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
- Patients must understand that their infection is a preventable STD. They must ensure that all their sexual partners are also treated, or they will become reinfected. Proper use of condoms reduces the risk of infection.
- For excellent patient education resources, visit eMedicine's Women's Health Center, Pregnancy and Reproduction Center. Also, see eMedicine's patient education articles Cervicitis, Ectopic Pregnancy, Female Sexual Problems, and Pap Smear.
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