Cervicitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Adolescents

All sexually active women under the age of 25, particularly in adolescence, should be screened annually if possible.[1] Routine screening includes testing for gonococcal and chlamydial infection, and tests for other sexually transmitted infections (STIs) are offered after possible exposure. Guidelines on the recommended initiation and frequency of Papanicolaou test screening vary.

Reproductive age, non-pregnant

Routine screening for Chlamydia trachomatis and Neisseria gonorrhoeae of all sexually active females aged ≤25 years is recommended annually and could be considered on an ‘opt out’ basis. Depending on sexual behaviour, testing for pharyngeal and rectal infection should be offered.[1] Other risk factors that place women at increased risk include a previous gonorrhoea infection, the presence of other sexually transmitted infections (STIs), new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.[1] Patients should be screened immediately following unprotected intercourse.[1] In some women, especially those at risk for STIs, the use of a vulvovaginal swab, as opposed to clinician-directed endocervical swab, may be at least as effective in detecting infectious cervicitis.[29]

Herpes simplex virus (HSV) serological testing should be considered for people presenting for an STI evaluation (especially for those people with multiple sex partners), and people with HIV infection. Screening for HSV-1 and HSV-2 in the general population is not indicated.[1]

Follow-up screening should be performed at 3 to 12 months following possible exposure to an STI. If screened positive for gonorrhoeal or chlamydial infection, repeat screening should be offered 3 to 4 months following treatment, as unsuspecting partners may not have received simultaneous treatment. However, re-testing rates are disappointingly low. One US Centers for Disease Control and Prevention study showed that a 3-step process, including patient counselling and early reminders to return to the clinic, increased chlamydia re-testing rates within 4 months from 16% to 89%.[30]

Patients who desire placement of an IUD should be screened for asymptomatic cervicitis. If an IUD is placed during an active infection, this action will predispose the patient to an ascending infection (e.g., endometritis, acute salpingitis). Patients with a history of infectious cervicitis may still be candidates for placement as long as they do not have an active infection.

Pregnant

Routine screening for Chlamydia trachomatis and N Gonorrhoeae is recommended at the initial antepartum visit for all patients and again in the third trimester for high-risk patients.[31]

If diagnosed and treated for gonorrhoea during pregnancy, the patient should be re-tested in 3 weeks and then at 3 months.

Evidence does not support routine testing for bacterial vaginosis or Trichomonas vaginalis in pregnancy. Women who report symptoms should be evaluated and treated appropriately.[1] Evidence does not support routine HSV-2 serological screening among asymptomatic women during pregnancy.[1]

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