Cervicitis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation of the cervix most commonly caused by [[Chlamydia]] (about 40%) and [[Gonorrhea]] | |||
**Less commonly caused by [[Trichomonas]] and [[HSV-2]] | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC5345432 jphia-2013-2-e14-g003.png|thumb|Edematous and reddened cervix.]] | |||
*Mucopurulent endocervical discharge | |||
*May see endocervical bleeding easily induced by cotton swab | |||
*Frequently asymptomatic | |||
**Women may complain of abnormal [[vaginal discharge]] or post-coital [[vaginal bleeding]] | |||
*Pelvic/Abdominal pain or tenderness to palpation should prompt a diagnosis of [[pelvic inflammatory disease]] rather than [[cervicitis]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pelvic pain DDX}} | |||
== | ==Evaluation== | ||
*Swab (for [[GC]], [[Chlamydia]]) | |||
**Patient-obtained vaginal swabs are MORE sensitive than clinician-collected endocervical swabs for [[GC]]/[[Chlamydia]]<ref>Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.</ref><ref>Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.</ref> | |||
*Wet mount | |||
*Urine pregnancy test | |||
==Management== | ==Management== | ||
{{Cervicitis Urethritis Antibiotics}} | |||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
*[[Sexually transmitted diseases]] | |||
==External Links== | |||
*http://www.cdc.gov/std/treatment/2010/urethritis-and-cervicitis.htm | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
[[Category:OBGYN]] | |||
Latest revision as of 23:26, 10 March 2020
Background
- Inflammation of the cervix most commonly caused by Chlamydia (about 40%) and Gonorrhea
- Less commonly caused by Trichomonas and HSV-2
Clinical Features
- Mucopurulent endocervical discharge
- May see endocervical bleeding easily induced by cotton swab
- Frequently asymptomatic
- Women may complain of abnormal vaginal discharge or post-coital vaginal bleeding
- Pelvic/Abdominal pain or tenderness to palpation should prompt a diagnosis of pelvic inflammatory disease rather than cervicitis
Differential Diagnosis
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants may be noted on exam but generally do not cause pain or other symptoms
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervical Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Pelvic organ prolapse
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Evaluation
Management
Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[4]
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.
Standard
- Gonorrhea
- Ceftriaxone IM x 1
- 500 mg, if weight <150 kg
- 1 g, if weight ≥150 kg
- Ceftriaxone IM x 1
- Chlamydia
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
Ceftriaxone contraindicated
- Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
- Chlamydia^
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
^Additional chlamydia coverage only needed if treated with cefixime only
Partner Treatment
- Gonorrhea
- Cefixime 800mg PO x 1
- Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1
Associated Bacterial Vaginosis or Trichomonas vaginalis
Non-Pregnant
- Metronidazole 500mg PO BID for 7 days [5]
- Tinidazole 2g PO once
Pregnant
Only treat if the patient is symptomatic
- Metronidazole 500mg PO BID for 7 days [6]
Sexual Partner Treatment
- Female: Same as above
- Male: Metronidazole 2 gm PO x1 [7]
Disposition
- Discharge
See Also
External Links
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ. 2012;345:e8013.
- ↑ Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.
- ↑ Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
- ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
- ↑ CDC Trichomoniasis 2021. https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm
- ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon