Medical Care
Therapy for cervicitis depends on the etiologic agent. The Centers for Disease Control and Prevention (CDC) revised their treatment guidelines for sexually transmitted diseases in 2010 [16] ; in 2015, a further update was published. The 2015 CDC guidelines recommended the following for presumptive treatment of cervicitis [17] :
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Azithromycin, 1 g PO in a single dose, or
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Doxycycline, 100 mg PO q12hr for 7 days
Recommendations for treatment of chlamydial infection in adolescents and young adults were as follows [17] :
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Azithromycin, 1 g PO in a single dose, or
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Doxycycline, 100 mg PO q12hr for 7 days
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Alternative regimens - Erythromycin base, 500 mg PO q6hr for 7 days; erythromycin ethylsuccinate, 800 mg PO q6hr for 7 days; levofloxacin, 500 mg PO q24hr for 7 days; ofloxacin, 300 mg PO q12hr for 7 days
Recommendations for treatment of uncomplicated gonococcal infection of the cervix in adolescents and young adults were as follows [17] :
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Ceftriaxone, 250 mg intramuscularly (IM) in a single dose, plus
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Azithromycin, 1 g PO in a single dose
If ceftriaxone is unavailable, the following regimen may be employed instead [17] :
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Cefixime, 400 mg PO in a single dose, plus
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Azithromycin, 1 g PO in a single dose
Cefixime, however, has limited efficacy in the treatment of gonococcal pharyngitis and does not provide a high and sustained bactericidal level as compared with ceftriaxone, the preferred treatment choice.
Acyclovir may be used for primary herpes infection, but it is not curative, and recurrences are common. Valacyclovir and famciclovir are alternatives. [17]
Recommendations for infection by Trichomonas organisms were as follows [17] :
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Metronidazole, 2 g PO in a single dose, or
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Tinidazole, 2 g orally in a single dose
Ensuring that the patient's sexual contacts receive the appropriate examination and treatment is also essential. Most treatment failures are actually reinfections from an untreated sexual partner.
Activity
Advise patients to abstain from sexual activity until test results after therapy are negative and partners are treated. Advise them to use condoms when they resume sexual activity. Dual-method contraceptive use may be considered. [18]
Long-Term Monitoring
Gonococcal cultures are recommended 4-8 weeks after standard treatment or 1 week after alternative regimens are used.
Routine "test of cure" for chlamydial eradication is not indicated after treatment except in pregnant women; however, because of the risk of reinfection, repeat testing is advised fro all women 3-6 months after treatment of cervicitis.
Routine annual screening for chlamydial infection is recommended in all sexually active adolescents because of the high prevalence among asymptomatic females.
Treat sexual partners.
