Cervicitis

Key Features

• In most cases, no organism is isolated

• Most common causes include Chlamydia trachomatis or Neisseria gonorrhoeae

• Herpes simplex virus, Trichomonas vaginalis, and Mycoplasma genitalium are less common causes

• Bacterial vaginosis is recognized as a cause

• Cervicitis can also be present without a sexually transmitted infection

Clinical Findings

• Characterized by

  • Purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab

  • Easily induced bleeding with the passage of a cotton swab through the cervical os

• Often asymptomatic, but many patients have an abnormal vaginal discharge or postcoital bleeding

Diagnosis

• Although endocervical Gram stain may show an increased number of polymorphonuclear leukocytes, it has a low positive predictive value and is not recommended for diagnosis

• Patients with cervicitis should be tested for C trachomatis, N gonorrhoeae, and trichomoniasis by using the most sensitive and specific tests available

Treatment

• Azithromycin, 1 g orally as single dose

• Doxycycline, 100 mg orally twice a day for 7 days

• Ceftriaxone, 250 mg intramuscularly as single dose plus azithromycin, 1 g orally as single dose