Cervicitis

Cervicitis is inflammation of the cervix, often caused by a sexually transmitted infection, but a pathogen is not identified in many cases. The diagnosis is clinical. Either or both of the following findings establishes the syndrome: - Purulent or mucopurulent exudate visible in the endocervical canal or on an endocervical swab - Sustained or easily induced bleeding or friability at the cervical os A patient may report abnormal vaginal discharge, postcoital bleeding, intermenstrual bleeding, dysuria, pelvic discomfort, or dyspareunia. Some patients have no symptoms and are identified during a pelvic examination. The experienced examiner looks at the cervix rather than assuming that all discharge is vaginitis: a friable, easily bleeding os points toward cervicitis, whereas bacterial vaginosis or trichomoniasis primarily affects vaginal secretions and the vaginal mucosa. These conditions can coexist. The immediate clinical question is not only “Which organism is present?” It is also “Has infection moved beyond the cervix?” New lower abdominal or pelvic pain, fever, deep dyspareunia, cervical motion tenderness, uterine tenderness, or adnexal tenderness raises concern for ascending infection and possible pelvic inflammatory disease. This changes...