Cervicitis

Background

  • Inflammation of the cervix most commonly caused by Chlamydia (about 40%) and Gonorrhea

Clinical Features

Differential Diagnosis

Pelvic Pain

Pelvic origin

Abdominal origin

Evaluation

  • Swab (for GC, Chlamydia)
    • Patient-obtained vaginal swabs are MORE sensitive than clinician-collected endocervical swabs for GC/Chlamydia[3][4]
  • Wet mount
  • Urine pregnancy test

Management

Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[5]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Associated Bacterial Vaginosis or Trichomonas vaginalis

Non-Pregnant

Pregnant

Only treat if the patient is symptomatic and avoid breast feeding until 24-hrs after last dose

Sexual Partner Treatment

Women with HIV Infection

Disposition

  • Discharge

See Also

References

  1. Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  3. Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
  4. Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.
  5. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  6. Kissinger P et al. Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: An open-label, randomised controlled trial. Lancet Infect Dis 2018 Oct 5; [e-pub].
  7. CDC Trichomoniasis 2015. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
  8. CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59(No. RR-12)
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