Description

• Cervicitis refers to any inflammatory changes of the cervix:
  • Ectropion: Presence of cervical columnar cells on the vaginal portion of the cervix (portio); often seen during adolescence and during pregnancy
  • True erosion: Loss of overlying cervical epithelium due to trauma (e.g., forceful insertion of vaginal speculum in patient with atrophic mucosa)
• System(s) affected: Reproductive

• Chronic cervicitis in postmenopausal women may be related to lack of estrogen.
• The possibility of infectious cervicitis should not be overlooked in geriatric patients, because many remain sexually active.

Pregnancy Considerations
Screen all pregnant women for infectious cervicitis because of risk of pregnancy complications and potential for transmission to the fetus.

Pediatric Considerations
Infectious cervicitis in children should lead to an investigation for possible sexual abuse.

Epidemiology

• Cervicitis: Cervicitis-specific data are not available:
  • Chlamydia incidence: 1,244,180 cases were reported to the CDC in 2009, although it is estimated that as many as 4 million new cases of chlamydia occur in the US annually. The total number of reported cases has been rising.
  • Gonorrhea: Next to chlamydia, gonorrhea is the 2nd-most common reported notifiable disease in the US, with 301,174 cases reported to the CDC in 2009. The number of reported cases has decreased in recent years, although higher rates persist among certain populations.
  • Trichomoniasis: Case reporting data are not available. National Health and Nutrition Examination Survey (NHANES) data estimate an overall prevalence in the US of 3.1% (1).
  • Mycoplasma genitalium is becoming recognized as an important sexually transmitted pathogen that may be as common as chlamydia among high risk, sexually active women (2).
• Ectropion: Common with oral contraceptive use and among pregnant women
• True erosion: Occasionally seen in postmenopausal women

Risk Factors

• Infectious cervicitis:
  • Multiple sexual partners
  • Adolescence and young adulthood
  • Unprotected sex
  • History of STD
  • Smoking
  • Other reproductive tract infections: Vaginitis, pelvic inflammatory disease (PID)
  • Foreign objects: Pessary, diaphragm, cervical cap, etc.
• Ectropion: Adolescence, pregnancy
• True erosion: Estrogen deficiency, trauma

General Prevention

• Sexually transmitted infections (gonorrhea, chlamydia, trichomoniasis):
  • Follow CDC-recommended screening measures: The US Preventive Services Task Force recommends screening for chlamydial infection in all sexually active nonpregnant young women ≤24 years and for older nonpregnant women who are at increased risk, but no routine screening for women >24 years not at increased risk (3)[C].
  • Treat sexual partners of infected women.
  • Advise use of condoms and safer sexual practices.
• Estrogen deficiency: Estrogen replacement therapy

Etiology

• Often, no specific etiology is identified.
• Cervicitis: C. trachomatis, N. gonorrhoeae, T. vaginalis, herpes simplex virus (HSV; especially primary infections of HSV-2), mycoplasmas (e.g., M. genitalium), Ureaplasma, cytomegalovirus
• Nonsexually transmitted infectious cervicitis can be caused by overgrowth of β-hemolytic streptococcus or E. coli.
• Noninfectious causes include chemical irritation (e.g., from douching or latex exposure) and local trauma from vaginal foreign bodies such as diaphragms or cervical caps.
• Ectropion:
  • Hormonal changes with oral contraceptive use (especially with progesterone) or pregnancy
  • Resulting from cervical laceration during childbirth
• True erosion: Injury to atrophic epithelium: Estrogen-deficient states such as menopause