An Overview of Cervical Infections

Gynecologist performing a cervical smear or pap test on a teenage patient

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The cervix, the donut-shaped opening of the uterus, is vulnerable to many types of infection, most especially sexually transmitted diseases (STDs) like chlamydia and gonorrhea. The ensuing inflammation is referred to as cervicitis.

Cervicitis may or may not cause symptoms. If it does, there may irregular bleeding, pain during intercourse, or vaginal discharge. In some cases, an infection can spread to the uterus, fallopian tubes, and ovaries, causing a painful and often debilitating condition known as pelvic inflammatory disease (PID).

Cervicitis has both infectious and non-infectious causes (such as cervical trauma, intrauterine devices, cervical diaphragms, or allergies to condom or spermicides). To ensure the appropriate treatment, the doctor must first establish if the cause is, in fact, infectious. If it is, it can be successfully treated with the appropriate antibiotic or antiviral drug.

Symptoms

Not all cervical infections cause symptoms. If symptoms do develop, they may include:

  • Abnormal gray, white, or yellow vaginal discharge
  • Abnormal bleeding between menstrual periods
  • Dyspareunia (pain during sex)
  • Dysuria (pain during urination)
  • Frequent urination
  • Pelvic heaviness or pain

There is no explanation for why some women have symptoms and others don't. However, some causes of cervicitis, such as herpes simplex virus (HSV), rarely present with outward symptoms and can go unnoticed for years at a time.

Causes

Cervicitis can be caused by any of a number of infections and the most common organisms identified are chlamydia and gonorrhea. However, in many women with cervicitis, no cause is found, and doctors may recommend treatment based on symptoms and risk factors (e.g., vaginal discharge, a cervix that bleeds easily, age under 25 years, sex with a new partner, sex with a partner with concurrent partners, or sex with a partner who has a sexually transmitted infection).

Other less common causes include trichomoniasis, genital herpes, and Mycoplasma genitalium.

Cervicitis may also be caused by non-sexually transmitted diseases like bacterial vaginosis (BV). In as many as 13% of BV cases, the primary bacterial infection will spread and infiltrate adjacent cervical tissues. A yeast infection is an unlikely cause of cervicitis and is more closely associated with vaginitis.

Younger women are more susceptible to cervical infections, which may in part be because they have larger cervical transformation zones. Transformation zones are areas of fast-changing cells that are vulnerable to infection and cervical erosion (ectopy). According to a 2015 study in Sexually Transmitted Infections, cervical ectopy was associated with nearly a twofold increase in the odds of chlamydia in sexually active high school girls in rural South Africa.

The risk factors for cervicitis are similar to those for STIs and include multiple sex partners, sex without condoms, and younger age.

Diagnosis

The first step in diagnosing cervicitis is to establish whether the cause is infectious or non-infectious. Generally speaking, acute cervicitis (cervical inflammation that develops suddenly and severely) is usually caused by an infection. Chronic cervicitis (inflammation that is slow and persistent) is more likely from a non-infectious cause.

The diagnosis will start with a review of your symptoms and medical history. This may include questions about your sexual practices, including the number of sex partners you have and whether or not you practice safer sex.

Next, the doctor will perform a pelvic exam, viewing the cervix and adjacent tissues with a device called a speculum that holds the vagina open. During the pelvic exam, the doctor may take a sample of discharge from your vagina or cervix, or you may have to give a urine sample, so that it can be tested in a lab.

If you have cervicitis, the lining of the cervix may appear inflamed, irritated, and swollen. In severe cases, there may be a pus discharge from the cervix.

The doctor will also do a manual exam of the vagina, inserting fingers inside the vagina to check for tenderness of the cervix, uterus, or ovaries. (Let your doctor know in advance if you are allergic to latex gloves.)

Most cervical lab test results are returned in two to three days detailing which, if any, infections you have. Standard cultures for HSV can take up to two weeks.

Treatment

The appropriate treatment of cervicitis is based on the underlying cause. If the cause is determined to be infectious, there are various standard treatment protocols a doctor may use:

  • Chlamydia is treated with antibiotics. This may include azithromycin taken in a single, large dose or doxycycline taken twice daily for around one week. Women who cannot take azithromycin or doxycycline may be given erythromycin, levofloxacin, or ofloxacin.
  • Uncomplicated gonorrhea (Not PID) is typically treated with two antibiotics, such as a single 250-milligram (mg) injection of ceftriaxone and a 1-gram (g) oral dose of azithromycin.
  • Trichomoniasis is often treated with a single large dose of the antibiotic metronidazole or Tindamax (tinidazole). In some cases, metronidazole may be prescribed at a lower dose and taken twice daily for seven days.
  • Genital herpes is treated with antiviral drugs, such as Famvir (famciclovir), Valtrex (valacyclovir), or Zovirax (acyclovir). The treatment course can range from seven to 10 days. Severe cases may require intravenous (IV) acyclovir.
  • Bacterial vaginosis is treated with oral antibiotics, including metronidazole (preferred). Alternatively, Tindamax or clindamycin pills. It can also be treated with either metronidazole gel or clindamycin cream, which are both topical antibiotics applied directed to the vagina.

Depending on the underlying cause, the infection should clear within several days or weeks.

Coping

Cervicitis is generally a once-off affair if appropriately treated. During treatment, you should avoid sexual intercourse or douching until symptoms resolve to avoid further irritation. Instead of tampons, use menstrual pads.

You should also avoid scented soaps, sprays, or lotions as well as constricting underwear made of synthetic fabrics. Instead, wear comfortable, 100% cotton underwear that allows the genitals to breathe and remain clean.

Cervicitis rarely returns unless you get a new infection from a sexual partner. The consistent use of condoms and a reduction in the number of sex partners can greatly reduce your risk.

The only exception is genital herpes which cannot be cured. However, if you have recurrent outbreaks, you can decrease their frequency and severity by taking an antiviral drug like Zovirax or Valtrex.

A Word From Verywell

Many women with cervicitis have no symptoms. Because cervicitis is most commonly caused by an STI, it is important to be screened for STIs if you are sexually active. Your sexual partners should be screened, as well.

The U.S. Preventive Services Task Force currently recommends the annual screening for chlamydia and gonorrhea in sexually active women 24 and younger as well as in older women who are at an increased risk of infection.

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Article Sources

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  1. Fowotade A, Okolo AC Manga MM. Apparent Rarity of Asymptomatic Herpes Cervicitis in a Woman with Intra-Uterine Contraceptive Device. J Public Health Africa. 2013 Dec 3;4(2):e14. doi:10.4081/jphia.2013.e14

  2. Marrazzo JM, Wiesenfeld HC, Murray PM, et al. Risk Factors for Cervicitis among Women with Bacterial Vaginosis. J Infect Dis. 2006;193(5):617-24. doi:10.1086/500149

  3. U.S. Preventive Services Task Force. Final Recommendation Statement: Chlamydia and Gonorrhea: Screening. Rockville, Maryland; September 2014.

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