Introduction
Background
Cervicitis is inflammation of the cervix. Patients usually present with cervical erythema and discharge.
Pathophysiology
Cervicitis is caused by a sexually transmitted bacterial infection. Infection of the cervix results in inflammation and may be accompanied by vulvovaginitis. Mucopurulent cervicitis is a clinical diagnosis, one typically characterized by friability of the cervix, mucopurulent discharge from the os, and increased numbers of polymorphs in endocervical secretions.1 An ascending infection can cause endometritis, salpingitis, tuboovarian abscess, or perihepatitis.
Frequency
United States
In the United States, the prevalence of chlamydial infection is 5-15% in sexually active teenagers and young adults, who are asymptomatic.2 The prevalence increases to almost 50% in symptomatic patients; however, the incidence of gonorrhea has declined steadily over the last 20 years.3 Adolescents and young adults continue to have the highest rates of infection, with a transmission risk of 20-50% per sexual contact. The incidence of co-infection with both gonorrheal and chlamydial organisms may be 15-20%.
International
Chlamydia trachomatis is the most prevalent bacterial pathogen that causes sexually transmitted infections worldwide. According to the World Health Organization (WHO), 50-70 million cases occur each year.
Mortality/Morbidity
Primary morbidity results from ascending infection to the uterus and fallopian tubes (pelvic inflammatory disease) that leads to chronic abdominal pain and infertility.
Age
Compared with older populations, sexually active adolescents and young adults have a higher incidence of both chlamydial and gonococcal cervicitis.
Clinical
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 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.
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
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 anaerobes, such as Streptococcus, Peptostreptococcus, and Bacteroides species. Other sexually transmitted infections, such as those caused by Trichomonas species and herpes simplex virus, also may be associated with cervicitis.
- Trichomonas infection may result in a friable cervix with prominent papillae and punctate hemorrhages (ie, strawberry cervix). 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.
More on Cervicitis |
 Overview: Cervicitis |
| Differential Diagnoses & Workup: Cervicitis |
| Treatment & Medication: Cervicitis |
| Follow-up: Cervicitis |
| References |
| Next Page » |
References
Marrazzo JM. Mucopurulent cervicitis: no longer ignored, but still misunderstood. Infect Dis Clin North Am. Jun 2005;19(2):333-49, viii. [Medline].
Darville T. Chlamydia. Pediatr Rev. Mar 1998;19(3):85-91. [Medline].
Darville T. Gonorrhea. Pediatr Rev. Apr 1999;20(4):125-8. [Medline].
Simpson T, Oh MK. Urethritis and cervicitis in adolescents. Adolesc Med Clin. Jun 2004;15(2):253-71. [Medline].
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].
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].
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].
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.
Rome ES. Sexually transmitted diseases: testing and treating. Adolesc Med. Jun 1999;10(2):231-41, vi. [Medline].
Stuart GS, Castano PM. Sexually transmitted infections and contraceptives: selective issues. Obstet Gynecol Clin North Am. 30(4):795-808. [Medline].
Further Reading
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
