Cervicitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Cervicitis is the inflammation of the cervix, the lower part of the uterus that opens into the vagina. It can be caused by infectious agents, such as bacteria or viruses, or non-infectious factors, including chemical irritants and allergies.

Aetiology

Cervicitis can be caused by several factors, including:

• Infectious Causes: The most common infectious causes include sexually transmitted infections (STIs) such as Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus (HSV), and Trichomonas vaginalis.
• Non-Infectious Causes: Non-infectious causes include chemical irritants (e.g., spermicides, douches), allergies (e.g., latex in condoms), and physical irritation (e.g., from intrauterine devices or tampons).
• Idiopathic: In some cases, the cause of cervicitis may not be identified.

Pathophysiology

The inflammation of the cervical tissue can be due to direct infection by microorganisms, leading to an immune response. The presence of pathogens can result in localised inflammation, which may cause ulceration, erosion, and discharge from the cervix. Non-infectious causes of cervicitis result from an irritative response to chemical or physical agents, leading to inflammation and similar symptoms.

Risk Factors

• Sexually active women, particularly those with multiple sexual partners.
• History of STIs or having a partner with an STI.
• Use of barrier contraceptives, particularly if allergic to latex.
• Use of irritants such as douches or spermicides.
• Presence of a foreign body, such as an intrauterine device (IUD).

Signs and Symptoms

• Abnormal vaginal discharge, which may be purulent or mucopurulent.
• Intermenstrual or post-coital bleeding.
• Dyspareunia (pain during intercourse).
• Pelvic pain or discomfort.
• Itching or irritation in the genital area.
• In some cases, cervicitis may be asymptomatic and only detected during a routine gynaecological examination.

Investigations

• Speculum Examination: Visual inspection of the cervix may reveal erythema, friability, or purulent discharge.
• Cervical Swabs: Collection of cervical samples for nucleic acid amplification tests (NAAT) to detect Chlamydia, Gonorrhoea, and other STIs.
• Microscopy: Examination of vaginal and cervical secretions to identify the presence of Trichomonas or bacterial vaginosis.
• Colposcopy: May be indicated if there are suspicious findings on examination or if the cervicitis does not respond to standard treatment.

Management

• Primary Care:
  • Antibiotic Therapy: Empirical antibiotic treatment should be initiated if an STI is suspected, typically covering both Chlamydia (e.g., azithromycin or doxycycline) and Gonorrhoea (e.g., ceftriaxone).
  • Partner Notification and Treatment: Sexual partners should be informed, tested, and treated if necessary, to prevent reinfection and further transmission.
  • Symptomatic Relief: Advise on the use of over-the-counter pain relief and avoidance of irritants that may exacerbate symptoms.
  • Follow-Up: Ensure follow-up to confirm the resolution of symptoms and adherence to treatment. Repeat testing may be indicated to ensure clearance of infection.
• Specialist Care:
  • Referral to Gynaecology: Referral may be necessary for cases that are recurrent, resistant to treatment, or where there is suspicion of a more serious underlying condition such as cervical cancer.
  • Colposcopy: Indicated if there are abnormal cervical findings or if symptoms persist despite appropriate treatment.

References

1. NHS (2024) Cervicitis: Causes, Symptoms, and Treatment. Available at: https://www.nhs.uk/conditions/cervicitis/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Cervicitis: Assessment and Management. Available at: https://cks.nice.org.uk/topics/cervicitis/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Cervicitis: Diagnosis and Management in Primary Care. Available at: https://www.bmj.com/content/350/bmj.h4500 (Accessed: 24 June 2024).
4. Centers for Disease Control and Prevention (2024) Sexually Transmitted Infections Treatment Guidelines. Available at: https://www.cdc.gov/std/treatment-guidelines/cervicitis.htm (Accessed: 24 June 2024).

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