Guidelines Summary
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. [2] These are some of the highlights of the recommendations for presumptive therapy for cervicitis.
The recommended treatment regimen for cervicitis is as follows:
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Doxycycline 100 mg orally 2 times per day for 7 days
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.
The alternative treatment regimen for cervicitis is as follows:
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Azithromycin 1 g orally in a single dose
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.
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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.
