Cervicitis

Question 1

Aetiology of cervicitis

Answer 1

• Infectious (STIs)
  
  • Common
    
    • Chlamydia
    • Gonorrhoeae
  • Less common
    
    • HPV
    • Herpes simplex virus (HSV)
    • Trichomonas vaginalis
• Non-infectious
  
  • Trauma
  • Malignancy
  • Radiation

Question 2

Complications of cervicitis

Answer 2

• Untreated chlamydia & gonorrhoea
  
  • PID → infertility, ectopic pregnancy, preterm delivery
• HPV 16 & 18
  
  • Cervical cancer

Question 3

Presentation of cervicitis

Answer 3

• History
  
  • Asymptomatic
  • Discharge
  • Dysuria
  • Frequency
  • Intermenstrual/post-coital bleeding
  • Lower abdominal/pelvic pain (chronic)
• Examination
  
  • Speculum
    
    • Inflamed
    • Easily friable
    • Mucopurulent (thick yellow-green pus)
      
      • Typically chlamydia or gonorrhoea
    • Warts (HPV)
    • Ulcerations (HSV)
    • ‘Strawberry-like’ appearance (Trichomonas vaginalis)
  • Bimanual
    
    • Cervical excitation

Question 4

Investigations for cervicitis

Answer 4

• Endocervical/vaginal swab

Question 5

Management of cervicitis

Answer 5

• Chlamydia
  
  • Azithromycin (single dose)
  • Doxycycline (bd, 7 days)
• Gonorrhoea
  
  • Ceftriaxone (IM, one dose)
  • • Azythromycin
• Trichomonas
  
  • Metronidazole (single dose)
    
    • Must avoid alcohol
    • Do not breastfeed
• Pregnancy
  
  • Azithromycin