Pediatric Cervicitis Clinical Presentation

  • Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Jul 6, 2011
 

History

Elicit the patient's history of sexual activity, number of sexual partners, and type of contraception used (if any). An increased incidence of chlamydial cervicitis in women has been associated with use of oral (PO) contraceptives.

  • Most patients with cervicitis present with vaginal discharge or intermenstrual vaginal bleeding.
  • Other associated symptoms include dyspareunia and dysuria.
  • Abdominal pain and fever are associated with involvement of the upper genital tract.
  • Patients with mild cervicitis may be asymptomatic, and many patients with chlamydial cervicitis are asymptomatic.
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Physical

Upon physical examination, findings in the cervix include the following:

  • Erythematous and inflamed cervix on speculum examination (Possible edema of the cervical ectropion may be noted.)
  • Possible purulent discharge from the cervical os
  • Cervix tender to palpation
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Causes

Gonorrheal and chlamydial infections

The most common causative organisms are Neisseria gonorrhea and C trachomatis.

Gonococcal and chlamydial cervicitis may be associated with upper genital tract infection.

Patients with gonorrhea may have associated urethritis.[4]

Patients with chlamydial infections are often asymptomatic.

Other bacterial pathogens

Other bacterial pathogens implicated in cervicitis and upper genital infections include Mycoplasma genitalium, Ureaplasma urealyticum and parvum, and anaerobes, such as Streptococcus, Peptostreptococcus, and Bacteroides species. Other sexually transmitted infections, such as those caused by Trichomonas species, herpes simplex virus, and human papilloma virus, may also be associated with cervicitis.

Although an uncommon finding, Trichomonas vaginalis is known to cause multiple punctate hemorrhages and swollen papillae in the cervix, giving it a strawberry appearance. This causes the cervix to become friable and bleed easily on touch.

Herpetic cervicitis may be associated with multiple ulcerations.

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Contributor Information and Disclosures
Author

Latha Chandran, MBBS, MD, MPH  Professor of Pediatrics, Vice Dean for Undergraduate Medical Education, Stony Brook University School of Medicine, New York

Latha Chandran, MBBS, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director, Adolescent Ambulatory Service, Professor, Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD  Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Nothing to disclose.

References

  1. Marrazzo JM. Mucopurulent cervicitis: no longer ignored, but still misunderstood. Infect Dis Clin North Am. Jun 2005;19(2):333-49, viii. [Medline].

  2. Darville T. Chlamydia. Pediatr Rev. Mar 1998;19(3):85-91. [Medline].

  3. Darville T. Gonorrhea. Pediatr Rev. Apr 1999;20(4):125-8. [Medline].

  4. Simpson T, Oh MK. Urethritis and cervicitis in adolescents. Adolesc Med Clin. Jun 2004;15(2):253-71. [Medline].

  5. Smith KR, Ching S, Lee H, et al. Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic. J Clin Microbiol. Feb 1995;33(2):455-7. [Medline].

  6. [Guideline] Workowski KA, Berman S,. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. Dec 17 2010;59(RR-12):1-110. [Medline].

  7. Sexually transmitted diseases: gonorrhea, Chlamydia trachomatis, pelvic inflammatory disease and syphilis. In: Emans SJ, Laufer MR, Goldstein DP, et al, eds. Pediatric and Adolescent Gynecology. 4th ed. Philadelphia, PA: Lippincott-Raven; 1998:457-504.

  8. Rome ES. Sexually transmitted diseases: testing and treating. Adolesc Med. Jun 1999;10(2):231-41, vi. [Medline].

  9. Stuart GS, Castano PM. Sexually transmitted infections and contraceptives: selective issues. Obstet Gynecol Clin North Am. 30(4):795-808. [Medline].

 
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