eMedicine Specialties > Obstetrics and Gynecology > Infections

Cervicitis: Follow-up

Author: Arthur T Ollendorff, MD, Associate Professor of Clinical Obstetrics and Gynecology, Residency Program Director, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine; Chief of Gynecology, Veterans Affairs Medical Center, Cincinnati
Contributor Information and Disclosures

Updated: Aug 3, 2009

Follow-up

Further Inpatient Care

  • Admit to hospital if disseminated infection (ie, PID) is suspected, if the diagnosis is uncertain, or if the patient is unable to take oral medications.
    • If disseminated infection is suspected, then patients can quickly become unstable. These patients need intensive monitoring and parenteral medication.
    • If the diagnosis is uncertain, and competing diagnoses cannot be reliably excluded (eg, appendicitis, ectopic pregnancy), then further testing and monitoring is indicated.
  • If the patient is unable to take oral medication because of intractable nausea, vomiting, or abdominal pain, then hospitalization for intravenous medication is warranted.

Further Outpatient Care

  • In high-risk patients, consider screening for HIV, syphilis, and hepatitis B.
  • In most cases, a test of cure is not necessary because of the high efficacy of the medications used. In the case of persistent symptoms or pregnancy, follow-up testing is recommended.

Deterrence/Prevention

  • The most effective way to prevent the transmission of the infective agents that cause cervicitis is to avoid sexual intercourse with infected partners. Ideally, both partners should be tested for common STDs, including HIV, before initiating a sexual relationship. If the risk of infection is unknown by testing, then use a condom for all sexual acts. Condoms are available for men and women and have been proven to decrease the transmission of many STDs, including HIV, when used appropriately and consistently.

Complications

  • Untreated gonorrhea and chlamydia infections can lead to PID, which can then lead to infertility, chronic pelvic pain, and ectopic pregnancy. Certain subtypes of HPV are linked with the development of cervical cancer. Severe cases of condyloma may obstruct the birth canal during pregnancy, resulting in the need for cesarean section. Untreated active HSV infections can cause significant perinatal and neonatal complications such as mental retardation, blindness, meningitis, and death.

Prognosis

  • Gonorrhea, chlamydia, and T vaginalis infections can be cured with antibiotic therapy.
  • The number of HSV outbreaks, the duration of symptoms, and the severity of symptoms can be reduced with antiviral therapy.
  • External genital warts caused by infection with HPV can be controlled but not always eradicated by topical therapy and surgical therapy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • In women of childbearing age, always perform a urine pregnancy test before prescribing any medication.
  • Failure to adequately screen for sexually transmitted infections (STIs) in patients who present with symptoms of an STI.

Special Concerns

  • Be aware of local and state regulations regarding reporting of STIs.
  • In a young adolescent or child, suspect abuse and notify the proper authorities.
 


More on Cervicitis

Overview: Cervicitis
Differential Diagnoses & Workup: Cervicitis
Treatment & Medication: Cervicitis
Follow-up: Cervicitis
References
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References

  1. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young females enrollees of health plans - United States, 2000-2007. MMWR Weekly. April 17, 2009;58(14):362-365. [Full Text].

  2. Clifford GM, Gallus S, Herrero R, Munoz N, Snijders PJ, Vaccarella S. Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis. Lancet. Sep 17-23 2005;366(9490):991-8. [Medline].

  3. Wright TC Jr, Schiffman M, Solomon D, Cox JT, Garcia F, Goldie S. Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening. Obstet Gynecol. Feb 2004;103(2):304-9. [Medline].

  4. Goldie SJ, Kim JJ, Wright TC. Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more. Obstet Gynecol. Apr 2004;103(4):619-31. [Medline].

  5. CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  6. American College of Obstetricians and Gynecologists. Cervical Cytology and Screening. August 2003. ACOG Practice Bulletin.

  7. Anderson JR. Genital tract infections in women. Med Clin North Am. Nov 1995;79(6):1271-98. [Medline].

  8. CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline]. [Full Text].

  9. Griffith WF, Stuart GS, Gluck KL, Heartwell SF. Vaginal speculum lubrication and its effects on cervical cytology and microbiology. Contraception. Jul 2005;72(1):60-4. [Medline].

  10. Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Mosby; 2007:598-600.

  11. Low N, Cowan F. Genital chlamydial infection. Clin Evid. Jun 2003;(9):1721-8. [Medline]. [Full Text].

  12. Schiffman M, Khan MJ, Solomon D, Herrero R, Wacholder S, Hildesheim A. A study of the impact of adding HPV types to cervical cancer screening and triage tests. J Natl Cancer Inst. Jan 19 2005;97(2):147-50. [Medline].

  13. Sexually Transmitted Disease Surveillance 2007. Centers for Disease Control and Prevention; December 2008. [Full Text].

  14. Soper DE. Sexually transmitted disease & pelvic inflammatory disease. Primary Care of Women. 1995:339-347.

  15. World Health Organization. Sexually Transmitted Infections. October 2007. WHO Fact Sheet. [Full Text].

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Further Reading

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Keywords

cervicitis, female lower genital tract infections, mucopurulent cervicitis, sexually transmitted diseases, STDs, vulvovaginitis, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, human papillomavirus, HPV, herpes simplex virus, HSV, pelvic inflammatory disease, PID, infertility, ectopic pregnancy, spontaneous abortion, cervical cancer, preterm delivery, condylomata acuminata, Papanicolaou test, Pap smear

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Contributor Information and Disclosures

Author

Arthur T Ollendorff, MD, Associate Professor of Clinical Obstetrics and Gynecology, Residency Program Director, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine; Chief of Gynecology, Veterans Affairs Medical Center, Cincinnati
Arthur T Ollendorff, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Public Health Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey B Garris, MD, Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine
Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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