsch and Keck, 2023