Cervical inflammation

Alternative names
Cervicitis; Inflammation - cervix

Definition
Cervicitis is an inflammation of the uterine cervix, usually caused by infection.

Causes, incidence, and risk factors

Cervicitis is most often caused by an infection. However, in a few cases it may be attributed to chemical exposure or a foreign body, such as a pessary (a device inserted into the vagina to support the uterus), cervical cap (a birth control device), or diaphragm.

The condition may also be caused by an allergy to contraceptive spermicides or to latex in condoms. In cases of cervicitis attributed to foreign objects, infection is still frequently the cause, but the presence of the foreign object may make the cervix more susceptible to infection (irritated or raw areas, buildup of discharge, unsanitary insertion methods, etc.).

Cervicitis is very common, affecting more than half of all women at some point during their adult lives. Increased risk is associated with intercourse at an early age, high-risk sexual behavior, multiple sexual partners, and a history of sexually transmitted disease.

Increased risk is also associated with having a partner who has engaged in high-risk sexual behavior or who has had a previous sexually transmitted disease. Gonorrhea, chlamydia, and trichomonas are commonly seen sexually transmitted infections that can cause cervicitis.

The herpes virus (genital herpes) and human papilloma virus (genital warts) are two other sexually transmitted diseases that can cause cervicitis and abnormal changes in a Pap smear. Organisms, such as staphylococcus and streptococcus, and excessive growth of normal vaginal bacteria (bacterial vaginosis), can also cause cervicitis.

Symptoms

     
  • unusual vaginal discharge       o persistent       o may be profuse and have an odor       o gray, white or yellow color  
  • abnormal vaginal bleeding       o after intercourse       o between periods       o after menopause       o a sense of pelvic pressure or heaviness  
  • sexual intercourse, painful  
  • vaginal pain

Note: There may be no symptoms.

Signs and tests

A pelvic examination reveals redness of the cervix or evidence of a cervical discharge. It may also reveal inflammation of the vaginal walls caused by the infected discharge.

Tests:

     
  • Tests for gonorrhea or Chlamydia may be positive.  
  • A wet mount inspection of the discharge may show evidence of candidiasis, Trichomonas, or bacterial vaginosis.  
  • A Pap smear may show evidence of inflammation or infection.

Treatment

Infectious causes are treated with prescription medication (antibiotics or antifungals). Medications may be taken orally (by mouth) or applied in the vagina (cream or lotion).

Hormonal therapy may be initiated, especially in postmenopausal women. Cryosurgery, electrocauterization, and laser therapy are other treatment options that may be considered, if less invasive measures are not successful.

Expectations (prognosis)

Simple cervicitis typically heals with treatment if the cause is adequately identified and treatment is available for that specific cause.

Complications

Chronic (long-term) cervicitis may develop and persist for months to years. Cervicitis may be a causative factor in dyspareunia (pain with intercourse).

Calling your health care provider

Call for an appointment with your health care provider if you are a woman, age 20 or older, and have had no prior pelvic examination and Pap smear.

Call for an appointment with the health care provider if you have not obtained a pelvic exam and Pap smear at the recommended intervals. Typical recommendations are:

     
  • every year initially  
  • for women up to age 35 or 40: every 2 to 3 years after having three negative, consecutive annual Pap smear tests and a single sexual partner or no sexual partner  
  • every year for women over age 35 or 40  
  • every year for women who have had multiple sexual partners  
  • every year for women who are taking oral contraceptives (birth control pills)  
  • every 6 months for women who have a history of HPV (genital warts)  
  • every year for women who were prenatally exposed to DES  
  • the frequency recommended by your health care provider after an abnormal Pap smear

Prevention

Studies indicate that women who begin sexual activity at a later age and engage only in a monogamous relationship have a markedly decreased likelihood of both cervicitis and abnormal Pap smears.

Safer sex behaviors, including monogamy, will reduce the chance of getting cervicitis. Chemical irritants, such as douches and deodorant tampons, should be avoided. Women who have active cervicitis should avoid using spermicidal contraceptives, if possible. However, if they are the only form of contraceptive available to you, it is better to practice safer sex by using them.

Many women use barrier methods of contraception (diaphragm, condoms, cervical caps) which must be used with a spermicidal jelly for best protection against unwanted pregnancy. See your health care provider to discuss alternative contraceptive methods prior to stopping your present barrier method.

Make sure that any foreign objects that you insert into your vagina, such as a pessary, diaphragm, sponge, or tampon, are inserted and placed properly. Be sure to follow the recommended guidelines as to how long to leave the object in, how often to change it, or how often to clean it. Good hygiene is always recommended.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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