Therapy Regimens

CDC guidelines for the treatment of cervicitis

In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections.^[1]

Empiric therapeutic regimens for cervicitis are outlined below, including presumptive treatment, treatment for recurrent and persistent cervicitis, and treatment for pregnant patients with nongonococcal cervicitis.^{[2, 3, 4, 5, 6]}

Presumptive treatment for cervicitis

Recommended regimen:

Doxycycline 100 mg orally BID for 7days (contraindicated during the second and third trimesters of pregnancy)

Alternative regimen:

Azithromycin 1 g orally in a single dose

Concurrent therapy for gonococcal infection should be considered if the patient is at risk for gonorrhea or lives in a community with a high prevalence of gonorrhea:

Ceftriaxone 250 mg IM in a single dose (strongly preferred)

The following regimens are safe and effective for the treatment of gonococcal infections, but offer no advantages over ceftriaxone:

Ceftizoxime 500 mg IM in a single dose or
Cefotaxime 500 mg IM in a single dose or
Cefoxitin 2 g IM plus probenecid 1 g PO in a single dose

If ceftriaxone can not be used:

Gentamicin 240 mg IM in a single dose plus
Azithromycin 2 g orally in a single dose
Oral cephalosporins are no longer a recommended treatment for gonococcal infections^[4]
Fluoroquinolones should not be used as empiric therapy because of increasing resistance of Neisseria gonorrhoeae isolates^[3]

Women who have received treatment for cervicitis should be advised to avoid sexual intercourse until they and their partners have been treated (ie, until completion of a 7-day regimen or for 7 days after single-dose therapy) and all symptoms have resolved.

Recurrent and persistent cervicitis

Reevaluate for possible reexposure to a sexually transmitted disease, and reassess the patient for potential bacterial vaginosis. It is important to assess, manage, and treat partners. Management of persistent cervicitis of unknown etiology is undefined. Tesing for Mycoplasma genitalium should be considered.

Management of pregnant patients with nongonococcal cervicitis

The regimens are as follows:

Azithromycin 1 g orally in a single dose or
Amoxicillin 500 mg orally TID for 7d
Doxycycline and fluoroquinolones are contraindicated during pregnancy

Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for cervicitis are provided below, including those for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis.^{[1, 2, 3, 4]}

Neisseria gonorrhoeae (gonococcal cervicitis)

Recommendations are as follows:

Ceftriaxone 250 mg IM in a single dose (strongly preferred)

If ceftriaxone is not available or patient has severe cephalosporin allergy:

Azithromycin 2 g orally in a single dose plus
Gentamicin 240 mg IM in a single dose

A test of cure is not required for any patient treated with the recommended or alternative therapy. Treatment failure should be considered in persons whose symptoms do not resolve within 3–5 days after appropriate treatment, when no sexual contact is reported during the post-treatment follow-up period. Before retreatment, relevant clinical specimens should be obtained for culture and antimicrobial susceptibility testing if N gonorrhoeae is isolated

Chlamydia trachomatis

Recommended regimen:

Doxycycline 100 mg orally BID for 7 days

Alternative regimens:

Azithromycin 1 g orally in a single dose or
Levofloxacin 500 mg orally once daily for 7 days

Mycoplasma genitalium

Recommendations when resistance testing is available:

If macrolide sensitive - Doxycycline 100 mg orally BID for 7 days, followed by azithromycin 1 g orally for one single dose then 500 mg orally daily for 3 additional days
If macrolide resistant - Doxycycline 100 mg orally BID for 7 days, followed by moxifloxacin 400 mg orally daily for 7 days

Recommendation when resistance testing is NOT available:

If macrolide resistant - Doxycycline 100 mg orally BID for 7 days, followed by moxifloxacin 400 mg orally daily for 7 days

Trichomonas vaginalis

Recommendations are as follows:

Metronidazole 500 mg orally twice a day for 7 days or
Tinidazole 2 g orally in a single dose

* Patients should be advised to avoid consuming alcohol during treatment with metronidazole or tinidazole. Abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.