Цервіцит

Acute cervicitis is usually caused by a sexually transmitted infection; the most common infectious cause of cervicitis is Chlamydia trachomatis, followed by Neisseria gonorrhea. Other causes include herpes simplex virus (HSV), Trichomonas vaginalis, and Mycoplasma genitalium. Often, a pathogen cannot be identified.

The cervix may be inflamed but not infected as part of vaginitis (eg, bacterial vaginosis, trichomoniasis).

Noninfectious causes of cervicitis include gynecologic procedures, foreign bodies (eg, pessaries, barrier contraceptive devices), chemicals (eg, in douches or contraceptive creams or gels), and allergens (eg, latex).

Cervicitis may not cause symptoms. The most common symptoms are vaginal discharge and intermenstrual or postcoital vaginal bleeding. Some women have dyspareunia.

Mucopurulent Cervicitis

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By permission of the publisher. From Goldfarb A. In Atlas of Clinical Gynecology: Pediatric and Adolescent Gynecology. Edited by M Stenchever (series editor) and AF Goldfarb. Philadelphia, Current Medicine, 1998.

Examination findings can include purulent or mucopurulent discharge, cervical friability (eg, bleeding after touching the cervix with a swab), and cervical erythema and edema.

• Pelvic examination

• Testing for vaginitis and sexually transmitted infections

Cervicitis is diagnosed if women have a cervical exudate (purulent or mucopurulent) or cervical friability.

Findings that suggest a specific cause or other disorders include the following:

• Fever: Pelvic inflammatory disease (PID) or herpes simplex virus (HSV) infection

• Cervical motion tenderness: PID

• Vesicles, vulvar or vaginal pain, and/or ulceration: HSV infection

• Punctate hemorrhages (strawberry spots): Trichomoniasis

Women should be evaluated clinically for PID and tested for chlamydia and gonorrhea, bacterial vaginosis, and trichomoniasis.

• Usually treatment for chlamydia and gonorrhea

In certain clinical situations, patients with signs and symptoms suggestive of cervicitis should be treated empirically for gonorrhea and chlamydia, even before test results are received. This includes settings in which patient follow up is uncertain (eg, emergency department, urgent care clinic) or if the clinical suspicion is high and expediting treatment may benefit the patient. Treatment is the following:

• Chlamydia: Azithromycin 1 g orally once or doxycycline 100 mg orally twice a day for 7 days

• Gonorrhea: Ceftriaxone 500 mg IM once for patients weighing < 150 kg or 1g IM once for patients weighing ≥ 150 kg plus azithromycin 1 g orally once (due to emerging resistance of N. gonorrhoeae to cephalosporins)

Once the cause or causes are identified based on the results of microbiologic testing, subsequent treatment is adjusted accordingly.

If the cause is the herpes simplex virus, infection usually persists for life. Antiviral medications can control but not cure these infections.

If cervicitis persists despite treatment, reinfection with chlamydiae and N. gonorrhoeae should be ruled out, and empiric treatment with moxifloxacin 400 mg orally once a day for 7 to 14 days (eg, for 10 days) should be started to cover possible M. genitalium infection. M. genitalium has been associated with cervicitis, pelvic inflammatory disease, preterm delivery, and infertility and should be investigated in patients with nongonococcal, nonchlamydial cervicitis if polymerase chain reaction (PCR) testing is available.

If the cause is a bacterial STI, sex partners should be tested and treated simultaneously. They should abstain from sexual intercourse until the infection has been eliminated from the patient and all partners.

All women with confirmed chlamydia or gonorrhea, and those diagnosed with trichomoniasis, should be tested 3 months after treatment because reinfection is common.