What Is Cervicitis?

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Cervicitis is inflammation of the cervix, the donut-shaped opening that connects the vagina to the uterus. It doesn't always cause symptoms but if it does these may include bleeding, pain during sex, and vaginal discharge. In some cases, cervicitis can spread to the uterus, fallopian tubes, or ovaries, causing a painful condition known as pelvic inflammatory disease (PID). Cervicitis most often results from a sexually transmitted infection (STI) such as chlamydia or gonorrhea, although there are a handful of non-infectious causes including allergies, physical trauma, or chemical irritants. The condition can be diagnosed with a pelvic exam and lab tests to identify the underlying cause. If an infection is involved, medication may be prescribed. In some cases, cervicitis resolves without treatment.

Gynecologist ready to perform a cervical smear or pap test on a teenage patient
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Cervicitis Symptoms

Cervicitis does not always cause symptoms. If symptoms do develop, they may include:

  • Gray, white, or yellowish vaginal discharge, in which case the condition is referred to as mucopurulent cervicitis
  • Vaginal bleeding between menstrual periods or after sex
  • Pain during sex (dyspareunia)
  • Pain during urination (dysuria)
  • Frequent urination
  • Pelvic heaviness or pain
  • Irritation of the vulva (vulvitis)

Some causes of cervicitis, such as herpes simplex virus (HSV), rarely cause symptoms and may only be spotted during a routine pelvic exam.

Causes

Cervicitis can be caused by any of a number of STIs, the majority of which involve Chlamydia trachomatis (the bacteria that cause chlamydia) and Neisseria gonorrhoeae (the bacteria that causes gonorrhea). Less common causes include trichomoniasis, Mycoplasma genitalium, and genital herpes.

Cervicitis also may be caused by non-sexually transmitted diseases like bacterial vaginosis (BV).

There are many non-infectious causes of cervicitis as well, including:

  • Trauma to the cervix
  • Insertive devices, such as IUDs, cervical caps, tampons, or pessaries
  • Allergy to latex condoms
  • Chemical irritants, such as douches, spermicides, or vaginal suppositories
  • Systemic inflammation, such as that caused by autoimmune diseases
  • Radiation therapy

Cervicitis doesn't always have a known cause. In a 2013 study, around 60% of cases were idiopathic (of unknown origin).

Given the majority of cervicitis cases involve either chlamydia or gonorrhea, those of unknown origin usually are approached as an STI and treated with antibiotic drugs.

The risk factors for cervicitis are similar to those for STIs and include multiple sex partners, sex without condoms, and younger age. Having engaged in sex at an early age or having a history of a sexually transmitted infection also increases the risk.

Diagnosis

The first step in diagnosing cervicitis is to establish whether the cause is infectious or non-infectious.

Acute cervicitis (cervical inflammation that develops suddenly and severely) usually is caused by an infection. Chronic cervicitis (inflammation that arises slowly and persists) is more likely due to a non-infectious cause.

If you're being evaluated for cervicitis, your doctor will begin with a review of symptoms and medical history. This may include questions about your sexual practices, including the number of partners you've had and whether or not you practice safer sex.

Pelvic Exam and Lab Tests

Next, the doctor will do a manual exam of your vagina to check for tenderness involving the cervix, uterus, or ovaries, followed by a pelvic exam using a speculum to hold open your vagina so there's a clear view of your cervix and nearby tissues. They also may obtain a sample of discharge from your vagina or cervix using a cotton swab or brush. You may be asked to submit a urine sample as well. The samples will then be sent to a lab for evaluation.

Most lab test results are returned within two to three days and will detail what, if any, infections you have. Cultures for HSV can take up to two weeks.

Treatment

Cervicitis is treated based on what has caused it. In the case of an infection, there are standard protocols:

  • 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.
  • Gonorrhea 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 often is 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) or, 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 microorganism involved, the infection should clear within several days or weeks. Non-infectious causes can usually be alleviated by avoiding the substance or activity that incites inflammation. Any underlying disease or condition that promotes cervical inflammation will also need to be controlled.

It is important to treat cervicitis promptly: Untreated infections may lead to pelvic inflammatory disease, a painful and often debilitating condition that can cause scarring, ectopic pregnancy, and infertility.

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 and constricting underwear made of synthetic fabrics. Instead, wear comfortable, 100% cotton underwear.

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 it's most often caused by an infection 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 sexually active women 24 and younger and older women who are at an increased risk of infection be screened once a year for chlamydia and gonorrhea in .

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