eMedicine Specialties > Pediatrics: Surgery > Gynecology

Cervicitis: Differential Diagnoses & Workup

Author: Latha Chandran, MD, MPH, Associate Professor of Pediatrics, Associate Dean for Academic Affairs, Director, Division of General Pediatrics, State University of New York at Stony Brook School of Medicine
Contributor Information and Disclosures

Updated: Mar 6, 2008

Differential Diagnoses

Child Abuse & Neglect: Sexual Abuse
Chlamydial Infections
Gonorrhea

Other Problems to Be Considered

Other causes of vaginal discharge

Physiologic leukorrhea
Vaginitis
Vaginal foreign body
Cervical ectropion
Bacterial vaginosis

Consider associated pelvic inflammatory disease, perihepatitis, or both.

Consider sexual abuse if gonococcal or chlamydial cervicitis is detected in the prepubertal child.

Workup

Laboratory Studies

  • Traditional tests
    • Wet mount of the discharge usually demonstrates more than 5 WBCs per high-power field. Most practice guidelines recommend a threshold of 10-30 polymorphonuclear (PMN) leukocytes per high-power field to support the diagnosis of mucopurulent cervicitis. However, inflammation alone is not considered presumptive evidence of chlamydial infection.
    • Gram stains of the cervical mucopus may reveal gram-negative intracellular diplococci in cases of gonorrhea. Culturing in modified Thayer-Martin medium is the criterion standard for confirming gonorrhea.
    • Enzyme-linked immunosorbent assay or direct fluorescent antibody testing is often used to detect chlamydial infection. DNA probes with 90-97% sensitivity are also available for the simultaneous detection of gonococcal and chlamydial organisms.
    • When indicated, chlamydial cultures are performed on McCoy cells (evaluations in prepubertal children in whom sexual abuse is suspected, testing response to therapy in a previously treated infection).
  • Newer tests
    • Several highly specific and sensitive tests have been developed. These nucleic acid amplification tests (NAATs) include the polymerase chain reaction (PCR), the ligase chain reaction (LCR),5 and transcription-mediated amplification (TMA). Probes used in these tests are at least 20% more sensitive than the earlier DNA probes and are the tests of choice.
    • PCR and LCR testing consists of amplification of specific DNA sequences, while TMA testing is an RNA amplification assay.
    • Although endocervical specimens are preferred, these tests may be easily performed on first-void morning urine samples. Urine NAATs are highly sensitive for the diagnosis of endocervical chlamydial infection.

Other Tests

  • Because of the possible association between bacterial vaginosis and mucopurulent cervicitis, perform NAATs and look for Amsel criteria for the diagnosis of bacterial vaginosis
  • Three of the following 4 criteria suffices:
    • Homogenous vaginal discharge
    • Vaginal fluid pH greater than 4.5
    • Clue cells greater than 20% of total vaginal epithelial cells on 100X magnification
    • Amine odor on addition of potassium hydroxide to vaginal fluid

More on Cervicitis

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

  7. 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].

  8. 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.

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

  10. 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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Further Reading

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Keywords

cervicitis, cervix, gonococcal cervicitis, chlamydial cervicitis, vaginal discharge, sexually transmitted disease, STD, cervical infection, cervical inflammation, cervical erythema, vulvovaginitis, endometritis, salpingitis, tubo-ovarian abscess, perihepatitis, gonorrhea, Neisseria gonorrhea, Chlamydia trachomatis, C trachomatis, Neisseria gonorrhea, N gonorrhea vaginal bleeding, PID, pelvic inflammatory disease

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Contributor Information and Disclosures

Author

Latha Chandran, MD, MPH, Associate Professor of Pediatrics, Associate Dean for Academic Affairs, Director, Division of General Pediatrics, State University of New York at Stony Brook School of Medicine
Latha Chandran, MD, MPH is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth Alderman, MD, Director of Fellowship Training Program, Director, Adolescent Ambulatory Service, Clinical Professor, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
Elizabeth Alderman, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
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.

CME Editor

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

Maureen Strafford, MD, Arnold P Gold Foundation Associate Professor, Departments of Anesthesiology and Pediatrics, Tufts University and Tufts-New England Medical Center
Maureen Strafford, MD is a member of the following medical societies: American Medical Women's Association, American Pain Society, American Society of Anesthesiologists, International Anesthesia Research Society, Society for Education in Anesthesia, Society for Pediatric Anesthesia, and Society of Cardiovascular Anesthesiologists
Disclosure: Nothing to disclose.

 
 
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