Disease Description (Causes and Symptoms)
- Definition summary: Cervicitis is a condition in which inflammation develops in the mucous membrane of the cervix (the opening of the uterus), caused by infectious or noninfectious factors. Some cases may be asymptomatic, but it is often contagious.
- Main causes
- Infectious: Chlamydia (Chlamydia trachomatis), gonorrhea (Neisseria gonorrhoeae), trichomoniasis (Trichomonas vaginalis), herpes simplex (HSV), candidiasis, etc.
- Noninfectious: Trauma, chemical irritation (vaginal douching, exposure to preservatives, etc.), chronic irritation of the cervix
- Pathophysiology (briefly): Pathogens or irritants damage the cervical epithelium, and inflammatory cells (neutrophils and lymphocytes) infiltrate the tissue, causing mucous or purulent discharge and mucosal edema. If the infection ascends, it can spread to the endometrium and fallopian tubes, causing pelvic inflammatory disease (PID).
- Main symptoms
- Abnormal vaginal discharge (possibly yellow or mucoid, with odor)
- Postcoital bleeding or irregular bleeding
- Dyspareunia, pelvic pain, abdominal pain
- Urethral irritation symptoms (feeling of incomplete bladder emptying, dysuria)
- Asymptomatic cases are also common
Treatment Methods
- Diagnosis (recommended tests before treatment)
- NAAT (nucleic acid amplification test) using vaginal/cervical samples — recommended for gonorrhea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis)
- Numerous neutrophils on smear (Gram stain), and, if necessary, culture (gonococcus), PCR (HSV), microscopy (trichomoniasis), KOH testing (candidiasis), etc.
- Empirical treatment may be started immediately based on clinical findings (while awaiting test results)
- Drug treatment (typical recommendations)
- Suspected/confirmed gonorrhea: Ceftriaxone 500 mg IM once (1 g if body weight is ≥150 kg) — may vary according to regional guidelines
- Suspected/confirmed chlamydia: Doxycycline 100 mg PO every 12 hours for 7 days (preferred). During pregnancy, azithromycin 1 g PO once is recommended
- Trichomoniasis: Metronidazole 500 mg PO every 12 hours for 7 days or 2 g PO once (recommendations for the two options during pregnancy may differ)
- HSV (initial symptoms rather than recurrence): Antiviral drugs such as Acyclovir/Valacyclovir (as directed by a physician)
- Candidal vaginitis: Antifungal drugs (such as fluconazole)
- In cases of clinically evident mucopurulent cervicitis, consider empirical treatment for both gonorrhea and chlamydia
- Non-drug/lifestyle management
- Abstain from sexual intercourse: Until both the patient and partner have received treatment and symptoms have resolved (follow the physician’s instructions)
- Avoid vaginal douching, irritating menstrual products, and prolonged tampon use
- Simultaneous treatment of partners is recommended (to prevent reinfection in cases of sexually transmitted infections)
- Follow-up and additional treatment
- Repeat testing within 3 months after chlamydia treatment is recommended (to identify reinfection)
- If symptoms persist or recur, pelvic examination and additional tests (colposcopy and biopsy) may be used to distinguish cervical lesions and tumors
- If an abscess or ascending infection (PID) is present, hospitalization, intravenous antibiotics, drainage, or other treatment may be necessary
- Pregnancy-specific considerations
- Some drugs (e.g., doxycycline) are contraindicated during pregnancy. During pregnancy, consult an obstetrician-gynecologist to use a safe alternative treatment (such as azithromycin)
Checklist Before an Outpatient Visit (Preparation and Sample Questions)
- Items to bring (recommended)
- A list of current medications (prescription drugs, over-the-counter drugs, and supplements)
- Information about allergies (medications, foods, etc.)
- Recent test results (if possible, previous STI test results, ultrasound results, etc.)
- A record of when symptoms began and how they have changed (discharge color, amount, odor; presence of bleeding; degree of pain)
- Recent sexual history (number of recent partners, condom use), and contraceptive method
- Possibility of pregnancy/whether pregnant (menstrual cycle, first day of the last menstrual period)
- Main questions you may be asked at the outpatient visit (items for the patient to think about in advance)
- When did the symptoms begin? What are the color, odor, and amount of the discharge?
- Have you recently changed sexual partners or had sex without a condom?
- Do you have a fever or severe pelvic pain?
- Have you ever been diagnosed with an STI? Have you taken antibiotics recently?
- Are you pregnant or planning to become pregnant?
Examples of General Questions to Ask the Doctor
- What is the most likely cause of these symptoms?
- What tests are recommended and why? Is a NAAT necessary?
- What are the names of the prescribed medications, how long should I take them, and what side effects should I expect?
- When is it safe to resume sexual intercourse? How should my partner be treated?
- When should I have repeat testing or a follow-up visit?
Examples of Condition-Specific Questions
- I am pregnant and suspected of having cervicitis. Which medications are safe? (Request an explanation of medication selection and risks by stage of pregnancy)
- My test results are negative, but my symptoms continue. What additional tests or treatment do you recommend? (Ask about colposcopy, biopsy, and non-gynecologic causes, etc.)