Acute or chronic forms are distinguished, with acute cervicitis having infectious causes, while chronic is caused predominantly by non-infectious sources.

Diffuse endocervicitis — Diffuse Endocervicitis – 3D Model

The exact prevalence of cervicitis is difficult to determine due to the lack of standardized diagnostic criteria. Since sexual activity is a major risk factor for infectious diseases, the highest incidence is found in sexually active women between the ages of 15 and 24.

Etiology of cervicitis

According to etiology, cervicitis can be divided into infectious and non-infectious.

Infectious agents include:

Neisseria gonorrhoea;
Chlamydia trachomatis;
Herpes simplex virus (HPV);
Trichomonas vaginalis;
Mycoplasma genitalium.

Neisseria gonorrhoea and Chlamydia trachomatis predominantly infect the prismatic epithelium of the endocervix, whereas HPV and trichomonads infect the squamous epithelium of the ectocervix. Bacterial vaginosis is also associated with cervicitis.

Non-infectious causes of cervicitis include:

Mechanical irritants: surgical instruments or foreign objects such as pessaries, diaphragms, cervical caps, tampons, condoms, which may cause mechanical trauma;
Chemical irritants cause allergic reactions and include soaps, laundry products, spermicides, latex, and vaginal sprays;
Systemic inflammatory diseases such as red squamous lichen planus and Behçet’s syndrome can also be a cause of cervicitis;
The hypoestrogenic state seen in natural or surgical menopause can mimic cervicitis. It occurs due to atrophy of the vaginal and uterine mucosa.

It is worth noting that in most cases the exact etiology cannot be established. It is clinically impossible to distinguish inflammation caused by mechanical or chemical stimuli from inflammation caused by infectious etiology.

Clinical manifestations of cervicitis

Patients present with nonspecific complaints, including purulent or purulent mucous discharge from the vagina and intermenstrual or postcoital bleeding. Patients may also present with dyspareunia or pulling pains in the lower abdomen.

History taking

History taking plays an important role in identifying risk factors. All women, regardless of symptoms, who come for a check-up should be asked about their sexual history in detail, using five key points:

Partners;
Practice;
Pregnancy Prevention;
Protection from STIs;
Previous STIs.

Gynecological examination

Cervix: Diffuse Exocervicitis – 3D Model

The classic signs are yellow or mucous discharge from the pharynx and slight contact bleeding from the endocervix when touched with a cotton applicator. There may also be hyperemia of the mucosa.

3D Animation – Nonspecific Cervicitis

In addition, visible pinpoint hemorrhages on the exocervix (so-called strawberry cervix) indicate trichomonad infection, and vesicles and ulcers indicate HPV infection. Many women are asymptomatic with mycoplasma cervicitis, so this infection is often missed.

Internal genital lesions should be suspected in the case of:

High temperature;
Bimanual examination pain;
Soreness when moving the cervix.

Diagnosis of cervicitis

The initial investigation is aimed at identifying the causative agent. The most sensitive and specific test is the nucleic acid amplification test (NAAT). This NAAT test can be performed on samples of endocervical and vaginal secretions as well as urine.

The criteria for using an elevated leukocyte count in Gram staining of endocervical material for the diagnosis of cervicitis have not been standardized. This method has low sensitivity and low positive predictive value.

Methods of diagnosing cervicitis

Sample	Test	Conclusion
Endocervical swab	Chlamydia and gonorrhea NAAT	Positive – confirmed Chlamydia trachomatis and Neisseria gonorrhoeae. Negative – cervicitis of other cause.
	Smear microscopy, request a culture for Neisseria gonorrhoeae	Sensitivity and possible resistance of Neisseria gonorrhoeae
	Mycoplasma genitalium NAAT	Positive – further antibiotic sensitivity testing is required
	NAAT for HPV (in cases of untreated or recurrent cervicitis in the absence of other causes)	Positive – antiviral therapy
Vaginal swab	Trichomonas NAAT	Positive result – confirmation of diagnosis, treatment required
Vaginal pH	Normal 3.5-4.5	> 4.5 indicates an abnormal vaginal flora
Anal/ rectal swabs	Chlamydia trachomatis and Neisseria gonorrhoeae NAAT	Positive – confirmed Chlamydia trachomatis and Neisseria gonorrhoeae. Negative – in the presence of a history of anal intercourse may be the cause of recurrent bacterial vaginosis.
	Microscopy and culture for Neisseria gonorrhoeae	Sensitivity to Neisseria gonorrhoeae and possible resistance profile

Cervicitis treatment

Treatment tactics depend on the etiology of cervicitis and may vary depending on the cause of the disease.

Empirical treatment

According to CDC guidelines, empiric treatment is recommended for women at increased risk for sexually transmitted infections: girls younger than 25 years of age, women with a new sexual partner, a partner with a previously established sexually transmitted infection, and those who have multiple sexual partners at the same time.Such patients are prescribed antibiotic therapy for chlamydia and gonorrhea.

Empirical treatment is also recommended for women in whom testing fails to detect the causative agent. Treatment may be deferred until confirmatory test results are available in women at lower risk of sexually transmitted infections.

There are the following drugs for empiric therapy:

Azithromycin – orally once a day;
Ceftriaxone – intramuscularly once;
Doxycycline – orally for 7 days;
Cefixime – once orally.

For severe penicillin/cephalosporin allergies, it is recommended:

Azithromycin – orally once a day.

Treatment based on laboratory results

If infectious agents are detected by laboratory tests, treatment is as follows:

Chlamydia: single oral dose of azithromycin or doxycycline course;
Gonorrhea: ceftriaxone intramuscularly once for those with body weight less than 150 kg and negative other infections;
Mycoplasma: doxycycline for 3 days or azithromycin for 3 days;
Trichomonads: single oral dose of metronidazole or tinidazole;
Bacterial vaginosis: metronidazole oral course, metronidazole gel 0.75% vaginally, clindamycin cream 2% intravaginally, clindamycin in suppositories intravaginally;
HPV: oral acyclovir, valacyclovir, famciclovir.

Contact tracking

Contact tracing is the first priority for chlamydia, gonorrhea, trichomoniasis and M. genitalium and should be performed in all patients with confirmed infection. Contact tracing for herpes simplex virus is not recommended. Sexual activity should be discontinued until completion of the therapeutic regimen. HIV-positive women with cervicitis receive the same treatment as HIV-negative women.

Timely treatment in these women reduces viral shedding and may reduce the risk of HIV transmission.

Chronic cervicitis

The term “chronic cervicitis” is used for women with persistent discharge persisting for three months despite exclusion of infection and empirical antibiotic therapy. Patients should be re-examined for possible re-exposure to an infectious agent. In the absence of infection, there is no evidence for the efficacy of repeated or prolonged antimicrobial therapy for persistent symptomatic cervicitis.

Complications

The spread of infection to the uterus, fallopian tubes and ovaries with the development of pelvic inflammatory disease (PID) is a dangerous complication of cervicitis. PID can lead to both an acute condition and have chronic consequences, including chronic pelvic pain, ectopic pregnancy and infertility.

Pregnancy

The presence of cervicitis associated with sexually transmitted infections correlates with unfavorable pregnancy outcomes, especially premature rupture of the fetal membranes, premature delivery, and birth of low birth weight babies for gestational age. Untimely diagnosed chlamydial infection during pregnancy leads to perinatal exposure of the child to an infected maternal cervix. Primary neonatal C. trachomatis infection affects the mucous membranes of the eyes, oropharynx, urogenital tract and rectum.

The most severe manifestations of infection with N. gonorrhoeae infection in neonates are neonatal conjunctivitis and sepsis, which may include arthritis and meningitis. Less severe manifestations are rhinitis, vaginitis, urethritis and scalp infection.

Pregnant women, regardless of gestational age, should undergo mandatory prenatal infection screening and, if infection is detected, recommended treatment.

FAQ

1. What is cervicitis and what are its main causes?

Cervicitis is inflammation of the cervix caused by infections (gonorrhea, chlamydia, trichomoniasis) or non-infectious factors such as trauma or allergies. Infectious agents may include viruses, bacteria, or fungi.

2. What is chronic cervicitis?

Chronic cervicitis is inflammation of the cervix that lasts for more than three months. It can develop after acute cervicitis or as a result of long-term infections or trauma.

3. Can cervicitis lead to cancer?

Cervicitis itself does not cause cancer, but chronic inflammation caused by human papillomavirus (HPV) infection can increase the risk of cervical cancer. Regular checkups and treatment can help reduce this risk.

4. How is cervicitis transmitted?

Cervicitis can be sexually transmitted if it is caused by an infection such as gonorrhea or chlamydia. It can also develop after medical interventions or trauma to the cervix.

5. Is cervicitis dangerous in pregnancy?

Cervicitis can be dangerous to pregnancy, especially if it is caused by a sexually transmitted infection. It can lead to premature labor, rupture of the fetal membranes, or infection in the newborn.

6. Can I get pregnant with cervicitis?

Cervicitis by itself is not a direct obstacle to pregnancy, but if the inflammation is accompanied by complications such as pelvic inflammation, it can increase the risk of infertility. Treatment can help restore fertility.

7. Is cervicitis transmitted to men?

Cervicitis is not directly transmitted to men, but infections that cause cervicitis can be transmitted to men, causing inflammation of the urethra and other genital organs.

8. What are the dangers of cervicitis?

Cervicitis can be dangerous if left untreated. It can cause the infection to spread to other parts of the reproductive organs, such as the uterus, fallopian tubes and ovaries, which can cause pelvic inflammatory disease (PID). In severe cases, it can lead to infertility, chronic pelvic pain and an increased risk of ectopic pregnancy.

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https://catalog.voka.io/

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