Cervicitis refers to inflammation of the uterine cervix. The inflammation primarily affects the columnar epithelial cells of the endocervical glands, but can also affect the squamous epithelium of the ectocervix. It may be due to an infectious or noninfectious etiology and may be acute or chronic. Acute cervicitis is usually due to infection (eg, chlamydia, gonorrhea), although a specific infection cannot be determined in a large proportion of cases. Chronic cervicitis usually has a noninfectious source.
Cervical infection is clinically important because it can ascend and cause endometritis or pelvic inflammatory disease (PID); the pathogens involved can be transmitted to sexual partners; and, in pregnant women, it may cause pregnancy and/or neonatal complications as a result of infection of the fetus, placenta, amniotic fluid, decidua, or membranes. In addition, cervicitis appears to be associated with a significant increase in risk of HIV-1 acquisition and shedding . Sequelae of PID include chronic pelvic pain, infertility, and an increased risk of ectopic pregnancy. (See "Long-term complications of pelvic inflammatory disease".)
Infection — When an infectious etiology can be documented, Chlamydia trachomatis (typically serovars D-K) and Neisseria gonorrhoeae are the most common organisms identified, even though a relatively small proportion of women with these infections develop cervicitis. Chlamydial cervicitis occurs more often than gonococcal, and both primarily affect the columnar epithelium of the endocervix.
Herpes simplex virus (HSV) and Trichomonas vaginalis account for a few cases, but primarily affect the squamous epithelium of the ectocervix. Tuberculosis involves the cervix in a small proportion of women with tuberculous endometritis (see "Endometritis unrelated to pregnancy", section on 'Tuberculous endometritis') . Mycoplasma genitalium may be an important pathogen, as well [3-5]. Bacterial vaginosis and streptococci (group A) have also been implicated as causative agents of acute cervicitis [6-10]. Bacterial vaginosis is unlikely to be a cause of isolated cervicitis, without concurrent vaginal findings.
Mycoplasma hominis, Ureaplasma urealyticum, and group B beta-hemolytic streptococci are commonly found in the genital tract, but there is little evidence that they cause cervicitis [11,12]. Case reports have described cervicitis associated with other infectious agents (bacteria, viruses, fungi, parasites).