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. The recommended initiation of Papanicolaou test screening is at the age of 21 years or within 3 years of the initiation of intercourse, but not as part of STI screening.

Reproductive age, nonpregnant

Routine screening for Chlamydia trachomatis and Neisseria gonorrhoeae of all sexually active females ages ≤25 years is recommended annually and could be considered on an "opt out" basis. Depending on sexual behavior, testing for pharyngeal and rectal infection should be offered.[1] Other risk factors that place women at increased risk include a previous gonorrhea infection, the presence of other 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.[28]

Herpes simplex virus (HSV) serologic 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 gonorrheal or chlamydial infection, repeat screening should be offered 3 to 4 months following treatment, as unsuspecting partners may not have received simultaneous treatment. However, retesting rates are disappointingly low. One Centers for Disease Control and Prevention study showed that a 3-step process, including patient counseling and early reminders to return to the clinic, increased chlamydia retesting rates within 4 months from 16% to 89%.[29]

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.[30]

If diagnosed and treated for gonorrhea during pregnancy, the patient should be retested 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 serologic screening among asymptomatic women during pregnancy.[1]

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