Cervicitis 

• Cervicitis is an inflamed cervix characterised by friability of the cervix with easily induced bleeding and/or mucopurulent discharge at the cervical os.
• Gonorrhoea as the causative organism of cervicitis is increasing in Australia.

Possible Causes The most common causes of cervicitis include:

• Chlamydia trachomatis
• Neisseria gonorrhoeae

Less common causes are:

• Mycoplasma genitalium
• Herpes simplex virus (HSV)
• Trichomonas vaginalis
• Non-infectious causes:
  • Radiation treatment
  • malignancy
  • trauma (e.g., recent surgery)
  • chemical irritants (e.g., douching)
  • allergic reactions (e.g., to latex in condoms)
  • bacterial overgrowth (e.g., bacterial vaginosis).

In individuals with a low risk of sexually transmitted infections (STIs), cervicitis is often not associated with an identifiable pathogen.

Clinical Presentation Symptoms and signs of cervicitis include:

• Vaginal discharge: Speculum examination is essential, and a bimanual exam may be performed if pelvic pain or dyspareunia is reported.
• Intermenstrual or post-coital bleeding: Requires assessment for pregnancy and potentially a cervical screening test (CST).
• Vulval or vaginal pain and irritation: Often associated with profuse discharge.
• Abdominal and pelvic pain: May indicate endometritis or pelvic inflammatory disease (PID).
• Friable cervix: Bleeds easily upon examination.

Diagnosis

Diagnosis involves:

• Speculum examination
• Endocervical swab

Testing Sites and Specimens:

Site/Specimen	Test	Consideration
Endocervical swab	Chlamydia and gonorrhoea NAAT	Positive results confirm infection; negative indicates other causes.
	MC&S – Neisseria gonorrhoeae culture	Assess sensitivity and resistance.
	Mycoplasma genitalium NAAT	Requires further testing for antibiotic sensitivity.
	HSV NAAT (if cervicitis persists or recurs)	Positive results guide management.
High vaginal swab	Trichomonas vaginalis NAAT	Positive results guide treatment.
Vaginal pH	pH level > 4.5	Indicates disturbance in vaginal flora.
Anal/rectal swab	Chlamydia and gonorrhoea NAAT	Positive results confirm infection.
	MC&S – Neisseria gonorrhoeae	Assess sensitivity and resistance.

Management

Initial Steps:

• Identify the causative organism: Await test results for targeted treatment. If immediate treatment is required, treat for Chlamydia trachomatis and Neisseria gonorrhoeae.

Principal Treatment Options:

Situation	Recommended Treatment	Alternative Treatment
Chlamydia	Doxycycline 100 mg PO, BD for 7 days	Azithromycin 500 mg x 2 PO, stat (safe in pregnancy)
Gonorrhoea	Ceftriaxone 500 mg IMI, plus azithromycin 500 mg x 2 PO, stat	Not recommended due to resistance, except in specific locations or severe allergies. Seek specialist advice.

• STI-related cervicitis: Follow relevant guidelines for treatment (e.g., HSV, M. genitalium, trichomoniasis, PID).

Other Immediate Management:

• Advise no sexual contact for 7 days after treatment or until symptoms resolve.
• Contact tracing if an STI is confirmed.
• Conduct a blood-borne virus (BBV) screen if an STI is diagnosed.

Follow-Up

Routine follow-up is not required unless an STI or PID is diagnosed. If indicated, review on day 7 with a speculum and/or bimanual examination.

Follow-up Provides an Opportunity to:

• Confirm adherence to treatment and symptom resolution.
• Ensure contact tracing has been undertaken.
• Provide further sexual health education and prevention counseling.