Cervicitis

Background

Inflammation of the cervix most commonly caused by Chlamydia (about 40%) and Gonorrhea
- Less commonly caused by Trichomonas and HSV-2

Clinical Features

Edematous and reddened cervix.

Mucopurulent endocervical discharge
May see endocervical bleeding easily induced by cotton swab
Frequently asymptomatic
- Women may complain of abnormal vaginal discharge or post-coital vaginal bleeding
Pelvic/Abdominal pain or tenderness to palpation should prompt a diagnosis of pelvic inflammatory disease rather than cervicitis

Differential Diagnosis

Pelvic Pain

Pelvic origin

Abdominal origin

Evaluation

Swab (for GC, Chlamydia)
- Patient-obtained vaginal swabs are MORE sensitive than clinician-collected endocervical swabs for GC/Chlamydia[1][2]
Wet mount
Urine pregnancy test

Management

Treatment covers both gonorrhea and chlamydia

Uncomplicated Infection

Ceftriaxone 250mg IM once PLUS
- Azithromycin 1g PO once OR
- Doxycycline 100mg PO BID x 14 days (7 days for gonorrhea, 14 days for chlamydia)[3]

Cephalosporin Allergy

Azithromycin 2g PO once PLUS
- Gentamicin 240mg IM once[4]
- In theory this high dose macrolide will provide treatment for both GC and Chlamydia

Partner treatment

Cefixime 400mg PO once PLUS
- Azithromycin 1g PO once OR
- Doxycycline 100mg PO BID x 7 days

Associated Bacterial Vaginosis or Trichomonas vaginalis

Non-Pregnant

Metronidazole 2g PO once OR 500mg PO BID for 7 days [5]
Tinidazole 2g PO once

Pregnant

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

Metronidazole 2g PO once[6]

Sexual Partner Treatment

Metronidazole 500mg PO BID x 7 days OR
Tinidazole 2g PO once

Women with HIV Infection

Metronidazole 500 mg PO BID x 7 days[7]

Disposition

Discharge

External Links

http://www.cdc.gov/std/treatment/2010/urethritis-and-cervicitis.htm

References

Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.
2015 CDC guidelines
CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines
Kissinger P et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: An open-label, randomised controlled trial. Lancet Infect Dis 2018 Oct 5; [e-pub].
CDC Trichomoniasis 2015. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59(No. RR-12)

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[1] Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.

[2] Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.

[3] 2015 CDC guidelines

[4] CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines

[5] Kissinger P et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: An open-label, randomised controlled trial. Lancet Infect Dis 2018 Oct 5; [e-pub].

[6] CDC Trichomoniasis 2015. https://www.cdc.gov/std/tg2015/trichomoniasis.htm

[7] CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59(No. RR-12)