Cervicitis is inflammation of the cervix, most often caused by the sexually transmitted infections chlamydia and gonorrhea. Many patients have no symptoms, so testing and treatment protect against pelvic inflammatory disease and infertility.
Key symptoms
- Often no symptoms
- Abnormal yellow or cloudy vaginal discharge
- Bleeding after sex or between periods
- Pain with sex or painful urination
What you find on exam
- Mucopurulent discharge from the cervical os
- Friable cervix that bleeds easily with a swab
- Bimanual exam: check for cervical motion, uterine or adnexal tenderness
- Look for vulvar ulcers or other signs of STI
Tests
- NAAT for chlamydia and gonorrhea from a vaginal or cervical swab
- Trichomonas testing and wet mount
- Pregnancy test
- Offer HIV and syphilis screening
Treatment basics
- Doxycycline 100 mg twice daily for 7 days (azithromycin in pregnancy)
- Ceftriaxone 500 mg intramuscular once if gonorrhea is likely or confirmed
- Treat partners and avoid sex for 7 days after treatment
- Retest for infection about 3 months later
- Counsel on condoms and safer sex
Red flags
- Cervical motion or adnexal tenderness suggesting PID
- Fever, vomiting or a pelvic mass
- Positive pregnancy test with pain or bleeding
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.