Diagnostic Considerations
Screen for sexually transmitted infections (STIs), particularly C trachomatis and N gonorrhoeae, in patients who present with symptoms of an STI. In high-risk patients, consider screening for HIV, syphilis, and hepatitis B.
Consider also the possibility of a retained foreign body (eg, tampon, condom), or, in a young adolescent or child, sexual abuse, and notify the proper authorities if abuse is suspected. Other conditions to consider in the differential diagnosis of cervicitis include the following:
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Endometritis
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Nonbacterial cystitis
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Ectopic pregnancy
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Trigonitis
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Adnexal tumors
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Benign/malignant ovarian lesions
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Malignant vulvar lesions
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Uterine cancer
In women of childbearing age, always perform a urine pregnancy test before prescribing any medication.
Differential Diagnoses
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Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
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Cystitis, Nonbacterial
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Normal cervix
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Cervix of a lactating woman without sexually transmitted infections. The patient had twice given birth vaginally.
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Cervical cellularity (ectopy), which is often present in adolescents, allows for greater adherence of infectious organisms in the cervix. The risk of acquiring acute salpingitis for a sexually active 15-year-old is 1:8, compared with 1:80 for women aged 24 years and older.
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Signs of chlamydial cervicitis on speculum examination may include mucopurulent endocervical discharge and spontaneous or easily induced endocervical bleeding or any zones of ectopy.
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In women with gonococcal cervicitis, the cervix may show mucopurulent or purulent cervical discharge and easily induced cervical bleeding.
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Herpes simplex virus (HSV) cervicitis may involve the exocervix or endocervix, and it may be symptomatic or asymptomatic. Usually, the cervix appears abnormal to inspection, with diffuse vesicular lesions, ulcerative lesions, erythema, or friability.
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T vaginalis can have a characteristic "frothy" gray or yellow-green vaginal discharge and pruritus. The occurrence of cervical petechiae, or "strawberry cervix," is a classic presentation that is seen in less than 2% of cases. T vaginalis may also infect the Skene glands and the urethra and may be asymptomatic in women.
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Papanicolaou (Pap) stain, high power, showing the Herpes simplex virus (HSV) infecting cells with multiple nuclei, intranuclear inclusions, and margination of the chromatin to the outer portion of the nuclei.
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Pap stain, high power, showing human papillomavirus (HPV) infecting a cell with a dark, wrinkled nucleus surrounded by a clear cytoplasmic halo.
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Pap stain, high power (under oil immersion), showing 2 pear-shaped structures representing Trichomonas. Small, pale nuclei and cytoplasmic granules are present.