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:

Endometritis
Nonbacterial cystitis
Ectopic pregnancy
Trigonitis
Adnexal tumors
Benign/malignant ovarian lesions
Malignant vulvar lesions
Uterine cancer

In women of childbearing age, always perform a urine pregnancy test before prescribing any medication.

Differential Diagnoses

Workup

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Media Gallery

Normal cervix
Cervix of a lactating woman without sexually transmitted infections. The patient had twice given birth vaginally.
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.
Signs of chlamydial cervicitis on speculum examination may include mucopurulent endocervical discharge and spontaneous or easily induced endocervical bleeding or any zones of ectopy.
In women with gonococcal cervicitis, the cervix may show mucopurulent or purulent cervical discharge and easily induced cervical bleeding.
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.
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.
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.
Pap stain, high power, showing human papillomavirus (HPV) infecting a cell with a dark, wrinkled nucleus surrounded by a clear cytoplasmic halo.
Pap stain, high power (under oil immersion), showing 2 pear-shaped structures representing Trichomonas. Small, pale nuclei and cytoplasmic granules are present.

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Author

Arthur T Ollendorff, MD Associate Dean for Graduate Medical Education, Professor of Obstetrics/Gynecology, Virginia Tech Carilion School of Medicine

Arthur T Ollendorff, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North Carolina Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

Acknowledgements

A David Barnes, MD, PhD, MPH, FACOG Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)

A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association

Disclosure: Nothing to disclose.

Jeffrey B Garris, MD Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine

Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Sabrina R Kendrick, MD, FACP Assistant Professor, Department of Internal Medicine, Rush University Medical Center; Director, Screening Clinic, The CORE Center; Consulting Staff, Division of Infectious Diseases, John H Stroger Hospital of Cook County

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Anita B Varkey, MD Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center

Anita B Varkey, MD is a member of the following medical societies: American College of Physicians and Society of General Internal Medicine

Disclosure: Nothing to disclose.