Cervicitis

Basic Information

Cervicitis is an inflammation of the cervix and is most often caused by a direct infection of the cervix, usually by bacterial agents such as chlamydia or gonorrhea, or sometimes by viral agents such as herpes simplex or HPV (human papilloma virus). (It can also be secondary to a vaginal infection.) It can also be caused by the protozoan agent Trichomonas vaginalis. All of these are sexually transmitted organisms. But occasionally cervicitis can be caused by a foreign body such as a diaphragm or an IUD (intrauterine device). But it is believed that chlamydia, the most common sexually transmitted disease (STD), and gonorrhea, are the most frequent causes of infection, accounting for over 50% of all cases.

This is a common illness, especially in adolescents -- but it is also common in women who are sexually active. In fact cervicitis is the diagnosis made for 25% of women with abnormal vaginal discharge. Having unsafe or unprotected sex will increase the risk of cervicitis. Having multiple sexual partners also increases the risk.

Symptoms

Cervicitis usually presents no symptoms but when the infection is more severe symptoms can include having an increased vaginal discharge, often yellowish in color as well as pelvic pain. Another symptom may be bleeding when a Pap smear is done.

The underlying cause of cervicitis often indicates what symptoms will be present.

CAUSE	SYMPTOMS
herpes	usually asymptomatic
Trichomonas	increased vaginal discharge irritation, itching
chlamydia	may be asymptomatic; cervical swelling, discharge, pelvic pain, infertility if infection spreads into the fallopian tubes
gonorrhea	vaginal discharge pelvic pain, infertility if infection spreads into the fallopian tubes

Diagnosis/Treatment

During an examination by her health care provider, a patient with cervicitis will usually have a vaginal discharge or a history of post-coital bleeding. If asymptomatic, a cotton swab can be used to check for yellow mucopurulent material -- an indication of cervicitis.

During the exam cultures should be taken for both chlamydia and gonorrhea and a wet amount should be used to investigate the presence of Trichomonas. In addition the patient should have a Pap smear.

Treatment, like symptoms, generally depends on the cause of cervicitis. It is usually curable with the correct treatment. If caused by gonorrhea, chlamydia or Trichomonas, antibiotics are prescribed, and if herpes is the cause, medications that are used to treat that virus usually work well in lessening the severity and length of symptoms. Sometimes a vaginal yeast infection will occur after taking antibiotics since the antibiotics kill "healthy" as well as "unhealthy" bacteria. Your health care provider will want to follow-up with you after you have completed the antibiotics to check for yeast infection and to check for PID and infertility which can occur in 5%--10% of patients. Should PID occur, IV antibiotic treatment in a hospital setting is often recommended. Sexual relations should be halted until cultures come back negative.

If you are diagnosed with this disease it is important that you notify your sexual partners so that they may seek treatment. Also your health care provider will want to check for the presence of other sexually transmitted diseases.

Also if you are diagnosed with cervicitis, a discussion about HIV testing and counseling is very important and indicated. When a person has at least one sexually transmitted disease, studies have shown that the risk for HIV transmission is much greater.

Cervicitis is common in adolescents because of the high occurrence of gonorrhea (1/5th of the cases in the U.S. are among teenagers) and chlamydia (thought to be even higher, though it is not reportable). Contraception is not widely used among this age group, increasing the risk for sexually transmitted diseases. A major concern is the possible development of PID (pelvic inflammatory disease) which can cause infertility. It is estimated that 1/5th of PID cases occur in adolescents. Therefore it is important that sexually active adolescents are routinely tested for PID as well as chlamydia and gonorrhea by a sensitive, supportive health care provider.

If you feel you are at risk for cervicitis or any sexually transmitted disease, please see your health care provider promptly.