Cervicitis

Cervicitis is inflammation of the cervix, the narrow, lower portion of the uterus that connects to the vagina. This common gynecological condition can be caused by infections, hormonal changes, or irritants, leading to symptoms such as abnormal vaginal discharge, pelvic pain, and painful urination. While often mild, cervicitis requires proper diagnosis and treatment to prevent complications and address underlying causes.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. If you suspect you have cervicitis or experience persistent vaginal symptoms, consult a healthcare provider for proper diagnosis and treatment.

Overview

The cervix serves as a protective barrier between the vagina and the upper reproductive tract, producing mucus that changes throughout the menstrual cycle. When the cervix becomes inflamed, this condition is known as cervicitis. The inflammation can affect the cervical epithelium (the tissue lining) and may extend to surrounding structures.

Cervicitis is classified into two main types: acute and chronic. Acute cervicitis typically results from infections and presents with more pronounced symptoms, while chronic cervicitis may develop gradually and present with milder, persistent symptoms. The condition is particularly common among sexually active women of reproductive age, with studies showing prevalence rates of 8-25% in this population.

While cervicitis itself is rarely life-threatening, it can lead to serious complications if left untreated. These may include pelvic inflammatory disease (PID), which can affect fertility, or increase the risk of ectopic pregnancy. Early recognition and appropriate treatment are essential for preventing these complications and maintaining reproductive health.

Symptoms

Cervicitis symptoms can vary from mild to severe and may sometimes be absent entirely. Many women with cervicitis are asymptomatic, which is why regular gynecological examinations are important for early detection.

Common Symptoms

Infectious Cervicitis Symptoms

  • Yellow or green vaginal discharge with strong odor
  • Increased vaginal discharge volume
  • Post-coital bleeding (bleeding after intercourse)
  • Intermenstrual bleeding (bleeding between periods)
  • Fever and general malaise in severe cases

Pregnancy-Related Symptoms

  • Pain during pregnancy - increased pelvic discomfort
  • Nausea - may be exacerbated by the condition
  • Changes in normal pregnancy discharge
  • Increased risk of pregnancy complications if untreated

Chronic Cervicitis Symptoms

  • Persistent mild vaginal discharge
  • Recurrent urinary tract infections
  • Chronic pelvic pain
  • Discomfort during gynecological examinations

Causes

Cervicitis can result from various infectious and non-infectious causes. Understanding these causes is essential for appropriate treatment and prevention strategies.

Infectious Causes

Sexually Transmitted Infections (STIs)

  • Chlamydia trachomatis: Most common bacterial cause, often asymptomatic
  • Neisseria gonorrhoeae: Can cause severe inflammation and complications
  • Herpes simplex virus (HSV): Both HSV-1 and HSV-2 can affect the cervix
  • Human papillomavirus (HPV): Certain high-risk types can cause persistent cervicitis
  • Trichomonas vaginalis: Parasitic infection causing frothy discharge

Other Bacterial Infections

  • Bacterial vaginosis-associated bacteria
  • Streptococcus agalactiae (Group B Strep)
  • Escherichia coli (rare)
  • Mycoplasma genitalium

Non-Infectious Causes

  • Chemical irritants: Douches, spermicides, latex sensitivity
  • Hormonal changes: Pregnancy, menopause, contraceptive use
  • Mechanical trauma: IUD insertion, childbirth, sexual activity
  • Autoimmune conditions: Behçet's disease, systemic lupus erythematosus
  • Radiation therapy: Pelvic radiation treatment

Contributing Factors

  • Compromised immune system
  • Poor hygiene practices
  • Frequent antibiotic use disrupting normal flora
  • Stress and lifestyle factors

Risk Factors

Several factors can increase the likelihood of developing cervicitis. Understanding these risk factors helps in prevention and early identification.

Sexual and Reproductive Risk Factors

  • Multiple sexual partners: Increases exposure to STIs
  • Unprotected sexual activity: Lack of barrier contraception
  • Early sexual debut: Sexual activity before age 18
  • Previous STI history: Prior infections increase recurrence risk
  • Partner with STI: Infected sexual partner
  • Frequent douching: Disrupts normal vaginal flora

Demographic and Health Factors

  • Age: Most common in women 15-24 years old
  • Pregnancy: Hormonal and physical changes increase risk
  • Immunocompromised state: HIV, diabetes, corticosteroid use
  • Smoking: Reduces cervical immunity
  • Nutritional deficiencies: Particularly folate and vitamin C

Medical and Procedural Factors

  • Recent gynecological procedures
  • IUD insertion or presence
  • Frequent antibiotic use
  • Hormonal contraceptive use
  • Cervical biopsy or surgery

Protective Factors

  • Consistent condom use
  • Monogamous relationships
  • Regular STI screening
  • HPV vaccination
  • Good personal hygiene

Diagnosis

Accurate diagnosis of cervicitis requires a combination of clinical assessment, physical examination, and laboratory testing to identify the underlying cause and guide appropriate treatment.

Clinical Assessment

Healthcare providers begin with a detailed medical history including:

  • Symptom onset, duration, and severity
  • Sexual history and partner information
  • Menstrual and contraceptive history
  • Previous gynecological conditions
  • Recent medications or treatments

Physical Examination

Pelvic Examination

  • External examination: Assessment of vulvar area for lesions or irritation
  • Speculum examination: Visualization of cervix for:
    • Cervical erythema (redness)
    • Cervical edema (swelling)
    • Mucopurulent discharge
    • Cervical friability (easy bleeding)
    • Ectropion or other abnormalities
  • Bimanual examination: Assessment of uterine and adnexal tenderness

Laboratory Tests

Microbiological Testing

  • Nucleic acid amplification tests (NAATs): Gold standard for chlamydia and gonorrhea
  • Wet mount microscopy: Immediate assessment for trichomonas and clue cells
  • Gram stain: Evaluation of bacterial patterns and white blood cells
  • Bacterial culture: When specific antibiotic sensitivities needed
  • HSV PCR: If viral infection suspected

Additional Tests

  • Pap smear: To rule out malignancy and assess cellular changes
  • HPV testing: For high-risk types if indicated
  • pH testing: Vaginal pH assessment
  • KOH preparation: To detect yeast infections

Differential Diagnosis

Healthcare providers must distinguish cervicitis from:

  • Cervical cancer or precancerous lesions
  • Vaginal infections (bacterial vaginosis, yeast)
  • Pelvic inflammatory disease
  • Endometriosis
  • Urinary tract infections

Treatment Options

Treatment of cervicitis depends on the underlying cause identified through diagnostic testing. The primary goals are to eliminate infection, reduce inflammation, and prevent complications.

Infectious Cervicitis Treatment

Bacterial Infections

Chlamydia and Gonorrhea:

  • First-line: Azithromycin 1g orally single dose OR Doxycycline 100mg twice daily for 7 days
  • Gonorrhea: Ceftriaxone 500mg IM single dose plus azithromycin
  • Partner treatment essential to prevent reinfection

Other Bacterial Causes:

  • Guided by culture and sensitivity results
  • May include amoxicillin, clindamycin, or fluoroquinolones
  • Duration typically 7-14 days

Viral Infections

  • HSV: Acyclovir, valacyclovir, or famciclovir
  • HPV: Usually resolves spontaneously; focus on monitoring
  • Supportive care for symptom management

Parasitic Infections

  • Trichomonas: Metronidazole 2g orally single dose OR 500mg twice daily for 7 days
  • Partner treatment mandatory
  • Alcohol avoidance during treatment

Non-Infectious Cervicitis Treatment

  • Topical estrogen: For postmenopausal atrophic cervicitis
  • Anti-inflammatory agents: NSAIDs for pain and inflammation
  • Cessation of irritants: Stop douching, change contraceptive methods
  • Barrier repair: Vaginal moisturizers and lubricants

Symptomatic Treatment

  • Pain management with NSAIDs or acetaminophen
  • Topical anesthetics for severe discomfort
  • Probiotics to restore normal vaginal flora
  • Sitz baths for symptom relief

Treatment During Pregnancy

  • Pregnancy-safe antibiotics (azithromycin, amoxicillin)
  • Avoid doxycycline and fluoroquinolones
  • Close monitoring for complications
  • Treatment may reduce risk of preterm delivery

Follow-Up Care

  • Test of cure for gonorrhea and trichomonas
  • Symptom resolution assessment at 1-2 weeks
  • Partner notification and treatment
  • Sexual abstinence until treatment completion
  • Regular STI screening as appropriate

Prevention

Preventing cervicitis involves reducing exposure to infectious agents and minimizing risk factors that can lead to cervical inflammation.

Primary Prevention

  • Safe sexual practices:
    • Consistent and correct condom use
    • Limiting number of sexual partners
    • Mutual monogamy with uninfected partner
    • Communication about STI status
  • Vaccination:
    • HPV vaccination (Gardasil 9) for prevention of HPV-related cervicitis
    • Recommended for ages 9-45 years
    • Most effective when given before sexual debut

Secondary Prevention

  • Regular screening:
    • Annual STI testing for sexually active women
    • More frequent testing for high-risk individuals
    • Partner screening and treatment
  • Routine gynecological care:
    • Regular pelvic examinations
    • Pap smear screening as recommended
    • Prompt attention to symptoms

Lifestyle Modifications

  • Hygiene practices:
    • Avoid douching
    • Use mild, unscented soaps
    • Wipe front to back after urination
    • Change tampons and pads regularly
  • Clothing choices:
    • Cotton underwear
    • Avoid tight-fitting clothing
    • Change out of wet swimwear promptly

Risk Reduction Strategies

  • Smoking cessation
  • Stress management
  • Adequate nutrition and vitamin supplementation
  • Immune system support
  • Careful selection of contraceptive methods

When to See a Doctor

Seek immediate medical attention for:

  • Severe pelvic pain with fever
  • Heavy vaginal bleeding between periods
  • Signs of systemic infection (fever, chills, malaise)
  • Severe abdominal pain during pregnancy
  • Inability to urinate due to pain

Schedule an appointment for:

Routine screening recommended for:

  • Sexually active women under 25 annually
  • Women over 25 with risk factors
  • New sexual partners or multiple partners
  • Previous history of STIs
  • Partner diagnosed with STI

Related Conditions

References

  1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187.
  2. Marrazzo JM, Apicella MA. Neisseria gonorrhoeae (Gonorrhea). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:2612-2631.
  3. Stamm WE. Chlamydia trachomatis Infections of the Adult. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020:2354-2369.
  4. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 215: Cervicitis. Obstet Gynecol. 2020;135(1):e1-e14.
  5. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039-2048.