Cervicitis

Introduction & Australian Epidemiology

Cervicitis represents one of the most common presentations in sexual health clinics across Australia, affecting approximately 10-15% of sexually active women annually. The condition is particularly prevalent among women aged 15-24 years, with significant implications for reproductive health if left untreated.

Pathophysiology / Microbiology

Cervicitis results from ascending infection of the lower genital tract, with pathogens gaining access through the cervical os. The inflammatory response involves both innate and adaptive immune mechanisms, leading to characteristic clinical and microscopic findings.

Clinical Presentation & Diagnostic Criteria

Cervicitis may be asymptomatic in up to 70% of cases, making routine screening essential in high-risk populations. When symptomatic, presentation varies depending on the causative organism and host factors.

Symptomatic Presentation

• Vaginal discharge: Mucopurulent, yellow-green, may be malodorous
• Abnormal bleeding: Postcoital bleeding, intermenstrual bleeding
• Pelvic pain: Lower abdominal or pelvic discomfort
• Urinary symptoms: Dysuria, urinary frequency
• Dyspareunia: Pain during sexual intercourse

Clinical Examination Findings

• Cervical erythema: Red, inflamed cervical appearance
• Cervical friability: Bleeding with gentle manipulation
• Mucopurulent discharge: Visible at cervical os
• Cervical motion tenderness: May indicate ascending infection
• Adnexal tenderness: Concerning for PID development

Investigations

Diagnostic testing should be performed before initiating treatment when possible, with consideration of Australian laboratory availability and testing guidelines.

• Essential
  Nucleic Acid Amplification Test (NAAT)

  First-line testing for Chlamydia and Gonorrhoea. Cervical, urethral, or first-void urine specimens. Available at all Australian pathology services. Medicare rebate available.
• Available
  Mycoplasma genitalium PCR

  Consider in persistent or recurrent cervicitis. Available at major laboratories. Include macrolide resistance testing if positive.
• Available
  High Vaginal Swab (HVS) Microscopy

  Wet mount and gram stain for Trichomonas, bacterial vaginosis, and yeast. Immediate results if microscopy available on-site.
• Available
  Cervical Cytology (Pap Smear)

  Rule out malignancy if clinically indicated. Not part of routine cervicitis workup unless abnormal cervical appearance.
• Referral
  HSV Type-Specific Serology

  Consider if herpetic lesions present. HSV PCR from active lesions preferred over serology for acute diagnosis.
• Essential
  HIV, Syphilis, Hepatitis B & C Serology

  Routine STI screening as part of comprehensive sexual health assessment. Medicare rebate available for high-risk individuals.

Risk Stratification / Severity Scoring

Risk stratification focuses on identifying patients at risk for complications, particularly ascending infection leading to pelvic inflammatory disease (PID).

Empirical Antimicrobial Therapy

Empirical treatment should cover the most common pathogens (Chlamydia and Gonorrhoea) and may be initiated while awaiting test results in high-risk patients or when follow-up is uncertain.

First-Line Empirical Treatment

Alternative First-Line (

References

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