Background
Cervicitis is inflammation of the cervix, caused by a sexually transmitted bacterial infection. [1] Patients usually present with cervical erythema and discharge. Primary morbidity results from ascending infection to the uterus and fallopian tubes (pelvic inflammatory disease [PID]) that leads to chronic abdominal pain and infertility. The prognosis is excellent when the patient is compliant.
Pathophysiology
Infection of the cervix results in inflammation and may be accompanied by vulvovaginitis. Mucopurulent cervicitis is a clinical diagnosis, one typically characterized by friability of the cervix, mucopurulent discharge from the os, and increased numbers of polymorphs in endocervical secretions. [2, 3] An ascending infection can cause endometritis, salpingitis, tubo-ovarian abscess, or perihepatitis.
Etiology
Gonorrheal and chlamydial infections
The most common causative organisms are Neisseria gonorrhoeae and Chlamydia trachomatis. [4] Gonococcal and chlamydial cervicitis may be associated with upper genital tract infection. Patients with gonorrhea may have associated urethritis. [5] Patients with chlamydial infections are often asymptomatic. More recent studies have focused on diagnosis and treatment of cervicitis of unknown etiology. [6, 7]
Other bacterial pathogens
Other bacterial pathogens implicated in cervicitis and upper genital infections include Mycoplasma genitalium, [8] Ureaplasma urealyticum and parvum, and anaerobes such as Streptococcus, [9] Peptostreptococcus, and Bacteroides species. Other sexually transmitted infections, such as those caused by Trichomonas species, herpes simplex virus, and human papilloma virus, may also be associated with cervicitis.
Although an uncommon finding, Trichomonas vaginalis is known to cause multiple punctate hemorrhages and swollen papillae in the cervix, giving it a strawberry appearance. This causes the cervix to become friable and bleed easily on touch.
Herpetic cervicitis may be associated with multiple ulcerations.
Epidemiology
In the United States, the prevalence of chlamydial infection is 5-15% in sexually active teenagers and young adults who are asymptomatic. [10] The prevalence increases to almost 50% in symptomatic patients; however, the incidence of gonorrhea has declined steadily over the past 20 years. [11] Adolescents and young adults continue to have the highest rates of infection, with a transmission risk of 20-50% per sexual contact. The incidence of coinfection with both gonorrheal and chlamydial organisms may be 15-20%.
C trachomatis is the most prevalent bacterial pathogen that causes sexually transmitted infections worldwide. According to the World Health Organization (WHO), 50-70 million cases occur each year.
Compared with older populations, sexually active adolescents and young adults have a higher incidence of both chlamydial and gonococcal cervicitis.
Patient Education
Patients should be instructed to avoid sexual intercourse until treatment efficacy is confirmed. They should also be instructed in how to prevent reinfection by using condoms. [12]
Prevention counseling should be recommended to patients with sexually transmitted infections. Screening for other diseases, including HIV infection and syphilis, should be recommended as well.
For patient education resources, see the Women's Health Center, as well as Cervicitis.
