Acute cervicitis is usually caused by an infection; chronic cervicitis is usually not caused by an infection. Cervicitis may ascend and cause endometritis and pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. PID may be sexually transmitted... read more (PID).
Etiology of Cervicitis
The most common infectious cause of cervicitis is Chlamydia trachomatis Chlamydial, Mycoplasmal, and Ureaplasmal Mucosal Infections Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis not due to gonorrhea are caused predominantly by chlamydiae and infrequently by mycoplasmas or Ureaplasma sp. Chlamydiae... read more 
, followed by Neisseria gonorrhea Gonorrhea Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent discharge... read more 
; they are sexually transmitted Overview of Sexually Transmitted Diseases Sexually transmitted diseases (STDs), also termed sexually transmitted infections (STIs), can be caused by a number of microorganisms that vary widely in size, life cycle, the diseases and symptoms... read more . Other causes include herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Common severe infections include encephalitis... read more 
(HSV), Trichomonas vaginalis, and Mycoplasma genitalium. Often, a pathogen cannot be identified. The cervix may also be inflamed as part of vaginitis (eg, bacterial vaginosis Bacterial Vaginosis (BV) Bacterial vaginosis is vaginitis due to a complex alteration of vaginal flora in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a gray, thin, fishy-smelling vaginal... read more 
, trichomoniasis Trichomoniasis Trichomoniasis is infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or cause urethritis, vaginitis, or occasionally cystitis, epididymitis, or... read more ).
Noninfectious causes of cervicitis include gynecologic procedures, foreign bodies (eg, pessaries, barrier contraceptive devices), chemicals (eg, in douches or contraceptive creams), and allergens (eg, latex).
Symptoms and Signs of Cervicitis
Cervicitis may not cause symptoms. The most common symptoms are vaginal discharge and vaginal bleeding between menstrual periods or after coitus. Some women have dyspareunia, vulvar and/or vaginal irritation, and/or dysuria.
Examination findings can include purulent or mucopurulent discharge, cervical friability (eg, bleeding after touching the cervix with a swab), and cervical erythema and edema.
Diagnosis of Cervicitis
Clinical findings
Testing for vaginitis and sexually transmitted diseases (STDs)
Cervicitis is diagnosed if women have cervical exudate (purulent or mucopurulent) or cervical friability.
Findings that suggest a specific cause or other disorders include the following:
Fever: pelvic inflammatory disease (PID) or HSV infection
Cervical motion tenderness: PID
Vesicles, vulvar or vaginal pain, and/or ulceration: HSV infection
Punctate hemorrhages (strawberry spots): Trichomoniasis
Women should be evaluated clinically for PID Diagnosis Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. PID may be sexually transmitted... read more and tested for chlamydial infection Diagnosis Sexually transmitted urethritis, cervicitis, proctitis, and pharyngitis not due to gonorrhea are caused predominantly by chlamydiae and infrequently by mycoplasmas or Ureaplasma sp. Chlamydiae... read more and gonorrhea Diagnosis Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent discharge... read more (eg, with polymerase chain reaction [PCR] or culture), bacterial vaginosis Diagnosis Bacterial vaginosis is vaginitis due to a complex alteration of vaginal flora in which lactobacilli decrease and anaerobic pathogens overgrow. Symptoms include a gray, thin, fishy-smelling vaginal... read more , and trichomoniasis Diagnosis Trichomoniasis is infection of the vagina or male genital tract with Trichomonas vaginalis. It can be asymptomatic or cause urethritis, vaginitis, or occasionally cystitis, epididymitis, or... read more .
Treatment of Cervicitis
Usually empiric treatment for chlamydial infection and gonorrhea
At the first visit, most women with acute cervicitis should be treated for chlamydial infection empirically, particularly if they have risk factors for STDs (eg, age < 25, new or multiple sex partners, unprotected sex) or if follow-up cannot be ensured. Women should also be treated empirically for gonorrhea if they have risk factors for STDs, if local prevalence is high (eg, > 5%), or if follow-up cannot be ensured.
Treatment of cervicitis consists of the following:
Chlamydial infection: Azithromycin 1 g orally once or with doxycycline 100 mg orally twice a day for 7 days
Gonorrhea: Ceftriaxone 500 mg IM once for patients weighing < 150 kg (300 lb) or 1g IM once for patients weighing > 150 kg ( > 300 lb) plus azithromycin 1 g orally once (due to emerging resistance of N. gonorrhoeae to cephalosporins)
Once the cause or causes are identified based on the results of microbiologic testing, subsequent treatment is adjusted accordingly.
If cervicitis persists despite this treatment, reinfection with chlamydiae and N. gonorrhoeae should be ruled out, and empiric treatment with moxifloxacin 400 mg orally once a day for 7 to 14 days (eg, for 10 days) should be started to cover possible M. genitalium infection.
If the cause is a bacterial STD, sex partners should be tested and treated simultaneously. Women should abstain from sexual intercourse until the infection has been eliminated from them and their sex partners.
All women with confirmed chlamydial infection or gonorrhea should be tested between 3 and 6 months after treatment because reinfection is common.
Key Points
Acute cervicitis is usually caused by an STD and can presage PID.
Infection may be asymptomatic.
Test women for chlamydial infection, gonorrhea, bacterial vaginosis, and trichomoniasis.
Treat most women for chlamydial infection and gonorrhea at the first visit.
