eMedicine Specialties > Pediatrics: Surgery > Gynecology

Cervicitis: Treatment & Medication

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

Treatment

Medical Care

  • Establishing the etiologic agent is a key to successful treatment (see Medication).
  • Ensuring that the patient's sexual contacts receive the appropriate examination and treatment is also essential.
  • Most treatment failures are actually reinfections from an untreated sexual partner.

Activity

Advise patients to abstain from sexual activity until test results after therapy are negative and partners are treated. Advise them to use condoms when they resume sexual activity.

Medication

The Centers for Disease Control and Prevention (CDC) revised their treatment guidelines for sexually transmitted diseases in 2006.6 Therapy for cervicitis depends on the etiologic agent. Ceftriaxone is the recommended drug for gonorrhea; doxycycline is recommended for chlamydial cervicitis. Other effective antibiotics for treatment of gonorrheal disease include cefixime 400 mg. All are administered as single PO doses. For chlamydial infections, azithromycin 1 g PO as a single dose is an acceptable alternative to doxycycline 100 mg PO bid for 7 days.

Alternatives for patients presenting with ceftriaxone allergy include spectinomycin, ciprofloxacin, or norfloxacin. Fluoroquinolones are not approved by the US Food and Drug Administration (FDA) for use in children younger than 18 years and are no longer recommended for gonorrhea in the United States because of increased resistance. Erythromycin is recommended for patients with chlamydial infections who are unable to take doxycycline. A single dose of azithromycin 1 g PO is also highly effective for treatment of chlamydial disease. If a patient has clinical cervicitis, both ceftriaxone and azithromycin are recommended as empirical treatment. Acyclovir may be used for primary herpes infection, but it is not curative, and recurrences are common. Metronidazole is the drug of choice for infection by Trichomonas organisms.

In April 2007, the CDC updated treatment guidelines for gonococcal infection and associated conditions.7 Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose). Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented. For more information, see the CDC's Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.

Antibiotics

Testing to determine the specific microorganism causing the infection is recommended because both chlamydial and gonococcal infections are reportable to state health departments. If diagnostic tools (eg, Gram stain, microscope) are unavailable, treat patients for both infections.


Ceftriaxone (Rocephin)

First choice for treatment for gonococcal cervicitis.

Adult

125 mg IM as single dose

Pediatric

Administer as adults

Concurrent use with furosemide or aminoglycosides may increase renal toxicity; decreases efficacy of PO contraceptives

Documented hypersensitivity; hyperbilirubinemic neonates

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution with history of penicillin allergy; mix with lidocaine 1% to decrease injection pain; reversible sonographic gallbladder anomalies reported


Doxycycline (Bio-Tab, Vibramycin, Doryx)

Treatment of choice for chlamydial cervicitis.

Adult

100 mg PO bid for 7 d

Pediatric

<8 years: Contraindicated
>8 years: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate (administer doxycycline 1 h before or 2 h after); tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of PO contraceptives, causing breakthrough bleeding and increasing risk of pregnancy; barbiturates, rifampin, phenytoin, or carbamazepine induce metabolism of doxycycline; milk or dairy products, calcium, and iron may decrease doxycycline absorption; administer 1 h before or 2-3 h after milk, dairy products, or iron ingested

Documented hypersensitivity; severe hepatic dysfunction; pregnancy

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May cause photosensitivity (avoid prolonged exposure to sunlight or tanning equipment); associated with retardation of skeletal development in infants; use during tooth development (last half of pregnancy through age 8 y) can permanently discolor teeth


Metronidazole (Flagyl)

Synthetic antimicrobial agent active against most obligate anaerobes. Used in Trichomonas infection.

Adult

2 g PO as single dose

Pediatric

15 mg/kg/d PO divided q8h for 7 d; not to exceed 1 g/d

May increase toxicity of anticoagulants, lithium, and phenytoin; cimetidine may increase toxicity of metronidazole; disulfiram reaction may occur with PO ingested ethanol

Documented hypersensitivity; first trimester of pregnancy

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Pregnancy category X in first trimester; caution in breastfeeding and later stages of pregnancy; adjust dose in patients with hepatic disease; monitor for seizures and development of peripheral neuropathy; blood dyscrasias have been reported rarely


Azithromycin (Zithromax)

Macrolide antibiotic for treatment of C trachomatis infection.

Adult

1 g PO as single dose 1 h ac or 2 h pc

Pediatric

10 mg/kg PO as single dose; not to exceed 1 g/dose

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution with hepatic dysfunction


Cefixime (Suprax)

Effective PO for treating gonococcal cervicitis. Arrests bacterial cell-wall synthesis and inhibits bacterial growth by binding to one or more penicillin-binding protein.

Adult

400 mg PO as single dose

Pediatric

<45 kg: 8 mg/kg PO as single dose
>45 kg: Administer as in adults

Coadministration of aminoglycosides increases nephrotoxicity; probenecid may increase effects of cefixime

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy; cross sensitivity exists with penicillins; administer with food to minimize adverse GI effects


Spectinomycin (Trobicin)

Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit and structurally different from related aminoglycosides. Alternative antimicrobial in to treat urethral, endocervical, or rectal gonococcal infections in patients who cannot take cephalosporins or fluoroquinolones. Can be administered to pregnant women allergic to cephalosporins.

Adult

2 g IM as single dose

Pediatric

<45 kg and cannot tolerate ceftriaxone: 40 mg/kg IM as single dose; not to exceed 2 g/dose
>45 kg and cannot tolerate ceftriaxone: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Benzyl alcohol used as diluent associated with fatal gasping syndrome in infants; antibiotics may mask or delay symptoms of incubating syphilis; perform serologic testing for syphilis in all patients with gonorrhea at time of diagnosis followed by additional testing after 3 mo; monitor clinical effects to detect resistance by N gonorrhea

More on Cervicitis

Overview: Cervicitis
Differential Diagnoses & Workup: Cervicitis
Treatment & Medication: Cervicitis
Follow-up: Cervicitis
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.