Cervicitis is an inflammation of the uterine cervix, characteristically diagnosed by: (1) a visible, purulent or mucopurulent endocervical exudate in the endocervical canal or on an endocervical swab specimen and/or (2) sustained, easily induced endocervical bleeding when a cotton swab is gently passed through the cervical os.
A normal cervix is pictured below. (See Presentation.)
Noninfectious cervicitis can be caused by the following:
Local trauma – eg, cervical irritation caused by tampons, a cervical cap, the string from an intrauterine contraceptive device, a pessary, or a diaphragm
Chemical irritation – eg, vaginal douches, latex exposure, or contraceptive creams
Systemic inflammation – eg, Behçet syndrome
The infectious etiologies of cervicitis, all of which are sexually transmitted infections (STIs), are significantly more common than the noninfectious causes. This article focuses on the infectious etiologies of cervicitis. (See Etiology.)
Infectious cervicitis may be caused by Chlamydia trachomatis (see the first image below), Neisseria gonorrhoeae, or herpes simplex virus (HSV) (see the second image below). In most cases of cervicitis, however, lab tests fail to isolate an organism; this is particularly true in women with low risk factors. (See Etiology and Workup.)
Signs of chlamydial cervicitis on speculum examination may include mucopurulent endocervical discharge and spontaneous or easily induced endocervical bleeding or any zones of ectopy.
Herpes simplex virus (HSV) cervicitis may involve the exocervix or endocervix, and it may be symptomatic or asymptomatic. Usually, the cervix appears abnormal to inspection, with diffuse vesicular lesions, ulcerative lesions, erythema, or friability.
Trichomonas vaginalis, which, technically, causes vaginal infections, is commonly included in the discussion of cervicitis.
Because the female genital tract is contiguous from the vulva to the fallopian tubes, there is some overlap between vulvovaginitis and cervicitis; both conditions are commonly categorized as lower genital tract infections. Infections involving the endometrium and fallopian tubes are commonly categorized as upper genital tract infections and are not discussed in this article. (See DDx.)