Cervicitis is common and often asymptomatic, but if left undiagnosed or untreated can result in pelvic inflammatory disease, which can lead to substantial long-term ill effects such as infertility and chronic pelvic pain.
Implementing screening protocols for high-risk populations may reduce adverse outcomes from cervicitis. Screening for other sexually transmitted infections (STIs) should be offered concomitantly.
While Neisseria gonorrhoeae and Chlamydia trachomatis are the most commonly isolated organisms, in most cases no organism is identified.
Clinical suspicion is generally sufficient to justify therapy, but of the diagnostic aids, nucleic acid amplification testing remains the most sensitive and specific tool for accurately diagnosing N gonorrhoeae and C trachomatis.
If the presentation suggests cervicitis, and the patient is deemed at high risk for STI, patients are empirically treated with a regimen targeting STIs.
Inflammation of the cervix characterised by a purulent endocervical exudate and/or easily induced endocervical bleeding caused by manipulation with an atraumatic instrument such as a cotton swab.
History and exam
Key diagnostic factors
- presence of risk factors
- purulent vaginal or cervical discharge
- dysuria and urinary frequency
- intermenstrual/postcoital bleeding
- easily induced cervical bleeding
Other diagnostic factors
- vulval and/or vaginal inflammation
- strawberry cervix
- age 15 to 25 years
- inconsistent condom use
- multiple sexual relationships
- previous STIs
- bacterial vaginosis (BV)
- sex worker
- absence of hydrogen peroxide-producing lactobacilli
- education <12 years
1st investigations to order
- pregnancy test
- wet mount examination of cervical discharge
- nucleic acid amplification testing (NAAT)
- rapid tests (OSOM Trichomonas, AFFIRM VPIII)
- Thayer-Martin agar cervical culture
- Gram stain of cervical discharge
Investigations to consider
- cervical cytology
- herpes simplex virus (HSV) serology
- HIV serology
- hepatitis B and C serologies
- rapid plasma reagin testing
high-risk non-pregnant women
- Cervical ectropion
- Cervical dysplasia
- Cervical cancer
- European guideline on the management of Mycoplasma genitalium infections
- Sexually transmitted infections treatment guidelines, 2021
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