Cervicitis

What cervicitis is

The cervix acts as a barrier between the vagina and the uterus. When it is inflamed, it can look red and swollen, bleed easily when touched, and produce yellowish (mucopurulent) discharge. Inflammation makes it easier for infection to travel upward into the uterus, fallopian tubes and ovaries.

Cervicitis is classified as:

• Acute: sudden, usually infectious
• Chronic: long-lasting, often low-grade, sometimes non-infectious

Causes

Infections (most common)

• Chlamydia: the most commonly reported bacterial STI in the US, often silent.
• Gonorrhea: frequently occurs together with chlamydia.
• Trichomoniasis: a parasite causing frothy, yellow-green discharge and itching.
• Genital herpes: painful sores that can involve the cervix.
• Mycoplasma genitalium: a bacterium increasingly recognized as a cause, especially when cervicitis persists.
• Bacterial vaginosis: an imbalance of vaginal bacteria, which may contribute.

In many cases, no organism is found.

Non-infectious causes

• allergy or irritation from spermicides, latex condoms or douches
• devices such as cervical caps, diaphragms or retained tampons
• chemical irritation
• radiation therapy
• hormonal changes

Risk factors

• age under 25
• a new sexual partner, or multiple partners
• a partner with other partners or an STI
• not using condoms
• previous STIs

Symptoms

Many people with cervicitis notice nothing, which is why screening is important. Possible symptoms:

• increased or unusual vaginal discharge: yellow, green, gray or with a bad smell
• bleeding after sex or between periods
• pain during sex
• burning when urinating, or needing to go more often
• vaginal itching or irritation
• pelvic pressure or lower back ache

Diagnosis

• Pelvic examination: a speculum exam shows a red, inflamed cervix, discharge and bleeding when the cervix is touched with a swab.
• Nucleic acid amplification tests (NAATs): highly accurate tests for chlamydia and gonorrhea, done on a vaginal swab, cervical swab or urine sample.
• Tests for trichomoniasis and Mycoplasma genitalium, and microscopy for bacterial vaginosis.
• Herpes testing if sores are present.
• HIV and syphilis testing, recommended for anyone diagnosed with an STI.
• Pregnancy test if relevant.

Treatment

Because test results take time and complications can be serious, doctors often start treatment the same day if an STI is likely, based on CDC guidance.

• Chlamydia: usually doxycycline for 7 days (azithromycin is an alternative, especially in pregnancy).
• Gonorrhea: an injection of ceftriaxone. If chlamydia has not been excluded, it is treated too.
• Trichomoniasis: metronidazole.
• Herpes: antiviral medicine.
• Mycoplasma genitalium: specific antibiotic regimens, guided by resistance testing where available.
• Non-infectious: remove or avoid the irritant.

Important steps after treatment

• Treat sexual partners: all partners from the past 60 days should be tested and treated. In many US states, expedited partner therapy lets you bring medicine to your partner.
• Avoid sex until 7 days after treatment is completed and symptoms have gone, and partners have been treated.
• Retest for chlamydia and gonorrhea about 3 months after treatment, because reinfection is common.

Persistent cervicitis despite treatment needs reassessment for reinfection, Mycoplasma genitalium, trichomoniasis or non-infectious causes.

Complications

Untreated infectious cervicitis can lead to:

• Pelvic inflammatory disease (PID): infection of the uterus, tubes and ovaries, which can cause chronic pelvic pain
• Infertility and ectopic pregnancy from scarred fallopian tubes
• Higher risk of acquiring HIV
• Pregnancy complications: preterm birth, and infection passed to the baby during birth (eye infection or pneumonia)

Prevention

• use condoms consistently and correctly
• limit the number of sexual partners and get tested with new partners
• get regular STI screening. The USPSTF recommends yearly chlamydia and gonorrhea screening for sexually active women 24 and younger, and older women at increased risk
• avoid douching and irritating products

Frequently asked questions

What is cervicitis?

Cervicitis is inflammation of the cervix, the narrow lower part of the uterus. It is usually caused by sexually transmitted infections such as chlamydia or gonorrhea, but can also result from irritants, devices or other infections.

What are the symptoms of cervicitis?

Many people have no symptoms. When present, they include unusual vaginal discharge, bleeding after sex or between periods, pain during sex, burning urination and vaginal irritation.

How is cervicitis treated?

Treatment depends on the cause. Bacterial STIs are treated with antibiotics, trichomoniasis with metronidazole and herpes with antivirals. Sexual partners should be treated too, and you should avoid sex until treatment is complete.

Can cervicitis go away on its own?

Non-infectious cervicitis may improve once the irritant is removed. Infectious cervicitis should always be treated, because untreated chlamydia or gonorrhea can spread and cause pelvic inflammatory disease and infertility, even without symptoms.