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 characterized 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
- risk factors for sexually transmitted infection (STI)
- purulent vaginal or cervical discharge
- intermenstrual/postcoital bleeding
- dysuria and urinary frequency
- 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
- Papanicolaou test
- herpes simplex virus (HSV) serology
- HIV serology
- hepatitis B and C serologies
- rapid plasma reagin testing
high-risk nonpregnant women
M. Jonathon Solnik, MD, FACOG, FACS
Associate Professor of Obstetrics & Gynaecology
Head of Gynaecology & Minimally Invasive Surgery
University of Toronto Faculty of Medicine
Mount Sinai Hospital
MJS serves as a consultant for Medtronic, Olympus, and Hologic, and on the advisory board for Abbvie. He holds stocks in Felix and Field Trip Inc.
Dr M. Jonathon Solnik would like to gratefully acknowledge Dr Sharon Jakus, a previous contributor to this topic.
SJ declares that she has no competing interests.
Sandra R. Valaitis, MD
Associate Professor and Chief
Gynecology and Reconstructive Pelvic Surgery
University of Chicago
SRV declares that she has no competing interests.
Justin C. Chura, MD
Associate Division Director
Crozer Chester Medical Center
JCC declares that he has no competing interests.
Eva Jungmann, FRCP, MSc
GUM/HIV Camden Primary Care Trust
Archway Sexual Health Clinic
EJ declares that she has no competing interests.
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- Sexually transmitted infections treatment guidelines, 2021
- Oral cephalosporins no longer a recommended treatment for gonococcal infections: update to CDC's sexually transmitted diseases treatment guidelines, 2010
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