Cervicitis

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Background

Clinical Features

  • 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

Differential Diagnosis

Pelvic Pain

Pelvic origin

Abdominal origin

Evaluation

  • Swab (for GC, Chlamydia)
    • Patient-obtained vaginal swabs are MORE sensitive than clinician-collected endocervical swabs for GC/Chlamydia[1][2]
  • Wet mount
  • Urine pregnancy test

Management

Treatment covers both gonorrhea and chlamydia

Uncomplicated Infection

Cephalosporin Allergy

Partner treatment

Associated Bacterial Vaginosis or Trichomonas vaginalis

Non-Pregnant

Pregnant

  • Only treat if the patient is symptomatic and avoid breast feeding until 24hrs after last Metronidazole treatment and 72hrs after Tinidazole
  • Metronidazole 2g PO once[4]

Sexual Partner Treatment

Women with HIV Infection

  • Metronidazole 500 mg PO BID x 7 days[5]

Disposition

  • Discharge

See Also

External Links

References

  1. 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.
  2. 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.
  3. CDC: 2015 Sexually Transmitted Diseases Treatment Guidelines
  4. CDC Trichomoniasis 2015. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
  5. CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59(No. RR-12)