- Jeanne Marrazzo, MD, MPH, FACP, FIDSA
Jeanne Marrazzo, MD, MPH, FACP, FIDSA
- Professor and Chief, Division of Infectious Diseases
- University of Alabama at Birmingham School of Medicine
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Noreen A Hynes, MD, MPH, DTM&H
Noreen A Hynes, MD, MPH, DTM&H
- Section Editor — Sexually Transmitted Diseases
- Associate Professor of Infectious Diseases; International Health; and Population, Family, and Reproductive Health
- Johns Hopkins University Schools of Medicine and Public Health
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; a recent meta-analysis reported that women with M. genitalium detected at the cervix had a significantly increased risk of cervicitis [3-7]. Bacterial vaginosis and streptococci (group A) have also been implicated as causative agents of acute cervicitis [8-10]. 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).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Samantaray S, Parida G, Rout N, et al. Cytologic detection of tuberculous cervicitis: a report of 7 cases. Acta Cytol 2009; 53:594.
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- Marrazzo JM, Wiesenfeld HC, Murray PJ, et al. Risk factors for cervicitis among women with bacterial vaginosis. J Infect Dis 2006; 193:617.
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- Short VL, Totten PA, Ness RB, et al. Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis 2009; 48:41.
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- Jensen JS, Bradshaw CS, Tabrizi SN, et al. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin Infect Dis 2008; 47:1546.
- Bradshaw CS, Chen MY, Fairley CK. Persistence of Mycoplasma genitalium following azithromycin therapy. PLoS One 2008; 3:e3618.
- Bissessor M, Tabrizi SN, Twin J, et al. Macrolide resistance and azithromycin failure in a Mycoplasma genitalium-infected cohort and response of azithromycin failures to alternative antibiotic regimens. Clin Infect Dis 2015; 60:1228.
- Manhart LE, Jensen JS, Bradshaw CS, et al. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. Clin Infect Dis 2015; 61 Suppl 8:S802.
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- Mattson SK, Polk JP, Nyirjesy P. Chronic Cervicitis: Presenting Features and Response to Therapy. J Low Genit Tract Dis 2016; 20:e30.
- Noninfectious causes
- CLINICAL FINDINGS
- Signs and symptoms
- Physical examination
- DETERMINING THE CAUSE
- Less useful - unnecessary tests
- Empiric therapy
- Treatment of specific infections
- - Gonorrhea, chlamydia, and mycoplasma
- - Bacterial vaginosis
- - Trichomonas vaginalis
- - Herpes simplex virus
- Sex partners
- Women with no identifiable pathogen
- Women with a foreign body/substance
- Asymptomatic women with inflammation on histology or cytology
- RECURRENT OR PERSISTENT DISEASE
- CHRONIC CERVICITIS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS