An Overview of Cervicitis

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

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Cervicitis is the inflammation of the cervix, the donut-shaped opening that connects the vagina to the uterus. Cervicitis is most commonly associated with sexually transmitted diseases (STDs) like chlamydia or gonorrhea. Non-infectious causes of cervicitis include allergies, physical trauma, or chemical irritants.

Cervicitis may not cause symptoms. If it does, there may be bleeding, pain during sex, 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).

The diagnosis will typically involve a pelvic exam and lab tests to identify the underlying cause. if an infection is involved, antibiotic or antiviral drugs may be prescribed. In some cases, cervicitis can resolve on its own without treatment.

Symptoms

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

  • Gray, white, or yellowish vaginal discharge
  • 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)

Cervicitis that present with discharge is often referred to as mucopurulent cervicitis.

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

Causes

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

Cervicitis may also be caused by non-sexually transmitted diseases like bacterial vaginosis (BV). (A yeast infection is an unlikely cause and is more closely associated with vaginitis.)

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

  • Local trauma
  • 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

Not all cases of cervicitis have a known cause. A 2013 study in the Sexually Transmitted Diseases concluded that cervicitis was idiopathic (of no known origin) in around 60% of cases.

Given that the majority of cervicitis cases involve either chlamydia or gonorrhea, those of unknown origin will usually be approached as an STD and treated with the appropriate antibiotic drugs.

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

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 arises slowly and persists) is more likely due to 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.

Pelvic Exam and Lab Tests

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 obtain a sample of discharge from your vagina or cervix (using a cotton swab or brush). You may also be asked to submit a urine sample. The samples will then be sent to the lab for evaluation.

The doctor will also do a manual exam of the vagina, inserting fingers inside the vagina to check for any tenderness involving the cervix, uterus, or ovaries.

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

The appropriate treatment of cervicitis is based on the underlying cause. If the cause is determined to be infectious, there are 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.
  • 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 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 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 as untreated infections may lead to pelvic inflammatory disease (PID), the condition of which 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 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 STD, it is important to be screened for STDs 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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