Cervicitis is a common yet often underdiagnosed condition characterized by inflammation of the cervix, the lower portion of the uterus that connects to the vagina. While it may be asymptomatic in many individuals, cervicitis can cause vaginal discharge, intermenstrual or postcoital bleeding, pelvic discomfort, and pain during sexual intercourse. This condition not only affects reproductive health but can also increase susceptibility to sexually transmitted infections (STIs) and lead to complications such as pelvic inflammatory disease (PID) and infertility if untreated. 

Cervicitis can arise from infectious and non-infectious causes. The most frequent infectious agents are Chlamydia trachomatis and Neisseria gonorrhoeae, but other pathogens, irritants, and immune responses may also contribute. Understanding its causes, symptoms, and management is essential to prevent long-term reproductive complications and transmission of infection. 

Cervicitis refers to inflammation of the cervix, involving both the endocervical canal and ectocervix. Histologically, it is characterized by the presence of neutrophils, lymphocytes, and mucopurulent discharge with epithelial erosion. Clinically, cervicitis is often diagnosed based on: 

• Mucopurulent or purulent endocervical discharge 

• Cervical friability (bleeding when touched) 

Two primary forms are recognized: 

• Acute cervicitis: Usually infectious, with noticeable inflammation and discharge. 

Chronic cervicitis: Low-grade or persistent inflammation, often with mild or absent symptoms. 

Cervicitis is one of the most frequent gynecological diagnoses worldwide, especially among women of reproductive age. In STI clinics, cervicitis accounts for 40–60% of visits related to genital symptoms. Up to half of women with Chlamydia trachomatis infection have associated cervicitis. 

Risk factors include: 

• Multiple sexual partners or new partner 

• Unprotected intercourse 

• Age under 25 years 

• Prior STI history 

• High-risk sexual behavior 

As many cases are asymptomatic, cervicitis contributes significantly to STI transmission and chronic reproductive tract complications. Routine screening and education remain vital for prevention. 

Infectious causes 

Most cases result from infectious agents, particularly sexually transmitted pathogens: 

• Chlamydia trachomatis (most common cause) 

• Neisseria gonorrhoeae 

• Mycoplasma genitalium (increasingly recognized) 

• Trichomonas vaginalis 

• Herpes simplex virus (HSV) 

Non-sexually transmitted infections can also contribute: 

• Gardnerella vaginalis and anaerobes (from bacterial vaginosis) 

• Candida species (secondary cervical irritation) 

• Cytomegalovirus, particularly in immunocompromised patients 

Non-infectious causes 

Non-infectious cervicitis can arise from: 

• Chemical irritants: douching, spermicides, or latex allergy 

• Mechanical trauma: sexual activity, IUD insertion, or cervical instrumentation 

• Radiation therapy affecting pelvic tissues 

• Autoimmune or inflammatory responses (rare) 

Infectious cervicitis begins with the colonization of cervical epithelial cells by pathogens such as Chlamydia or Gonorrhea. These organisms adhere to and invade the mucosal epithelium, causing cellular injury and triggering inflammation. Cytokine release leads to mucosal damage, increased mucus production, and friability. Over time, the disruption of cervical barriers facilitates the spread of infection to the uterus, fallopian tubes, and ovaries, resulting in PID. 

In non-infectious cervicitis, direct irritation or trauma provokes a localized inflammatory response without microbial invasion. Persistent exposure to irritants or foreign materials can perpetuate chronic inflammation. 

Cervicitis presents with variable symptoms depending on the cause and severity. Many individuals are asymptomatic, but when symptoms occur, they often include: 

• Abnormal vaginal discharge (mucopurulent or purulent) 

• Intermenstrual or postcoital bleeding 

• Pelvic or lower abdominal pain 

• Pain during intercourse (dyspareunia) 

• Vaginal itching or irritation 

• Dysuria, especially if urethritis coexists 

Physical examination findings 

During a speculum exam, the cervix may appear erythematous, edematous, and friable. A mucopurulent discharge is often seen exuding from the cervical os. Gentle swabbing may cause bleeding. Ectropion (eversion of the endocervical epithelium) may also be visible. In cases progressing to PID, cervical motion tenderness or adnexal tenderness may be observed during bimanual examination. 

Clinical diagnosis 

Cervicitis can be diagnosed based on the presence of: 

• Purulent or mucopurulent discharge 

• Cervical friability upon gentle manipulation 

However, laboratory testing is necessary to identify the underlying cause. 

Laboratory evaluation 

• NAATs (Nucleic Acid Amplification Tests): Gold standard for Chlamydia trachomatis and Neisseria gonorrhoeae. 

• Testing for Mycoplasma genitalium: Recommended in persistent or recurrent cases. 

• Wet mount microscopy: For Trichomonas vaginalis. 

• HSV PCR or culture: If herpes cervicitis is suspected. 

• Vaginal pH and whiff test: To evaluate for bacterial vaginosis. 

• HIV and syphilis screening: Routine in all STI evaluations. 

Conditions that mimic cervicitis include: 

• Vaginitis (bacterial vaginosis, candidiasis, trichomoniasis) 

• Cervical ectropion (physiological eversion) 

• Cervical polyps or malignancy 

• Pelvic inflammatory disease (PID) 

Accurate diagnosis ensures appropriate management and prevents overtreatment. 

General principles 

• Identify and treat the causative organism. 

• Initiate empirical treatment in high-risk cases while awaiting test results. 

• Treat sexual partners to prevent reinfection. 

• Abstain from sexual activity until treatment is complete and symptoms resolve. 

Pharmacologic treatment 

Empirical therapy: 

• Azithromycin 1 g orally in a single dose or Doxycycline 100 mg twice daily for 7 days (for Chlamydia). 

• Plus Ceftriaxone 500 mg intramuscularly once (for Gonorrhea). 

Targeted therapy: 

• Mycoplasma genitalium: Moxifloxacin 400 mg daily for 7–14 days. 

• Trichomonas vaginalis: Metronidazole 2 g orally single dose or 500 mg twice daily for 7 days. 

• HSV cervicitis: Acyclovir 400 mg three times daily for 7–10 days. 

Supportive management 

• Analgesics for pelvic discomfort. 

• Treatment of concurrent vaginal infections. 

• Counseling on safe sexual practices. 

Follow-up care 

• Test of cure for Chlamydia in pregnant patients or persistent infection. 

• Re-screen for STIs after 3 months due to reinfection risk. 

• Evaluate for PID if symptoms persist. 

If untreated, cervicitis can result in serious reproductive health complications: 

• Pelvic inflammatory disease (PID) 

• Infertility from tubal scarring 

• Ectopic pregnancy due to tubal damage 

• Chronic pelvic pain 

• Increased HIV transmission risk 

Adverse pregnancy outcomes (preterm labor, low birth weight) 

With prompt and appropriate treatment, cervicitis usually resolves without lasting effects. The prognosis depends on early detection, adherence to therapy, partner treatment, and avoidance of reinfection. Delayed diagnosis or untreated infection can lead to long-term reproductive consequences. 

Preventing cervicitis involves promoting safe sexual behavior and regular screening: 

• Consistent condom use 

• Limiting sexual partners 

• Routine STI testing, especially for women under 25 or at high risk 

• Early treatment of detected infections 

• Partner notification and treatment 

• Avoiding vaginal douching and irritant products 

• Regular gynecologic exams for early detection 

Public Health Considerations

Cervicitis significantly contributes to STI transmission and reproductive morbidity. Public health measures should focus on: 

• Comprehensive sexual health education 

• Accessible STI screening and treatment programs 

• Destigmatization of reproductive health conditions 

• Community outreach targeting high-risk groups 

Research continues to advance understanding and management of cervicitis, focusing on: 

• Rapid diagnostic tests for Chlamydia, Gonorrhea, and Mycoplasma genitalium 

• Development of a Chlamydia trachomatis vaccine 

• The role of the vaginal microbiome in cervicitis susceptibility 

• Addressing antibiotic resistance in Neisseria gonorrhoeae 

• Evaluating prevention programs for reducing PID and infertility 

Cervicitis is a prevalent yet often silent condition that can have profound reproductive health consequences if unrecognized. Early detection, accurate diagnosis, and effective treatment are crucial to prevent complications and interrupt transmission of STIs. A multidisciplinary approach involving primary care, gynecology, infectious disease specialists, and public health initiatives can significantly reduce the burden of cervicitis and improve women’s health outcomes globally. 

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