Cervicitis

Organism

Cervicitis (inflammation of the cervix) is considered the female equivalent of non-specific urethritis (NSU), although it may be a finding on clinical examination. Cervicitis is defined as >30 WBC/HPF, plus inflammation and/or a discharge. The cervix may be friable.

Clinical presentation

Symptoms

The symptoms of cervicitis are:

  • low abdominal pain
  • vaginal discharge
  • pain on sexual intercourse
  • a burning sensation on passing urine
  • contact bleeding from cervix.

Signs

The signs of cervicitis are:

  • endocervical discharge
  • cervical tenderness on examination
  • friable cervix.
Investigations
  • Endocervical specimens are essential. Mop ectocervix with cotton wool prior to taking specimens to avoid contamination with vaginal flora.
  • Endocervical microscopy – >30 WBC/HPF in the absence of gonococci.
  • Endocervical culture for gonorrhoea and other organisms.
  • Endocervical NAAT for chlamydia.
  • First void urine for NAAT for gonorrhoea and chlamydia.
  • Vaginal microscopy, and culture, to exclude other causes of discharge, eg candidiasis, bacterial vaginosis, T. vaginalis, anaerobes.
  • Consider HSV as a cause of cervicitis.
  • Consider endocervical mycoplasma culture or NAAT.
  • Added STI screen – treponemal serology, and HIV and HBV antibody.
Treatment

Adult

  • Azithromycin 1 g orally, as a single dose followed by:
    • doxycycline 100 mg orally, 12-hourly for 10 days

            or

    • erythromycin ethyl succinate 800 mg orally, 12-hourly for 10 days

            or

    • roxithromycin 300 mg orally, daily for 10 days.
  • Consider treatment for gonorrhoea in areas where this infection is common.

Pregnancy or breastfeeding

Management of partners

Sexual partners should be tested and treated for presumed NSU.

Follow-up

Until post-treatment review ask patients to avoid unprotected sexual intercourse. Review at one to two weeks after cessation of treatment and:

  • assess resolution of signs and symptoms
  • review success of contact tracing.

For patients with a positive chlamydia culture, the test of cure should be done four weeks after being treated to avoid detection on residual killed organisms on NAAT. (No unprotected intercourse should occur in the meantime).

Public health issues

This is not a notifiable disease, unless a specific cause is found.

Contact tracing and further counselling are important.

Always test for other STIs.