Cervicitis: Symptoms, Etiologies, and Management

Cervicitis = inflammation of the cervix; often infectious.

Symptoms

• Abnormal discharge (mucopurulent, yellow-green)
• Postcoital / intermenstrual bleeding
• Dyspareunia, pelvic discomfort
• Urinary frequency, dysuria (urethral involvement)
• Often asymptomatic

Common Causes

• STIs: Chlamydia trachomatis (most common), Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, HSV.
• Non-infectious: Chemical irritants (douches, spermicides), latex allergy, radiation, foreign body (IUD string), atrophy.

Diagnosis

• Speculum exam: friable cervix, discharge from os.
• NAAT for CT/GC/TV/MG (urine or swab).
• Wet mount for trichomonas, BV, yeast.

Treatment

• Empiric: Ceftriaxone 500 mg IM + Doxycycline 100 mg BID × 7d (covers CT/GC).
• Add metronidazole if trichomonas/BV.
• Partner treatment essential (expedited partner therapy).
• Test of cure if pregnant, persistent symptoms, or azithromycin used for CT.

Complications

PID, infertility, ectopic pregnancy, chronic pelvic pain, HIV acquisition risk ↑.

Screen annually <25 or with risk factors.