Cervicitis
Background
- Inflammation of the cervix most commonly caused by Chlamydia (about 40%) and Gonorrhea
- Less commonly caused by Trichomonas and HSV-2
Clinical Features
Edematous and reddened cervix.
- Mucopurulent endocervical discharge
- May see endocervical bleeding easily induced by cotton swab
- Frequently asymptomatic
- Women may complain of abnormal vaginal discharge or post-coital vaginal bleeding
- Pelvic/Abdominal pain or tenderness to palpation should prompt a diagnosis of pelvic inflammatory disease rather than cervicitis
Differential Diagnosis
Pelvic Pain
Pelvic origin
- Acute cystitis
- Ectopic
- Ovarian torsion
- Endometriosis
- Pelvic inflammatory disease
- Cervicitis
- Ectopic pregnancy
- Ovarian torsion
- Spontaneous abortion
- Septic abortion
- Myoma (degenerating)
- Ovarian cyst (rupture)
- Tubo-ovarian abscess
- Mittelschmerz
- Sexual assault/trauma
- Ovarian hyperstimulation syndrome
- Vaginitis (e.g. trichomoniasis, candidiasis)[1]
- Urethritis (e.g. N. gonorrhoeae/Chlamydia)[2]
Abdominal origin
- Appendicitis
- Kidney stone
- Psoas abscess
- Mesenteric adenitis
- Incarcerated hernia
- Diverticulitis
- Pyelonephritis
Evaluation
Management
Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[5]
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.
Standard
- Gonorrhea
- Ceftriaxone IM x 1
- 500 mg, if weight <150 kg
- 1 g, if weight ≥150 kg
- Ceftriaxone IM x 1
- Chlamydia
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
Ceftriaxone contraindicated
- Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
- Chlamydia^
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
^Additional chlamydia coverage only needed if treated with cefixime only
Partner Treatment
- Gonorrhea
- Cefixime 800mg PO x 1
- Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1
Associated Bacterial Vaginosis or Trichomonas vaginalis
Pregnant
Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose
- Metronidazole 2g PO once[7]
Disposition
- Discharge
See Also
References
- Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
- Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.
- Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
- Kissinger P et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: An open-label, randomised controlled trial. Lancet Infect Dis 2018 Oct 5; [e-pub].
- CDC Trichomoniasis 2015. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
- CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59(No. RR-12)
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