Cervicitis

Many women experience discomfort or unusual symptoms in their reproductive area, but they often hesitate to discuss these concerns. Cervicitis, an inflammation of the cervix, affects more than 50% of women at some point in their lives.

This common condition can range from mild to severe, with various symptoms that might go unnoticed. Understanding cervicitis symptoms, its causes, and available cervicitis treatment options is crucial for maintaining reproductive health. This comprehensive guide explores everything women need to know about this condition, from its early warning signs to effective management strategies.

What is Cervicitis?

The cervix, the lower narrow end of the uterine cavity that opens into the vagina, can sometimes become inflamed – a condition known as cervicitis. This inflammation causes the cervical tissue to become swollen and may bleed more easily when touched.

What makes cervicitis particularly concerning is its potential to develop into more serious complications, such as pelvic inflammatory disease (PID), regardless of how mild the initial symptoms might appear. The condition can manifest quickly with severe symptoms or persist for several months or longer.

Two major diagnostic signs characterize cervicitis: 

• a purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen (commonly referred to as mucopurulent cervicitis), and 
• sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os. Either or both signs might be present. Cervicitis frequently is asymptomatic; however, certain women might report an abnormal vaginal discharge and intermenstrual vaginal bleeding (e.g., especially after sexual intercourse). 

Etiology

• C. trachomatis or N. gonorrhoeae is the most common etiology of cervicitis defined by diagnostic testing. 
• Trichomoniasis, genital herpes (especially primary HSV-2 infection), or M. genitalium  also have been associated with cervicitis.

Types of Cervicitis

Doctors classify cervicitis into two distinct types based on its duration and causes. Understanding these types helps in determining the most effective treatment approach.

• Acute Cervicitis: Acute cervicitis develops suddenly and primarily results from sexually transmitted infections. This type typically presents with more noticeable symptoms and requires immediate medical attention. 
• Chronic Cervicitis: This condition persists for several months and usually stems from non-infectious sources. 

Cervicitis Symptoms 

The following are common cervicitis signs and symptoms:

• Abnormal vaginal discharge that may appear yellow, white, or grey with an unpleasant odour
• Unexpected light vaginal bleeding between periods or after intimate relations
• Painful sexual intercourse (dyspareunia)
• Frequent, painful urination
• Vaginal itching and discomfort
• Pressure or heaviness in the pelvic area

Risk Factors and Causes of Cervicitis

• Acute Cervicitis: The condition can develop from various sources, with sexually transmitted infections (STIs) being the most common trigger. The most common infectious causes include:
  • Chlamydia (accounts for approximately 40% of cases)
  • Gonorrhoea
  • Genital herpes
  • Trichomoniasis
  • Mycoplasma genitalium
• Chronic Cervicitis: The condition can result from various factors, including:
  • Exposure to chemical irritants in feminine products
  • Allergic reactions to latex or spermicides
  • Extended use of barrier contraceptive devices
  • The presence of foreign bodies like pessaries
  • Systemic inflammatory conditions
• Several factors can increase someone's risk of developing cervicitis. These include:
  • Individuals who engage in high-risk sexual behaviours, such as unprotected intercourse or having multiple partners, face a higher likelihood of developing the condition. 
  • Those with a history of sexually transmitted infections also show increased susceptibility.
  • Mechanical trauma from surgical instruments or foreign objects like pessaries can cause inflammation.

Complications of Cervicitis

While cervicitis itself isn't typically life-threatening, leaving it untreated can lead to serious health complications. 

• Pelvic Inflammatory Disease (PID) stands as one of the most significant complications of untreated cervicitis. This serious infection can cause scarring in the uterus, ovaries, and fallopian tubes. The resulting damage may lead to several long-term health issues:
  • Chronic pelvic pain
  • Fertility problems
  • Risk of ectopic pregnancy
  • Potential for peritonitis (a life-threatening infection)
• Another significant concern is the increased vulnerability to sexually transmitted infections, including HIV/AIDS. An inflamed or irritated cervix may allow viruses and bacteria to enter the bloodstream more readily. 

Cervicitis Diagnosis

The diagnostic process typically involves several key components. Doctors perform a comprehensive physical examination that includes:

• A detailed pelvic examination to check for swelling and tenderness
• Collection of cervical and vaginal fluid samples for laboratory testing
• Visual assessment of the cervix using a speculum
• Urine sample analysis when necessary

During the examination, doctors look specifically for signs such as redness or inflammation of the cervix, the presence of pus-like discharge, and inflammation of vaginal walls. The cervix may appear erythematous, oedematous, or easily friable, which are classic indicators of cervicitis.

Cervicitis Treatments

The treatment of cervicitis focuses on eliminating the underlying cause while providing relief from symptoms. Doctors typically prescribe antibiotics as the primary treatment method, which successfully resolves most cases of cervicitis.

Treatment Options Based on Cause:

• Doxycycline for chlamydial infections
• Ceftriaxone for gonorrhoea-related cases
• Metronidazole for bacterial vaginosis or trichomoniasis
• Antiviral medications to manage symptoms if herpes is the cause

Recommended Regimen for Cervicitis

Doxycycline 100 mg orally 2 times/day for 7 days,Consider concurrent treatment for gonococcal infection if the patient is at risk for gonorrhea or lives in a community where the prevalence of gonorrhea is high (see Gonococcal Infections). Alternative Regimen Azithromycin 1 g orally in a single dose

Persistent or Recurrent Cervicitis

Women with persistent or recurrent cervicitis despite antimicrobial therapy should be reevaluated for possible reexposure or treatment failure. 

The etiology of persistent cervicitis, including the potential role of M. genitalium is unclear. M. genitalium might be considered for cases of cervicitis that persist after azithromycin or doxycycline therapy in which re-exposure to an infected partner or medical nonadherence is unlikely. 

Among women with persistent cervicitis who were previously treated with doxycycline or azithromycin, testing for M. genitalium can be considered

For women with persistent symptoms that are clearly attributable to cervicitis, referral to a gynecologic specialist can be considered for evaluation of noninfectious causes (e.g., cervical dysplasia or polyps) (778).

Prevention

Safe Sexual practices play a key role in prevention. Using condoms consistently and correctly during intimate relations drastically reduces the risk of STIs that can lead to cervicitis. Maintaining a monogamous relationship with an uninfected partner also helps lower the chances of developing this condition.

Doctors recommend several preventive measures:

• Schedule regular gynecological examinations and STI testing.
• Remove tampons and other feminine products according to the instructions.
• Avoid using irritating personal care products like douches,contraceptive creams
• Avoid diaphragm insertion 
• Rule out latex allergy due to condoms
• Wear breathable cotton underwear
• Choose gentle, unscented hygiene products

Management of Sex Partners

Management of sex partners of women treated for cervicitis should be tailored for the specific infection identified or suspected. All sex partners during the previous 60 days should be referred for evaluation, testing, and presumptive treatment if chlamydia, gonorrhea, or trichomoniasis was identified. 

When to See a Doctor

Key symptoms that require immediate medical attention include:

• Persistent, unusual vaginal discharge
• Non-menstrual vaginal bleeding
• Pain during intercourse
• Unusual irritation or discomfort

Conclusion

Cervicitis affects numerous women but remains manageable with proper medical attention and care. Understanding its symptoms, causes, and treatment options helps women take control of their reproductive health. Medical treatments, particularly antibiotics for infectious cases, prove highly effective when administered early.

Regular health check-ups serve as the cornerstone of cervicitis prevention and management. Women should not hesitate to seek medical attention when unusual symptoms appear, as early intervention prevents serious complications. Simple preventive measures, combined with appropriate home remedies and prescribed treatments, create a comprehensive approach to managing this condition effectively.

FAQs

1. Is cervicitis contagious?

Yes, acute cervicitis caused by infectious agents can spread between sexual partners. Doctors recommend avoiding sexual activity for at least seven days after starting treatment and until all symptoms have cleared. Partners should also receive proper treatment to prevent reinfection.

2. How common is cervicitis?

Studies indicate that cervicitis affects a significant portion of the female population. Research suggests that up to half of all women will experience cervicitis at some point in their adult lives. The condition is prevalent among sexually active women aged 15 to 24.

3. Is cervicitis a serious problem?

While not typically life-threatening, cervicitis requires proper medical attention to prevent complications. If left untreated, it can lead to several serious issues:

• Pelvic inflammatory disease (PID)
• Scarring in reproductive organs
• Increased risk of STIs, including HIV
• Potential fertility problems
• Risk of ectopic pregnancy

4. How long is cervicitis recovery?

With proper treatment, most cases of cervicitis clear up within one to two weeks. However, recovery time can vary and depends on the underlying cause and treatment adherence. Doctors emphasise taking all prescribed antibiotics exactly as directed, even ifsymptoms improve before completing the course. symptoms improve before completing the course.

Dr Rajini

CARE Medical Team