Cervicitis overview: Difference between revisions

	Cervicitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cervicitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cervicitis overview On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Cervicitis overview All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cervicitis overview
CDC on Cervicitis overview
Cervicitis overview in the news
Blogs on Cervicitis overview
Directions to Hospitals Treating Cervicitis
Risk calculators and risk factors for Cervicitis overview

VisualWikitext

Latest revision as of 15:40, 27 October 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Cervicitis means inflammation of the tissues of the cervix. Cervicitis may be classified according to the etiology, anatomical location and disease duration, such as infectious, non-infectious, acute, subacute and chronic cervicitis. C. trachomatis or N. gonorrhea is the most common etiology of cervicitis. Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as endometritis, salpingitis, vaginitis and vulvovaginitis. Mucopurulent cervicitis is often asymptomatic, however, some patients may present with abnormal vaginal discharge, painful sexual intercourse, and intermenstrual vaginal bleeding. Common risk factors in the development of cervicitis include high-risk sexual behavior, history of sexually transmitted diseases, sexual intercourse at an early age, sexual partners who have engaged in high-risk sexual behavior or have a previous history of STDs, single marital status, urban residence, low socioeconomic status, smoking, alcohol or drug use, multiple sex partners, and bacterial vaginosis. There is no single diagnostic study of choice for the diagnosis of cervicitis. There are two major diagnostic signs that characterize cervicitis, Purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen (commonly referred to as mucopurulent cervicitis) and sustained endocervical bleeding is easily induced by gentle passage of a cotton swab through the cervical os. Cervicitis is usually asymptomatic, symptoms observed include, abnormal vaginal discharge, and/or intermenstrual vaginal bleeding (e.g., especially after sexual intercourse). Diagnosis of cervicitis is mostly clinical however, a finding of >10 WBC in vaginal fluid, in the absence of trichomoniasis, may indicate endocervical inflammation caused specifically by C. trachomatis or N. gonorrhea although culture is more accurate for gonococcal cervicitis. If left untreated, cervicitis may progress to PID with associated infertility especially in chronic cervicitis. Untreated active HSV infections in the perinatal and neonatal period may lead to neonatal morbidity. Complications that can develop as a result of infectious cervicitis include, pelvic inflammatory disease, infertility, chronic pelvic pain, ectopic pregnancy, spontaneous abortion, premature rupture of membranes and preterm delivery. Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT. Recommended regimen for cervicitis, doxycycline 100 mg PO bid for 7 days. The alternative regimen includes azithromycin 1 g PO in a single dose. Patients may also require concomitant therapy against N. gonorrhea. Medical therapies include either azithromycin, doxycycline, or a fluoroquinolone. Treatment of sexual partners is also indicated. Follow-up after completion of antimicrobial therapy regimen is required to evaluate for microbial resistance.

Historical Perspective

Cervicitis was first described formally by Dr. Voilet I. Russell and Dr. D. Cochrane Logan in 1926 during their addresses made before the Medical Society for the Study of Venereal Diseases on January 29, 1926. Before this time, no accurate record was made about the disease in the literature.

Classification

Cervicitis may be classified according to the etiology, anatomical location and disease duration, such as infectious, non-infectious, acute, subacute and chronic cervicitis. The infectious causes are gonococcal, C. trachomatis and herpes. Examples of the non-infectious causes are traumatic injury to the cervix, chemical exposure, douching, latex, contraceptive creams, systemic inflammation (e.g. Behcet syndrome), as well as radiation exposure.

Pathophysiology

The pathophysiology of cervicitis depends on the etiological agent and the physiological state of the patient. Under the influence of estrogen, the normal vaginal epithelium cornifies, making it somewhat resistant to infectious agents. The endocervix is lined by columnar epithelium which is susceptible to infectious agents leading to cervicitis. Gonococcal cervicitis results after the exposure of the cervix to N. gonorrhea in seminal fluid during sexual intercourse. N. gonorrhea infectivity is facilitated by type IV pilus-mediated motility of the bacterium. In the presence of seminal fluid, the bacterial motility is characterized by high velocity, low directional persistence and enhanced microcolony formation. Once the pili are attached, local inflammation results from the release of neutrophilic cytokines, leading to purulent or mucopurulent discharge. C. trachomatis infection is often associated with intense lymphocytic and neutrophilic inflammatory reactions in the affected areas, and is occasionally associated with follicular aggregation of lymphocytes. The chronic course of chlamydial cervicitis is associated with low content of cytokines, mainly IL-1α, IL-1β, and TNFα, and an elevated concentration of IL-8 in the pathogenesis.

Causes

Cervicitis is caused by infectious and non-infectious causes. The infectious causes are most commonly caused by chlamydia and gonorrhea, with chlamydia accounting for the majority of cases. Trichomonas vaginalis and herpes simplex (especially primary HSV-2 infection), or M. genitalium are less common causes of cervicitis. Non-infectious causes of cervicitis include: intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms.

Differentiating Cervicitis from Other Diseases

Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as endometritis, salpingitis, vaginitis and vulvovaginitis.

Epidemiology and Demographics

The incidence and prevalence of cervicitis depends on the study population.The prevalence of cervicitis is estimated to be 18,000 per 100,000 women diagnosed with gonococcal infection. The prevalence of cervicitis ranges from 7,600 to 24,900 per 100,000 female sex workers. The broad range is due to variation in demographic location. Cervicitis is relatively more prevalent in HIV-positive women than non-HIV positive women. Among this population, the prevalence of cervicitis is estimated to be 7,400 per 100,000 women diagnosed with HIV infection. Screening and treatment of M. genitalium among HIV-infected individuals may be needed to improve cervical health and reduce morbidity. The overall prevalence of nongonococcal cervicitis is higher than gonococcal cervicitis. Chlamydia cervicitis is four to five times more prevalent than gonococcal cervicitis. However, co-infection of gonococcal and chlamydia cervicitis is higher in PID than in cervicitis. Cervicitis commonly follows the pattern of age prevalence of sexually transmitted infections with the highest incidence among women aged 15-24. There is no racial predilection to developing cervicitis. The prevalence of cervicitis is higher in under-served communities and developing countries.

Risk Factors

Common risk factors in the development of cervicitis include high-risk sexual behavior, history of sexually transmitted diseases, sexual intercourse at an early age, sexual partners who have engaged in high-risk sexual behavior or have a previous history of STDs, single marital status, urban residence, low socioeconomic status, smoking, alcohol or drug use, multiple sex partners, and bacterial vaginosis.

Screening

Screening for the infectious causes of cervicitis are recommended according to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC. Screening for chlamydia and gonorrhea is recommended in sexually active women under 25 years of age, sexually active women aged 25 years and older if at increased risk, all pregnant women under 25 years of age, and pregnant women aged 25 and older if at increased risk.

Natural History, Complications, and Prognosis

If left untreated, cervicitis may progress to PID with associated infertility especially in chronic cervicitis. Untreated active HSV infections in the perinatal and neonatal period may lead to neonatal morbidity. Complications that can develop as a result of infectious cervicitis include, pelvic inflammatory disease, infertility, chronic pelvic pain, ectopic pregnancy, spontaneous abortion, premature rupture of membranes and preterm delivery.

Diagnosis

Diagnostic Study of Choice

There is no single diagnostic study of choice for the diagnosis of cervicitis. There are two major diagnostic signs that characterize cervicitis, Purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen (commonly referred to as mucopurulent cervicitis) and sustained endocervical bleeding is easily induced by gentle passage of a cotton swab through the cervical os. Cervicitis is usually asymptomatic, symptoms observed include, abnormal vaginal discharge, and/or intermenstrual vaginal bleeding (e.g., especially after sexual intercourse).

History and Symptoms

Mucopurulent cervicitis is often asymptomatic, however, some patients may present with abnormal vaginal discharge, painful sexual intercourse, and intermenstrual vaginal bleeding.

Physical Examination

Two major diagnostic signs that characterize cervicitis, include, a purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen (commonly referred to as mucopurulent cervicitis or cervicitis) and sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os. Either or both signs might be present.

Laboratory Findings

Diagnosis of cervicitis is mostly clinical however, a finding of >10 WBC in vaginal fluid, in the absence of trichomoniasis, may indicate endocervical inflammation caused specifically by C. trachomatis or N. gonorrhea although culture is more accurate for gonococcal cervicitis. The use of nucleic acid amplification tests is very helpful for the diagnosis of trichomoniasis. Wet mount microscopy and direct visualization have low sensitivity in detecting N. gonorrhea and T. vaginalis, because of this symptomatic women with cervicitis and negative microscopy should receive further testing (i.e., culture or other FDA-cleared methods). Although HSV-2 infection has been associated with cervicitis, the utility of specific testing (i.e., culture or serologic testing) for HSV-2 is unknown. DNA amplification techniques have good sensitivity but are not yet approved for diagnostic purposes of Trichomoniasis.

Electrocardiogram

There are no ECG findings specific for cervicitis.

X Ray

There are no x-ray findings associated with cervicitis.

CT

There are no CT scan findings associated with cervicitis.

MRI

There are no MRI findings associated with cervicitis.

Ultrasound

Ultrasound is not needed in diagnosing cervicitis, however, when complicated by PID, it may be helpful.

Other Imaging Findings

There are no other imaging findings of cervicitis.

Other Diagnostic Studies

There are no other diagnostic studies for cervicitis.

Treatment

Medical Therapy

Antimicrobial therapy with adequate coverage against C. trachomatis should be provided for women at increased risk for C. trachomatis or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT. Recommended regimen for cervicitis, doxycycline 100 mg PO bid for 7 days. The alternative regimen includes azithromycin 1 g PO in a single dose. Patients may also require concomitant therapy against N. gonorrhea. Medical therapies include either azithromycin, doxycycline, or a fluoroquinolone. Treatment of sexual partners is also indicated. Follow-up after completion of antimicrobial therapy regimen is required to evaluate for microbial resistance.

Surgery

Surgical intervention is unnecessary in the management of cervicitis.

Primary Prevention

Effective measures for the primary prevention of cervicitis include avoidance of the risk factors of cervicitis click here.

Secondary Prevention

Secondary prevention strategies of cervicitis include early diagnosis and treatment of patients with sexually transmitted infections especially gonorrhea and chlamydia.

References

Template:WikiDoc Sources

@@ Line 4: / Line 4: @@
 ==Overview==
-Cervicitis means nflammation of the tissues of the [[cervix]]. Cervicitis has many features in common with [[urethritis]] in men. These are commonly due to  sexually transmitted infections.
+Cervicitis means [[inflammation]] of the [[tissues]] of the [[cervix]]. Cervicitis may be classified according to the [[etiology]], anatomical location and disease duration, such as [[infectious]], non-infectious, [[Acute (medicine)|acute]], [[subacute]] and [[Chronic (medical)|chronic]] cervicitis. [[C. trachomatis]] or [[N. gonorrhea]] is the most common [[etiology]] of cervicitis. Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as [[endometritis]], [[salpingitis]], [[vaginitis]] and [[vulvovaginitis]]. [[Mucopurulent]] cervicitis is often [[asymptomatic]], however, some [[patients]] may present with [[abnormal]] [[vaginal]] [[discharge]], painful sexual intercourse, and intermenstrual [[vaginal]] [[bleeding]]. Common [[risk factors]] in the development of cervicitis include high-risk sexual behavior, history of [[sexually transmitted diseases]], sexual intercourse at an early age, sexual partners who have engaged in high-risk sexual behavior or have a previous history of [[Sexually transmitted disease|STDs]], single marital status, urban residence, low socioeconomic status, [[smoking]], alcohol or drug use, multiple sex partners, and [[bacterial vaginosis]]. There is no single [[diagnostic]] study of choice for the [[diagnosis]] of cervicitis. There are two major diagnostic signs that characterize cervicitis, Purulent or [[mucopurulent]] endocervical [[exudate]] visible in the [[endocervical canal]] or on an endocervical [[swab]] [[specimen]] (commonly referred to as [[mucopurulent]] cervicitis) and sustained [[endocervical]] [[bleeding]] is easily induced by gentle passage of a cotton swab through the [[cervical]] os. Cervicitis is usually [[asymptomatic]], [[symptoms]] observed include, [[abnormal]] [[vaginal discharge]], and/or intermenstrual [[vaginal]] [[bleeding]] (e.g., especially after sexual intercourse). [[Diagnosis]] of cervicitis is mostly [[clinical]] however, a finding of >10 [[WBC]] in [[vaginal fluid]], in the absence of [[trichomoniasis]], may indicate [[endocervical]] [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]] although culture is more accurate for [[gonococcal]] cervicitis. If left untreated, cervicitis may progress to [[PID]] with associated infertility especially in chronic cervicitis. Untreated active HSV infections in the perinatal and neonatal period may lead to neonatal morbidity. [[Complications]] that can develop as a result of infectious cervicitis include, [[pelvic inflammatory disease]], [[infertility]], [[chronic pelvic pain]], [[ectopic pregnancy]], [[spontaneous abortion]], [[premature rupture of membranes]] and preterm delivery. [[Antimicrobial]] [[therapy]] with adequate coverage against ''[[C. trachomatis]]'' should be provided for [[women]] at increased risk for ''[[C. trachomatis]]'' or if follow-up cannot be ensured and if a relatively insensitive [[diagnostic]] test is used in place of [[NAAT]]. Recommended regimen for cervicitis, [[doxycycline]] 100 mg PO bid for 7 days. The alternative regimen includes [[azithromycin]] 1 g PO in a single dose. [[Patients]] may also require concomitant [[therapy]] against ''[[N. gonorrhea]]''. Medical therapies include either [[azithromycin]], [[doxycycline]], or a [[fluoroquinolone]]. [[Treatment]] of sexual partners is also indicated. Follow-up after completion of [[antimicrobial]] [[therapy]] regimen is required to evaluate for [[microbial]] [[resistance]].
 ==Historical Perspective==
-Cervicitis was first described formally by Dr. Voilet I. Russell and Dr. D. Cochrane Logan in 1926 during their addresses made before the Medical Society for the Study of Veneral Diseases on January 29, 1926.  Before this time, no accurate record was made about the disease in literature.<ref name="pmid21772527">{{cite journal| author=Russell VI| title=DIAGNOSIS AND TREATMENT OF URETHRITIS AND CERVICITIS. | journal=Br J Vener Dis | year= 1926 | volume= 2 | issue= 6 | pages= 182-93 | pmid=21772527 | doi= | pmc=1046487 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21772527  }}</ref>
+Cervicitis was first described formally by Dr. Voilet I. Russell and Dr. D. Cochrane Logan in 1926 during their addresses made before the Medical Society for the Study of Venereal Diseases on January 29, 1926.  Before this time, no accurate record was made about the disease in the literature.
 ==Classification==
@@ Line 15: / Line 15: @@
 ==Pathophysiology==
-The pathophysiology of Cervicitis depends on the etiological agent and the [[physiological]] state of the patient. Under the influence of [[estrogen]], the normal vaginal [[epithelium]] cornifies making it somewhat resistant to infectious agents. The [[endocervix]] is lined by [[columnar epithelium]] which is susceptible to infectious agents leading to cervicitis.
+The [[pathophysiology]] of cervicitis depends on the [[etiological]] agent and the [[physiological]] state of the [[patient]].  Under the influence of [[estrogen]], the normal vaginal [[epithelium]] cornifies, making it somewhat [[resistant]] to [[infectious]] agents.  The [[endocervix]] is lined by [[columnar epithelium]] which is susceptible to [[infectious]] agents leading to cervicitis. [[Gonococcal]] cervicitis results after the exposure of the [[cervix]] to [[N. gonorrhea|''N. gonorrhea'']] in [[seminal fluid]] during sexual intercourse.  [[N. gonorrhea|''N. gonorrhea'']] infectivity is facilitated by type IV [[pilus]]-mediated motility of the [[bacterium]]. In the presence of [[seminal fluid]], the [[bacterial]] motility is characterized by high velocity, low directional persistence and enhanced microcolony formation. Once the [[pilus|pili]] are attached, local [[inflammation]] results from the release of neutrophilic [[cytokines]], leading to [[purulent]] or [[mucopurulent]] discharge. [[C. trachomatis|''C. trachomatis'']] [[infection]] is often associated with intense [[lymphocytic]] and [[neutrophilic]] [[inflammatory]] reactions in the affected areas, and is occasionally associated with [[follicular]] aggregation of [[lymphocyte|lymphocytes]]. The [[Chronic (medical)|chronic]] course of [[chlamydial]] cervicitis is associated with low content of [[cytokines]], mainly [[Interleukin 1|IL-1α]], [[Interleukin 1|IL-1β]], and [[TNF-alpha|TNFα]], and an elevated concentration of [[IL-8]] in the [[pathogenesis]].
-[[Gonococcal]] cervicitis results after the exposure of the cervix to [[N. gonorrhea]] in seminal fluid during sexual intercourse. [[N. gonorrhea]] infectivity is facilitated by type IV pilus-mediated motility of the [[bacterium]]. In the presence of [[seminal fluid]], the bacterial motility is characterized by high velocity, low directional persistence and enhanced microcolony formation.<ref name="pmid24595372">{{cite journal| author=Anderson MT, Dewenter L, Maier B, Seifert HS| title=Seminal plasma initiates a Neisseria gonorrhoeae transmission state. | journal=MBio | year= 2014 | volume= 5 | issue= 2 | pages= e01004-13 | pmid=24595372 | doi=10.1128/mBio.01004-13 | pmc=3958800 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24595372  }} </ref> Once [[pilus]] is attached, local [[inflammation]] results from release of neutrophilic [[cytokines]] leading to [[purulent]] or [[mucopurulent]] discharge.
-[[C. trachomatis]] infection is often associated with intense lymphocytic and neutrophilic inflammtory reaction in the affected areas and occasionally with follicular aggregation of [[lymphocyte]].<ref name="pmid7078909">{{cite journal| author=Paavonen J, Vesterinen E, Meyer B, Saksela E| title=Colposcopic and histologic findings in cervical chlamydial infection. | journal=Obstet Gynecol | year= 1982 | volume= 59 | issue= 6 | pages= 712-5 | pmid=7078909 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7078909  }} </ref><ref name="pmid2921049">{{cite journal| author=Dunlop EM, Garner A, Darougar S, Treharne JD, Woodland RM| title=Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis. | journal=Genitourin Med | year= 1989 | volume= 65 | issue= 1 | pages= 22-31 | pmid=2921049 | doi= | pmc=1196182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2921049  }} </ref> The chronic course of [[chlamydial]] cervicitis is associated with low content of [[cytokines]] mainly [[IL-1]] alpha, IL-1 beta, [[TNF-alpha]] and an elevated concentration of [[IL-8]] in the pathogenesis.<ref name="pmid15346950">{{cite journal| author=Dolgushin II, Kurnosenko IV, Dolgushina VF, Ugaĭ IIu, Abramovskikh OS, Gol'tsfarb VM| title=[Clinical and immunological aspects of cervicitis of chlamydial etiology]. | journal=Zh Mikrobiol Epidemiol Immunobiol | year= 2004 | volume=  | issue= 3 | pages= 48-52 | pmid=15346950 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15346950  }} </ref>
 ==Causes==
-Cervicitis is caused by infectious <ref name="pmid26586777">{{cite journal| author=Lusk MJ, Garden FL, Rawlinson WD, Naing ZW, Cumming RG, Konecny P| title=Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics. | journal=Sex Transm Infect | year= 2016 | volume= 92 | issue= 3 | pages= 175-81 | pmid=26586777 | doi=10.1136/sextrans-2015-052332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26586777  }} </ref><ref name="pmid19704398">{{cite journal| author=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC| title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. | journal=Sex Transm Dis | year= 2009 | volume= 36 | issue= 10 | pages= 598-606 | pmid=19704398 | doi=10.1097/OLQ.0b013e3181b01948 | pmc=2924808 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19704398  }} </ref><ref name="pmid22902666">{{cite journal| author=Mobley VL, Hobbs MM, Lau K, Weinbaum BS, Getman DK, Seña AC| title=Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: diagnostic specimen type, coinfections, and predictors. | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 9 | pages= 706-9 | pmid=22902666 | doi=10.1097/OLQ.0b013e318255de03 | pmc=3428747 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22902666  }} </ref><ref name="pmid27212873">{{cite journal| author=Ona S, Molina RL, Diouf K| title=Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women? | journal=Infect Dis Obstet Gynecol | year= 2016 | volume= 2016 | issue=  | pages= 4513089 | pmid=27212873 | doi=10.1155/2016/4513089 | pmc=4860244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27212873  }} </ref><ref name="pmid18192786">{{cite journal| author=Lusk MJ, Konecny P| title=Cervicitis: a review. | journal=Curr Opin Infect Dis | year= 2008 | volume= 21 | issue= 1 | pages= 49-55 | pmid=18192786 | doi=10.1097/QCO.0b013e3282f3d988 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18192786  }} </ref><ref name="pmid17342663">{{cite journal| author=Marrazzo JM, Martin DH| title=Management of women with cervicitis. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 3 | issue=  | pages= S102-10 | pmid=17342663 | doi=10.1086/511423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17342663  }} </ref><ref name="pmid16533338">{{cite journal| author=Korte JE, Baseman JB, Cagle MP, Herrera C, Piper JM, Holden AE et al.| title=Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium. | journal=Am J Reprod Immunol | year= 2006 | volume= 55 | issue= 4 | pages= 265-75 | pmid=16533338 | doi=10.1111/j.1600-0897.2005.00359.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16533338  }} </ref><ref name="pmid25732256">{{cite journal| author=Hezarjaribi HZ, Fakhar M, Shokri A, Teshnizi SH, Sadough A, Taghavi M| title=Trichomonas vaginalis infection among Iranian general population of women: a systematic review and meta-analysis. | journal=Parasitol Res | year= 2015 | volume= 114 | issue= 4 | pages= 1291-300 | pmid=25732256 | doi=10.1007/s00436-015-4393-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25732256  }} </ref><ref name="pmid1411834">{{cite journal| author=Nugent RP, Hillier SL| title=Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. | journal=Sex Transm Dis | year= 1992 | volume= 19 | issue= 4 | pages= 198-202 | pmid=1411834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1411834  }} </ref><ref name="pmid806017">{{cite journal| author=Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS et al.| title=Polymicrobial etiology of acute pelvic inflammatory disease. | journal=N Engl J Med | year= 1975 | volume= 293 | issue= 4 | pages= 166-71 | pmid=806017 | doi=10.1056/NEJM197507242930403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=806017  }} </ref>
+Cervicitis is caused by [[infectious]] and non-infectious causes.  The [[infectious]] causes are most commonly caused by [[chlamydia]] and [[gonorrhea]], with [[chlamydia]] accounting for the majority of cases.  [[Trichomonas vaginalis|''Trichomonas vaginalis'']] and [[herpes simplex]] (especially primary [[HSV-2]] [[infection]]), or [[M. genitalium]] are less common causes of cervicitis.  Non-infectious causes of cervicitis include: [[intrauterine devices]], [[Diaphragm (contraceptive)|contraceptive diaphragms]], and allergic reactions to [[Spermicide|spermicides]] or [[latex]] [[condoms]].
-and non infectious causes. The infectious causes are most commonly caused by [[chlamydia]] and [[gonorrhea]], with chlamydia accounting for the majority of cases. [[Trichomonas vaginalis]] and [[herpes simplex]] are less common causes of cervicitis. Non-infectious causes of cervicitis include: [[intrauterine devices]], contraceptive diaphragms, and allergic reactions to [[spermicides]] or latex  [[condoms]]
-==Differentiating {{PAGENAME}} from Other Diseases==
+==Differentiating Cervicitis from Other Diseases==
-Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as [[endometritis]], [[salpingitis]], [[vaginitis]] and vulvovaginatis.
+Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as [[endometritis]], [[salpingitis]], [[vaginitis]] and [[vulvovaginitis]].
 ==Epidemiology and Demographics==
-The [[incidence]] and [[prevalence]] of cervicitis depends on the study population.
+The [[incidence]] and [[prevalence]] of cervicitis depends on the study population.The [[prevalence]] of cervicitis is estimated to be 18,000 per 100,000 women diagnosed with [[gonococcal]] infection. The [[prevalence]] of cervicitis ranges from 7,600 to 24,900 per 100,000 female sex workers. The broad range is due to variation in demographic location. Cervicitis is relatively more prevalent in [[Human Immunodeficiency Virus (HIV)|HIV-positive]] women than non-HIV positive women. Among this population, the [[prevalence]] of cervicitis is estimated to be 7,400 per 100,000 women diagnosed with [[Human Immunodeficiency Virus (HIV)|HIV infection]]. [[Screening]] and [[treatment]] of [[M. genitalium|''M. genitalium'']] among [[HIV]]-infected individuals may be needed to improve cervical health and reduce [[morbidity]]. The overall [[prevalence]] of nongonococcal cervicitis is higher than gonococcal cervicitis. Chlamydia cervicitis is four to five times more prevalent than gonococcal cervicitis. However, co-infection of gonococcal and chlamydia cervicitis is higher in [[Pelvic inflammatory disease|PID]] than in cervicitis. Cervicitis commonly follows the pattern of age prevalence of [[sexually transmitted infections]] with the highest [[incidence]] among women aged 15-24. There is no racial predilection to developing cervicitis.  The [[prevalence]] of cervicitis is higher in under-served communities and developing countries.
-The prevalence of cervicitis is estimated to be 18000 per 100000 women diagnosed of [[gonococcal]] infection.<ref name="pmid76760">{{cite journal| author=Barlow D, Phillips I| title=Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. | journal=Lancet | year= 1978 | volume= 1 | issue= 8067 | pages= 761-4 | pmid=76760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76760  }} </ref>
-The prevalence of cervicitis ranges from 7600 to 24900 per 100000 female sex workers. The broad range is due to variation in demographic location.<ref name="pmid26633925">{{cite journal| author=Efosa OB, Uwadiegwu AP| title=Cytopathological Examination and Epidemiological Study of Cervicitis in Commercial Sex Workers (CSWs) in Coal City (Enugu), Nigeria. | journal=Ethiop J Health Sci | year= 2015 | volume= 25 | issue= 3 | pages= 225-30 | pmid=26633925 | doi= | pmc=4650877 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26633925  }} </ref><ref name="pmid23631602">{{cite journal| author=Pollett S, Calderon M, Heitzinger K, Solari V, Montano SM, Zunt J| title=Prevalence and predictors of cervicitis in female sex workers in Peru: an observational study. | journal=BMC Infect Dis | year= 2013 | volume= 13 | issue=  | pages= 195 | pmid=23631602 | doi=10.1186/1471-2334-13-195 | pmc=3664214 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23631602  }} </ref>
-Cervicitis is relatively more prevalent in HIV-positive women than non-HIV positive women.<ref name="pmid22706215">{{cite journal| author=Lewis DA, Chirwa TF, Msimang VM, Radebe FM, Kamb ML, Firnhaber CS| title=Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa. | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 7 | pages= 531-6 | pmid=22706215 | doi=10.1097/OLQ.0b013e31824cbecc | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22706215  }} </ref>. Among this population, prevalence of cervicitis is estimated to be 7400 per 100000 women diagnosed of HIV infection.<ref name="pmid26783349">{{cite journal| author=Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL| title=Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. | journal=J Infect Dis | year= 2016 | volume= 213 | issue= 11 | pages= 1828-35 | pmid=26783349 | doi=10.1093/infdis/jiw025 | pmc=4857473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26783349  }} </ref> Screening and treatment of [[M. genitalium]] among [[HIV]]-infected individuals may be needed to improve cervical health, and reduce mobidity.<ref name="pmid26783349">{{cite journal| author=Dehon PM, Hagensee ME, Sutton KJ, Oddo HE, Nelson N, McGowin CL| title=Histological Evidence of Chronic Mycoplasma genitalium-Induced Cervicitis in HIV-Infected Women: A Retrospective Cohort Study. | journal=J Infect Dis | year= 2016 | volume= 213 | issue= 11 | pages= 1828-35 | pmid=26783349 | doi=10.1093/infdis/jiw025 | pmc=4857473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26783349  }} </ref> The overall prevalence of nongonococcal cervicitis is higher than gonococcal cervicitis.<ref name="pmid19704398">{{cite journal| author=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC| title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. | journal=Sex Transm Dis | year= 2009 | volume= 36 | issue= 10 | pages= 598-606 | pmid=19704398 | doi=10.1097/OLQ.0b013e3181b01948 | pmc=2924808 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19704398  }} </ref>. Chlamydia cervicitis is four to five times more prevalent than gonococcal cervicitis.<ref name="pmid22030186">{{cite journal| author=Burnett AM, Anderson CP, Zwank MD| title=Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 7 | pages= 1114-7 | pmid=22030186 | doi=10.1016/j.ajem.2011.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22030186  }} </ref><ref name="pmid19704398">{{cite journal| author=Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC| title=Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. | journal=Sex Transm Dis | year= 2009 | volume= 36 | issue= 10 | pages= 598-606 | pmid=19704398 | doi=10.1097/OLQ.0b013e3181b01948 | pmc=2924808 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19704398  }} </ref> However, coinfection of gonococcal and chlamydia cervicitis is higher in [[PID]] than in cervicitis.<ref name="pmid22030186">{{cite journal| author=Burnett AM, Anderson CP, Zwank MD| title=Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 7 | pages= 1114-7 | pmid=22030186 | doi=10.1016/j.ajem.2011.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22030186  }} </ref> Cervicitis commonly follows the pattern of age prevalence of [[sexually transmitted infections]] with highest incidence among women aged 15-24.<ref name="pmid23403598">{{cite journal| author=Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC et al.| title=Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. | journal=Sex Transm Dis | year= 2013 | volume= 40 | issue= 3 | pages= 187-93 | pmid=23403598 | doi=10.1097/OLQ.0b013e318286bb53 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23403598  }} </ref><ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid12220782">{{cite journal| author=Marrazzo JM, Handsfield HH, Whittington WL| title=Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. | journal=Obstet Gynecol | year= 2002 | volume= 100 | issue= 3 | pages= 579-84 | pmid=12220782 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12220782  }} </ref> There is no racial predilection to developing cervcitis. The prevalence of cervicitis is higher in underserved communities and developing countries.<ref name="pmid22665107">{{cite journal| author=Chico RM, Mayaud P, Ariti C, Mabey D, Ronsmans C, Chandramohan D| title=Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review. | journal=JAMA | year= 2012 | volume= 307 | issue= 19 | pages= 2079-86 | pmid=22665107 | doi=10.1001/jama.2012.3428 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22665107  }} </ref><ref name="pmid8106727">{{cite journal| author=Toomey KE, Moran JS, Rafferty MP, Beckett GA| title=Epidemiological considerations of sexually transmitted diseases in underserved populations. | journal=Infect Dis Clin North Am | year= 1993 | volume= 7 | issue= 4 | pages= 739-52 | pmid=8106727 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8106727  }} </ref>
 ==Risk Factors==
-Common risk factors in the development of cervicitis include high-risk sexual behavior, history of [[sexually transmitted diseases]], sexual intercourse at an early age, sexual partners who have engaged in high-risk sexual behavior or have previous history of STD, single marital status, urban residence, low socioeconomic status, smoking, alcohol or drug use , multiple sex partners, and [[bacterial vaginosis]].<ref name="pmid16453256">{{cite journal| author=Marrazzo JM, Wiesenfeld HC, Murray PJ, Busse B, Meyn L, Krohn M et al.| title=Risk factors for cervicitis among women with bacterial vaginosis. | journal=J Infect Dis | year= 2006 | volume= 193 | issue= 5 | pages= 617-24 | pmid=16453256 | doi=10.1086/500149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16453256  }} </ref><ref name="pmid16453256">{{cite journal| author=Marrazzo JM, Wiesenfeld HC, Murray PJ, Busse B, Meyn L, Krohn M et al.| title=Risk factors for cervicitis among women with bacterial vaginosis. | journal=J Infect Dis | year= 2006 | volume= 193 | issue= 5 | pages= 617-24 | pmid=16453256 | doi=10.1086/500149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16453256  }} </ref><ref name="pmid22706215">{{cite journal| author=Lewis DA, Chirwa TF, Msimang VM, Radebe FM, Kamb ML, Firnhaber CS| title=Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa. | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 7 | pages= 531-6 | pmid=22706215 | doi=10.1097/OLQ.0b013e31824cbecc | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22706215  }} </ref><ref name="pmid21192172">{{cite journal| author=Ramos BR, Polettini J, Marcolino LD, Vieira EP, Marques MA, Tristão AR et al.| title=Prevalence and risk factors of Chlamydia trachomatis cervicitis in pregnant women at the genital tract infection in obstetrics unit care at Botucatu Medical School, São Paulo State University-UNESP, Brazil. | journal=J Low Genit Tract Dis | year= 2011 | volume= 15 | issue= 1 | pages= 20-4 | pmid=21192172 | doi=10.1097/LGT.0b013e3181ed3d58 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21192172  }} </ref><ref name="pmid18685547">{{cite journal| author=Nguyen TV, Van Khuu N, Thi Le TT, Nguyen AP, Cao V, Tham DC et al.| title=Sexually transmitted infections and risk factors for gonorrhea and chlamydia in female sex workers in Soc Trang, Vietnam. | journal=Sex Transm Dis | year= 2008 | volume= 35 | issue= 11 | pages= 935-40 | pmid=18685547 | doi=10.1097/OLQ.0b013e3181812d03 | pmc=2903543 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18685547  }} </ref>
+Common risk factors in the development of cervicitis include high-risk sexual behavior, history of [[sexually transmitted diseases]], sexual intercourse at an early age, sexual partners who have engaged in high-risk sexual behavior or have a previous history of [[Sexually transmitted disease|STDs]], single marital status, urban residence, low socioeconomic status, [[smoking]], alcohol or drug use, multiple sex partners, and [[bacterial vaginosis]].
 ==Screening==
-Screening for the infectious causes of cervicitis is recommended according to the 2015 [[Sexually Transmitted Diseases]] Treatment Guidelines by the [[CDC]].<ref name=STD-guildline>{{cite web | title = 2015 Sexually Transmitted Diseases Treatment Guidelines (CDC) | url = http://www.cdc.gov/std/tg2015/screening-recommendations.htm }}</ref><ref name=Gonorrhea-recomm>Workowski KA, Bolan GA. Sexually transmitted diseases treat- ment guidelines, 2015. MMWR Recomm Rep 2015;64:60–68.</ref><ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref><ref name=cde> Screening recommendation for chlamydia. UPSTF. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/chlamydia-and-gonorrhea-screening?ds=1&s=chlamydia(2014). Acessed on September 8, 2016</ref>
+[[Screening]] for the [[infectious]] causes of cervicitis are recommended according to the 2015 [[Sexually Transmitted Diseases]] Treatment Guidelines by the [[CDC]].
-Gonococcal and Chlamydial screening is recommended in sexually active women under 25 years of age, sexually active women aged 25 years and older if at increased risk, all pregnant women under 25 years of age and pregnant women aged 25 and older if at increased risk.
+[[Screening]] for [[Chlamydia infection|chlamydia]] and [[gonorrhea]] is recommended in sexually active [[women]] under 25 years of age, sexually active [[women]] aged 25 years and older if at increased risk, all pregnant [[women]] under 25 years of age, and [[pregnant]] [[women]] aged 25 and older if at increased risk.
 ==Natural History, Complications, and Prognosis==
-If left untreated, cervicitis may progress to [[PID]] with associated infectility especially in chronic cervicitis.<ref name="pmid25544050">{{cite journal| author=Holló P, Jókai H, Herszényi K, Kárpáti S| title=[Genitourethral infections caused by D-K serotypes of Chlamydia trachomatis]. | journal=Orv Hetil | year= 2015 | volume= 156 | issue= 1 | pages= 19-23 | pmid=25544050 | doi=10.1556/OH.2015.30078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25544050  }} </ref><ref name="pmid20664404">{{cite journal| author=Soper DE| title=Pelvic inflammatory disease. | journal=Obstet Gynecol | year= 2010 | volume= 116 | issue= 2 Pt 1 | pages= 419-28 | pmid=20664404 | doi=10.1097/AOG.0b013e3181e92c54 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20664404  }} </ref>
+If left untreated, cervicitis may progress to [[PID]] with associated infertility especially in chronic cervicitis. Untreated active HSV infections in the perinatal and neonatal period may lead to neonatal morbidity. [[Complications]] that can develop as a result of infectious cervicitis include, [[pelvic inflammatory disease]], [[infertility]], [[chronic pelvic pain]], [[ectopic pregnancy]], [[spontaneous abortion]], [[premature rupture of membranes]] and preterm delivery.
-Untreated active HSV infections in the perinatal and neonatal period may lead to neonatal morbidity.
-Complications that can develop as a result of infectious cervicitis include:<ref name="pmid8203320">{{cite journal| author=Majeroni BA| title=Chlamydial cervicitis: complications and new treatment options. | journal=Am Fam Physician | year= 1994 | volume= 49 | issue= 8 | pages= 1825-9, 1832 | pmid=8203320 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8203320  }} </ref><ref name="pmid25544050">{{cite journal| author=Holló P, Jókai H, Herszényi K, Kárpáti S| title=[Genitourethral infections caused by D-K serotypes of Chlamydia trachomatis]. | journal=Orv Hetil | year= 2015 | volume= 156 | issue= 1 | pages= 19-23 | pmid=25544050 | doi=10.1556/OH.2015.30078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25544050  }} </ref><ref name="pmid26380488">{{cite journal| author=Hill MG, Menon S, Smith S, Zhang H, Tong X, Browne PC| title=Screening for Chlamydia and Gonorrhea Cervicitis and Implications for Pregnancy Outcome. Are We Testing and Treating at the Right Time? | journal=J Reprod Med | year= 2015 | volume= 60 | issue= 7-8 | pages= 301-8 | pmid=26380488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26380488  }} </ref><ref name="pmid1411834">{{cite journal| author=Nugent RP, Hillier SL| title=Mucopurulent cervicitis as a predictor of chlamydial infection and adverse pregnancy outcome. The Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome. | journal=Sex Transm Dis | year= 1992 | volume= 19 | issue= 4 | pages= 198-202 | pmid=1411834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1411834  }} </ref><ref name="pmid22665107">{{cite journal| author=Chico RM, Mayaud P, Ariti C, Mabey D, Ronsmans C, Chandramohan D| title=Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review. | journal=JAMA | year= 2012 | volume= 307 | issue= 19 | pages= 2079-86 | pmid=22665107 | doi=10.1001/jama.2012.3428 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22665107  }} </ref><ref name="pmid26602619">{{cite journal| author=Manhart LE, Jensen JS, Bradshaw CS, Golden MR, Martin DH| title=Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. | journal=Clin Infect Dis | year= 2015 | volume= 61 Suppl 8 | issue=  | pages= S802-17 | pmid=26602619 | doi=10.1093/cid/civ785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602619  }} </ref> [[pelvic inflammatory disease]], [[infertility]], [[chronic pelvic pain]], [[ectopic pregnancy]], [[spontaneous abortion]], [[premature rupture of membranes]] and preterm delivery
 ==Diagnosis==
+===Diagnostic Study of Choice===
+There is no single [[diagnostic]] study of choice for the [[diagnosis]] of cervicitis. There are two major diagnostic signs that characterize cervicitis, Purulent or [[mucopurulent]] endocervical [[exudate]] visible in the [[endocervical canal]] or on an endocervical [[swab]] [[specimen]] (commonly referred to as [[mucopurulent]] cervicitis) and sustained [[endocervical]] [[bleeding]] is easily induced by gentle passage of a cotton swab through the [[cervical]] os. Cervicitis is usually [[asymptomatic]], [[symptoms]] observed include, [[abnormal]] [[vaginal discharge]], and/or intermenstrual [[vaginal]] [[bleeding]] (e.g., especially after sexual intercourse).
 ===History and Symptoms===
-Mucopurulent cervicitis is often asymptomatic,<ref name="pmid25544050">{{cite journal| author=Holló P, Jókai H, Herszényi K, Kárpáti S| title=[Genitourethral infections caused by D-K serotypes of Chlamydia trachomatis]. | journal=Orv Hetil | year= 2015 | volume= 156 | issue= 1 | pages= 19-23 | pmid=25544050 | doi=10.1556/OH.2015.30078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25544050  }} </ref><ref name="pmid76760">{{cite journal| author=Barlow D, Phillips I| title=Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. | journal=Lancet | year= 1978 | volume= 1 | issue= 8067 | pages= 761-4 | pmid=76760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76760  }} </ref> however, some patients may present with abnormal vaginal discharge, painful sexual intercourse and intermenstrual vaginal bleeding.<ref name="pmid16453256">{{cite journal| author=Marrazzo JM, Wiesenfeld HC, Murray PJ, Busse B, Meyn L, Krohn M et al.| title=Risk factors for cervicitis among women with bacterial vaginosis. | journal=J Infect Dis | year= 2006 | volume= 193 | issue= 5 | pages= 617-24 | pmid=16453256 | doi=10.1086/500149 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16453256  }} </ref><ref name="pmid2921049">Dunlop EM, Garner A, Darougar S, Treharne JD, Woodland RM (1989) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2921049 Colposcopy, biopsy, and cytology results in women with chlamydial cervicitis.] ''Genitourin Med'' 65 (1):22-31. PMID: [https://pubmed.gov/2921049 2921049]</ref>
+Mucopurulent cervicitis is often asymptomatic, however, some [[patients]] may present with abnormal vaginal discharge, painful sexual intercourse, and intermenstrual vaginal bleeding.
 ===Physical Examination===
-Two major diagnostic signs characterize cervicitis:<ref name="pmid12220782">{{cite journal| author=Marrazzo JM, Handsfield HH, Whittington WL| title=Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. | journal=Obstet Gynecol | year= 2002 | volume= 100 | issue= 3 | pages= 579-84 | pmid=12220782 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12220782  }} </ref><ref name="pmid23460336">{{cite journal| author=Berntsson M, Tunbäck P| title=Clinical and microscopic signs of cervicitis and urethritis: correlation with Chlamydia trachomatis infection in female STI patients. | journal=Acta Derm Venereol | year= 2013 | volume= 93 | issue= 2 | pages= 230-3 | pmid=23460336 | doi=10.2340/00015555-1536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23460336  }} </ref>
+Two major [[diagnostic]] [[signs]] that characterize cervicitis, include, a [[purulent]] or [[mucopurulent]] [[endocervical]] [[exudate]] visible in the [[endocervical]] canal or on an [[endocervical]] [[swab]] [[specimen]] (commonly referred to as [[mucopurulent]] cervicitis or cervicitis) and sustained [[endocervical]] [[bleeding]] easily induced by gentle passage of a cotton swab through the [[cervical os]]. Either or both signs might be present.
+===Laboratory Findings===
+[[Diagnosis]] of cervicitis is mostly [[clinical]] however, a finding of >10 [[WBC]] in [[vaginal fluid]], in the absence of [[trichomoniasis]], may indicate [[endocervical]] [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]] although culture is more accurate for [[gonococcal]] cervicitis.
+The use of nucleic acid amplification tests is very helpful for the diagnosis of trichomoniasis. Wet mount microscopy and direct visualization have low sensitivity in detecting N. gonorrhea and T. vaginalis, because of this symptomatic women with cervicitis and negative microscopy should receive further testing (i.e., culture or other FDA-cleared methods). Although [[HSV]]-2 infection has been associated with cervicitis, the utility of specific testing (i.e., culture or serologic testing) for [[HSV]]-2 is unknown. DNA amplification techniques have good sensitivity but are not yet approved for [[diagnostic]] purposes of [[Trichomoniasis]].
-) '''a purulent or mucopurulent endocervical exudate''' visible in the endocervical canal or on an endocervical swab specimen (commonly referred to as mucopurulent cervicitis or cervicitis)<br>
+===Electrocardiogram===
-) '''sustained endocervical bleeding''' easily induced by gentle passage of a cotton swab through the cervical os. Either or both signs might be present.
+There are no [[ECG]] findings specific for cervicitis.
-===Laboratory Findings===
+===X Ray===
+There are no [[x-ray]] findings associated with cervicitis.
-Diagnosis of cervicitis is mostly clinical however, a finding of >10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate [[endocervical]] [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]] although culture is more accurate for [[gonococcal]] cervicitis.<ref name="pmid6896368">{{cite journal| author=McLellan R, Spence MR, Brockman M, Raffel L, Smith JL| title=The clinical diagnosis of trichomoniasis. | journal=Obstet Gynecol | year= 1982 | volume= 60 | issue= 1 | pages= 30-4 | pmid=6896368 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6896368  }} </ref>
+===CT===
-The use of nucleic acid amplification tests is very helpful for the diagnosis of trichomoniasis.<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref>
+There are no [[CT]] [[scan]] findings associated with cervicitis.
-Wet mount microscopy and direct visualisation have low sensitivity in detecting N. gonorrhea and T. vaginalis, because of this symptomatic women with cervicitis and negative microscopy should receive further testing (i.e., culture or other FDA-cleared method). Although [[HSV]]-2 infection has been associated with cervicitis, the utility of specific testing (i.e., culture or serologic testing) for [[HSV]]-2 is unknown. DNA amplification techniques has good sensitivity, but are not yet approved for diagnostic purposes of [[Trichomoniasis]].<ref name="pmid15054166">{{cite journal| author=Swygard H, Seña AC, Hobbs MM, Cohen MS| title=Trichomoniasis: clinical manifestations, diagnosis and management. | journal=Sex Transm Infect | year= 2004 | volume= 80 | issue= 2 | pages= 91-5 | pmid=15054166 | doi= | pmc=1744792 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15054166  }} </ref>
-Microscopy (wet prep) and vaginal pH are useful for identifying [[bacterial vaginosis]] which may show clue cells.<ref name="pmid20221621">{{cite journal| author=Storti-Filho A, Souza PC, Souza RJ, Pereira MW, Mello IC, Svidizinski TI et al.| title=Prevalence of clue cells suggestive for Gardnerella vaginalis in population-based cervical screening in the public versus private health care in Maringá, Paraná, Brazil. | journal=Arch Gynecol Obstet | year= 2011 | volume= 283 | issue= 4 | pages= 781-5 | pmid=20221621 | doi=10.1007/s00404-010-1400-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20221621  }} </ref>
+===MRI===
+There are no [[MRI]] findings associated with cervicitis.
 ===Ultrasound===
-Ultrasound is not needed in diagnosing cervicitis, however, when complicated by [[PID]], it may be helpful.<ref name="pmid22030186">{{cite journal| author=Burnett AM, Anderson CP, Zwank MD| title=Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 7 | pages= 1114-7 | pmid=22030186 | doi=10.1016/j.ajem.2011.07.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22030186  }} </ref>
+[[Ultrasound]] is not needed in [[diagnosing]] cervicitis, however, when complicated by [[PID]], it may be helpful.
+===Other Imaging Findings===
+There are no other [[imaging]] findings of cervicitis.
 ===Other Diagnostic Studies===
+There are no other [[diagnostic]] studies for cervicitis.
-There are no other diagnostic studies for cervicitis.
 ==Treatment==
 ===Medical Therapy===
-Antimicrobial therapy with adequate coverage against ''[[C. trachomatis]]'' should be provided for women at increased risk for ''[[C. trachomatis]]'' or if follow-up cannot be ensured and if a relatively insensitive diagnostic test is used in place of NAAT. Patients may also require concomitant therapy against ''[[N. gonorrhea]]''. Medical therapies include either [[azithromycin]], [[doxycycline]], or a [[fluoroquinolone]]. Treatment of sexual partners is also indicated. Follow-up after completion of antimicrobial therapy regimen is required to evaluate for microbial resistance.<ref name=CDCCervicitis> Diseases Characterized by Urethritis and Cervicitis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/std/tg2015/urethritis-and-cervicitis.htm Accessed on July 28, 2016 </ref>
+[[Antimicrobial]] [[therapy]] with adequate coverage against ''[[C. trachomatis]]'' should be provided for [[women]] at increased risk for ''[[C. trachomatis]]'' or if follow-up cannot be ensured and if a relatively insensitive [[diagnostic]] test is used in place of [[NAAT]]. Recommended regimen for cervicitis, [[doxycycline]] 100 mg PO bid for 7 days. The alternative regimen includes [[azithromycin]] 1 g PO in a single dose. [[Patients]] may also require concomitant [[therapy]] against ''[[N. gonorrhea]]''. Medical therapies include either [[azithromycin]], [[doxycycline]], or a [[fluoroquinolone]]. [[Treatment]] of sexual partners is also indicated. Follow-up after completion of [[antimicrobial]] [[therapy]] regimen is required to evaluate for [[microbial]] [[resistance]].
 ===Surgery===
@@ Line 78: / Line 80: @@
 Surgical intervention is unnecessary in the management of cervicitis.
-===Prevention===
+===Primary Prevention===
+Effective measures for the [[primary prevention]] of cervicitis include avoidance of the [[risk factors]] of cervicitis click [[cervicitis risk factors|here]].
-Effective measures for the [[primary prevention]] of cervicitis include avoidance of the risk factors of cervicitis click [[cervicitis risk factors|here]].
+===Secondary Prevention===
-Secondary prevention strategies of cervicitis include early diagnosis and treatment of patients with sexually treatment infections especially gonorrhea and chlamydia.
+Secondary [[prevention]] strategies of cervicitis include early [[diagnosis]] and [[treatment]] of [[patients]] with sexually transmitted [[infections]] especially [[gonorrhea]] and [[chlamydia]].
 ==References==
 {{Reflist|2}}
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Gynecology]]
+[[Category:Emergency medicine]]
 [[Category:Infectious disease]]
-[[Category:Gynecology]]
-[[Category:Primary care]]
-{{WikiDoc Help Menu}}
-{{WikiDoc Sources}}