Cervicitis (Cervical Inflammation or Infection)

• Cervicitis is inflammation of the cervix (i.e. the portion of the uterus which protrudes downward into the vagina).
• Causes of the inflammation may be from infection from certain sexually transmitted diseases (STDs), injury to the cervix from a foreign body inserted into the vagina (for example, birth control devices such as the cervical cap or a diaphragm), or cervical cancer.
• Many women have cervicitis, but they don't know they are infected because they don't have symptoms.
• When symptoms do occur they may include:
  • Low back pain
  • Abdominal pain
  • Pain during intercourse
  • Vaginal itching
  • Burning during urination
• Cervicitis is a very common condition. In fact, more than half of all women may develop cervicitis during their adult lives.
• Risk factors for the development of cervicitis include early initiation of sexual activity, a history of sexually transmitted diseases, multiple sexual partners, and other high-risk sexual behaviors.
• Treatment regimens for cervicitis may include both antibiotics and surgery.
• If untreated, infectious cervicitis may progress to pelvic inflammatory disease, infertility, ectopic pregnancy, chronic pelvic pain, spontaneous abortion, cervical cancer, or complications related to childbirth.

Cervicitis is more commonly due to infection than to non-infectious causes, and there are a variety of cervicitis causes and risk factors including:

• Vaginal infections
• Sexually transmitted diseases (STDs) (for example, gonorrhea, Chlamydia, and Trichomonas)
• HIV infection
• Infection with the herpes virus (genital herpes)
• Infection with human papillomavirus (HPV, genital warts)
• Initiation of sexual activity at a young age
• Multiple sexual partners
• Prior history of sexually transmitted disease
• Injury or irritation of the cervix
• Cervical irritation can be due to chemicals contained in douches, as well as forgotten intravaginal foreign bodies such as tampons.
• Cervical irritation may render the cervix more susceptible to infection.
• Allergies to ingredients contained in contraceptive spermicides or to latex in condoms

Clinical cervicitis frequently has no signs or symptoms.

The most common sign of cervicitis is vaginal discharge, which is frequently heavier following menstruation. Other signs of cervicitis include:

1. Vaginal bleeding
2. Vaginal itching
3. Irritation of the external genitals.
4. Pain during intercourse.
5. Bleeding or spotting after sexual intercourse or between periods.
6. A burning sensation during urination
7. Lower back or abdominal pain, sometimes felt only during sexual intercourse
8. A more severe case of cervicitis can cause a profuse, pus-like (purulent) discharge with an unpleasant odor, accompanied by intense vaginal itching or abdominal pain.
9. If the infection spreads to other organs, there may be accompanying fever, nausea, and abdominal pain.

If a woman's male sex partner is diagnosed with urethritis (a urinary tract infection) or if he has symptoms of this condition (for example, pain or burning with urination, penile discharge, or staining of the underwear), the man should immediately seek medical care. If an infected partner is not treated, a woman may easily become re-infected.

Patient history

When a possible diagnosis of cervicitis is considered, a health-care professional will obtain a medical history and focus upon specific symptoms. These issues will include recent contraceptive usage, a sexual history, and a history of prior pregnancies and deliveries.

Pelvic exam

A pelvic exam will typically be performed.

• An instrument called a speculum will be inserted into the vagina to hold the vaginal walls apart, thus permitting an inspection of the cervix and vaginal walls for redness, irritation, unusual discharge, or sores.
• The doctor will collect a sample for a Pap smear by swabbing the cervix. The doctor will also collect samples to test for gonorrhea and Chlamydia. He also may collect vaginal discharge for microscopic examination to rule out other infections. The Pap smear is used to rule out pre-cancerous or malignant changes of the cervix.
• The pelvic organs will then be evaluated manually with both hands. The doctor will insert two fingers of his hand into the vagina with the fingers of the other hand pressing down on the abdominal wall. This procedure allows the doctor to determine the size and location of the uterus and cervix, as well as to check for pain, tenderness, or any other irregularity. This part of the exam creates pressure in the lower abdomen and pelvic area. While the perception of pressure is normal, frank pain should be absent. If pain is experienced, the doctor should be told. Pain can be felt when the cervix is moved from side to side in cervicitis.

Procedures

• If the cervix appears abnormal a biopsy or sample of tissue may be taken.
• Colposcopy is a procedure that employs a binocular-like instrument to obtain a magnified view of the surface of the cervix in order to delineate abnormalities that might not be visible to the naked eye.

Treatment for cervicitis depends upon the cause.

• Infectious causes of cervicitis due to gonorrhea and Chlamydia are treated with prescription antibiotics.
• Genital herpes is generally treated with oral or topical antiviral agents (for example, acyclovir [Zovirax]).
• If bacterial or viral cervicitis causes severe signs and symptoms, admission to a hospital may be necessary for intravenous anti-microbial agents and supportive care.

Patients are advised to not have sexual intercourse until treatment is completed and all symptoms have resolved for at least 7 days.

• In some people, a single dosage of medication, which may include an injection, has been shown to eradicate the disease. In other individuals, the health care professional may prescribe a longer course of medication that may be necessary for cure.
• If the infection stems from an STD, the partner should also be treated.
• Intercourse should not be resumed until after both partners have been treated, and follow-up testing on both is negative.

Cervicitis, if found in a young person or a child, frequently indicates sexual molestation.

If any of these symptoms develop, a health care professional should be consulted.

• A purulent or abnormal vaginal discharge is associated with pain or itching.
• Difficult or painful urination.
• Increased urinary frequency.
• Pelvic pain
• Bleeding or spotting after sexual intercourse or between periods.
• Lower abdominal pain is sometimes noted only during or following sexual intercourse.
• Signs of a potential pelvic emergency include copious vaginal discharge, fever, chills, nausea, vomiting, severe abdominal pain, and dizziness. These require urgent evaluation.

Untreated microbial cervicitis can spread throughout the genital tract, infecting the lining of the uterus (endometritis) and the Fallopian tubes (salpingitis). Such generalized infections can lead to infertility. Spread to the pelvic organs can cause pelvic inflammatory disease, a serious infection involving the upper genital tract resulting in adhesion formation and tubal blockage. If cervicitis due to an STI is present during pregnancy, the infant may be infected at the time of delivery, resulting in a newborn eye infection that can ultimately lead to blindness. Less commonly, the infant may develop pneumonia caused by a Chlamydia infection present in the cervix at the time of delivery.

Infectious causes of cervicitis are preventable by using common-sense, safe-sex practices. A woman should do the following:

• Limit her number of sexual contacts, and be aware of her partners' sexual histories.
• Condoms should be used routinely to prevent STDs.
• In addition to condoms, spermicides may also contribute to the prevention of cervicitis.
• Seek immediate treatment for suspected vaginal infections before the cervix becomes infected.
• Have regular physical examinations and PAP smears performed, regardless of whether there are any symptoms of infection, especially if you are sexually active.
• Recommend that her partner be screened periodically for STDs.
• Avoid chemical irritants to the vagina (typically found in deodorized tampons, douches, or sprays).