Cervicitis
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- Cervicitis is an inflamed cervix characterised by friability of the cervix with easily induced bleeding and/or mucopurulent discharge at the cervical os.
- Gonorrhoea as the causative organism of cervicitis is increasing in Australia.
Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes of cervicitis.
Other less common causes include:
- Mycoplasma genitalium, herpes simplex virus (HSV) and Trichomonas vaginalis.
- Radiation treatment, malignancy, trauma (e.g. recent surgery), chemical irritants in the vagina (douching), allergic reactions to latex in condoms.
- Bacterial overgrowth of some of the normal flora of the vagina (bacterial vaginosis).
In a person with a low risk of sexually transmitted infections (STIs), cervicitis is often not associated with an identifiable pathogen.
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Signs and symptoms |
Considerations |
|---|---|
|
Speculum examination to view the cervix, +/- bimanual if pelvic pain or dyspareunia is reported. | |
|
Intermenstrual or post-coital bleeding |
As above. |
|
If cervicitis found incidentally on speculum examination e.g. with CST, consider testing for STIs |
Especially if patient is < 30 years old; has had a previous STI, is an Aboriginal or Torres Strait Islander person; has had change in sexual partner or more than 1 partner in last 12 months. |
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Vulval or vaginal pain and irritation |
May be associated with profuse vaginal and cervical discharge. |
|
Abdominal and pelvic pain |
May occur if associated with endometritis or PID. |
|
Friable cervix |
Bleeds with gentle touch from a swab or opening the speculum. |
A speculum examination and endocervical swab, as a minimum, are required to diagnose cervicitis.
Assess for symptoms of PID.
|
Site/specimen |
Test |
Consideration |
|---|---|---|
|
Endocervical swab |
Chlamydia and gonorrhoea NAAT |
Positive – confirmed Chlamydia trachomatis and Neisseria gonorrhoeae |
|
MC&S – request Neisseria gonorrhoeae culture |
Neisseria gonorrhoeae sensitivity and possible resistance | |
|
Positive – requires further testing for antibiotic sensitivity (seek advice) | ||
|
HSV NAAT (only if cervicitis doesn’t settle or reoccurs in the absence of other causes) |
Positive – see HSV for management | |
|
High vaginal swab |
Positive – see Trichomonas vaginalis guidelines | |
|
Vaginal pH |
Normal 3.5-4.5 |
> 4.5 indicates disturbance to vaginal flora |
|
Anal / rectal swab1 |
Positive – confirmed Chlamydia trachomatis and Neisseria gonorrhoeae | |
|
Neisseria gonorrhoeae sensitivity and possible resistance profile |
NAAT – Nucleic acid amplification test
MC&S – microscopy culture and sensitivity
Specimen collection guidance
Clinician collected | Self-collection
If the client declines an examination, the NAAT specimens can be self-collected. Ideally samples for microscopy and culture should be clinician collected.
It is important to know which organism is causing the cervicitis.
If possible, wait for the test results before considering treatment as targeted treatment is more successful.
If same day treatment is given, treat for Chlamydia trachomatis and Neisseria gonorrhoeae at a minimum.
|
Principal treatment options | ||
|---|---|---|
|
Situation |
Recommended |
Alternative |
|
Doxycycline 100 mg PO, BD for 7 days |
Azithromycin 500 mg x 2 PO, stat | |
|
Ceftriaxone 500 mg, in 2 mL lignocaine 1% IMI, stat |
Safe in pregnancy | |
If organism is known or PID is suspected, see relevant STI guidelines for treatment recommendations:
- Herpes simplex virus
- M. genitalium
- Trichomoniasis
- PID
Treatment advice
- Patients with a clinical diagnosis of cervicitis who are at increased of being lost to follow-up should be treated at initial assessment whether a pathogen is identified or not.
- Testing and treatment of regular sexual partner/s should also occur.
- Refer to a specialist for review if persistent cervicitis in the absence STI re-infection or bacterial vaginosis and after treatment of partners.
- Use azithromycin 1g stat as first-line Chlamydia trachomatis treatment in pregnancy; Neisseria gonorrhoeae treatment is the same as in non-pregnant people.
Other immediate management
- Treat sexual partner(s) as appropriate for the identified infection/s.
- Contact tracing is a high priority for chlamydia, gonorrhoea, trichomoniasis and M. genitalium and should be performed in all patients with confirmed infection.
- Contact tracing for HSV 1 and 2 is not recommended.
See Australasian Contact Tracing Manual for more information.
- Routine follow-up is not required unless an STI has been identified or symptoms of pelvic inflammatory disease (PID).
- If indicated, review on day 7 with speculum, and/or bimanual, examination as required.
If PID diagnosed, assess response to antibiotics after 48-72 hours.
If STI confirmed, follow-up provides an opportunity to:
- Confirm patient adherence with treatment and assess for symptom resolution
- Confirm contact tracing procedures have been undertaken or offer more contact tracing support
- Provide further sexual health education and prevention counselling
- Mucopurulent cervicitis will often persist despite treatment if due to an ectropion, however no further treatment is required.3
For test of cure and retesting advice see:
- 100% of patients with cervicitis are tested for an STI.
- Dukers-Muijrers NH, Schachter J, van Liere GA, Wolffs PF, Hoebe CJ. What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion. BMC Infect Dis 2015;15:533.
- Australian Product Information. Doxycycline monohydrate. Available at: https://www.nps.org.au/medicine-finder/apo-doxycycline-tablets#full-pi (last accessed 22 October 2021).
- Centers for Disease Control and Prevention (CDC). Sexually Transmitted Infections Treatment Guidelines: Diseases characterised by urethritis and cervicitis. July 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/urethritis-and-cervicitis.htm (last accessed 22 October 2021).
