Cervicitis is defined clinically by the presence of cervical ectopy and/or a friable cervix with easily induced bleeding at the cervical os and/or mucopurulent (yellow coloured) discharge at the cervical os.
Symptoms | Comments/Considerations |
---|---|
Vaginal discharge | Speculum examination to view cervix, +/- bimanual if complaining of pelvic pain or dyspareunia. Cervicitis may be a sign of an upper genital-tract infection making it important to assess for pelvic inflammatory disease (PID), particularly in the context of uterine tenderness, adnexal tenderness, or cervical motion tenderness on pelvic exam. |
Intermenstrual or post-coital vaginal bleeding |
As above. May also require pregnancy test if at risk. |
If cervicitis found incidentally on vaginal examination eg PAP smear consider testing for STIs | Especially if patient is <30 years old, has had a previous STI, is an Aboriginal or Torres Strait Islander, has had a recent new partner or >1 partner in last 12 months. |
A speculum examination and cervical swab, at least, are required to diagnose cervicitis.
Infection | Site/Specimen | Test |
---|---|---|
Chlamydia |
Endocervical swab |
NAAT |
Gonorrhoea |
Endocervical swab |
NAAT. If positive, take swab at relevant site(s) for culture, before treatment. |
Trichomoniasis |
High vaginal swab or FPU |
NAAT pH test |
M. genitalium | Endocervical swab | NAAT |
Herpes (if cervical ulcers present) |
Cervical swab
|
NAAT |
NAAT - Nucelic acid amplification test |
In the absence of a definitive causative organism, in a woman with increased risk of STI treat sydromically.
Principal Treatment Options | ||
---|---|---|
Situation | Recommended | Alternative |
Unknown organism |
Doxycycline 100mg PO, BD for 7 days |
Azithromycin 1g PO, stat
|
Consider treatment for gonorrhoea if patient is at risk, or in a community with high gonorrhoea prevalence.
If organism is known, see relevant STI guidelines for treatment recommendations:
See Australasian Contact Tracing Manual for more information.
Review at day 7 with speculum, and/or bimanual, examination as required. Routine follow up is not required unless an STI has been identified or symptoms of pelvic inflammatory disease (PID).
If PID diagnosed, assess response to antibiotics after 7 days.
If STI confirmed, follow up provides an opportunity to:
Mucopurulent cervicitis will often persist despite treatment if due to an ectropion, however no further treatment is required.
For test of cure (TOC) and retesting advice see:
100% of patients diagnosed with cervicitis are treated with an appropriate antibiotic regime.