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{{CMG}}
{{Cervicitis}}
{{Cervicitis}}
 
{{CMG}}; {{AE}} {{PTD}}
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==Overview==
==Overview==
Antimicrobial therapy is indicated in cervicitis. In postmenopausal women with cervicitis, hormonal therapy may be administered. Women with persistent and recurrent cervicitis should be evaluated for possible reexposure to an STD.  
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>


==Medical Therapy==
==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.
*The following patients are at increased risk of ''C. trachomatis'':<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
**Age < 25 years
**New or multiple sex partners
**[[Patients]] who engage in unprotected sex
**Sex partner with concurrent partners
**Sex partner who has an STI


*Treatment with antibiotics for 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. *The following patients are at increased risk of ''C. trachomatis'':<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>:*Women aged ≤25 years
*Concomitant therapy for ''N. gonorrhea'' (gonococcal cervicitis) is recommended among the following [[patients]]:<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
:*New or multiple sex partners
:*[[Patients]] in regions with high [[incidence]] of [[gonococcal infections]]
:*Patients who engage in unprotected sex
:*[[Patients]] at high risk of [[gonococcal infections]]
 
*Concomitant therapy for ''N. gonorrhea'' (gonococcal cervicitis) is recommended among the following patients:<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
:*Patients in regions with high incidence of gonococcal infections
:*Patients at high risk of gonococcal infections
===Chlamydial Cervicitis===
===Chlamydial Cervicitis===
*'''Cervicitis, Chlamydial'''<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
*'''Cervicitis, Chlamydial'''<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
:*Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
 
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
:*'''Recommended Regimen for Cervicitis''':  
:*Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
:**[[Doxycycline]] 100 mg PO bid for 7 days
:*Alternative regimen (2): Erythromycin ethysuccinate 800 mg PO qid for 7 days
:*'''Alternative regimen''':
:*Alternative regimen (3): Ofloxacin 300 mg PO bid for 7 days
:**[[Azithromycin]] 1 g PO in a single dose
:*Alternative regimen (4): Levofloxacin 500 mg PO qd for 7 days
:*'''Other Alternative Therapy''':
:**[[Erythromycin]] base 500 mg PO qid for 7 days
:**[[Erythromycin]] ethysuccinate 800 mg PO qid for 7 days
:**[[Ofloxacin]] 300 mg PO bid for 7 days
:**[[Levofloxacin]] 500 mg PO qd for 7 days
:**[[Pregnancy]]: [[Azithromycin]] 1 g PO in a single dose {{or}} [[Amoxicillin]] 500 mg PO tid for 7 days {{or}} [[Erythromycin]] base 500 mg PO qid for 7 days {{or}} [[Erythromycin]] base 250 mg PO qid for 14 days {{or}} [[Erythromycin]] [[ethylsuccinate]] 800 mg PO qid for 14 days {{or}} [[Erythromycin]] ethylsuccinate 400 mg PO qid for 14 days
:*A test of cure is recommended 1 week after the first dose of [[antimicrobial therapy]].
:*Sexual activity should be withheld for 1 week until the [[antimicrobial]] regimen is complete.
:*Avoid [[doxycycline]] and [[fluoroquinolones]] among [[pregnant]] [[women]]
 
===Gonococcal Cervicitis===
===Gonococcal Cervicitis===
*'''Cervicitis, Gonococcal'''<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
*'''Cervicitis, Gonococcal'''<ref name="pmid22874837">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. | journal=MMWR Morb Mortal Wkly Rep | year= 2012 | volume= 61 | issue= 31 | pages= 590-4 | pmid=22874837 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22874837  }} </ref>
:*Preferred regimen: [[Cephalosporin]] IM in a single dose {{and}} ([[Azithromycin]] 1 g PO in a single dose {{or}} [[Doxycyline]] mg PO bid for 7 days)
:*Preferred regimen: [[Cephalosporin]] IM in a single dose {{and}} ([[Azithromycin]] 1 g PO in a single dose {{or}} [[Doxycycline]] mg PO bid for 7 days)
:*Alternative regimen, cephalosporin allergic: [[Azithromycin]] 2 g PO in a single dose
:*Alternative regimen, cephalosporin allergic: [[Azithromycin]] 2 g PO in a single dose
:*Note: A test of cure is recommended at 1 week after the first dose of antimicrobial therapy.
:*Note (1): A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
:*Note (2): Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.


 
===Treatment of Sexual Partners===
===Recurrent and Persistent Cervicitis===
*The partner's sexual activity should be withheld until the [[antimicrobial]] regimen is complete.
 
*All sex partners during the previous 60 days should be referred for evaluation, testing, and presumptive treatment if chlamydia, gonorrhea, or trichomoniasis was identified.
Women with persistent cervicitis should be reevaluated for possible reexposure to an STD. If relapse and/or reinfection with a specific STD has been excluded, BV is not present, and sex partners have been evaluated and treated, management options for persistent cervicitis are undefined; in addition, the utility of repeated or prolonged administration of antibiotic therapy for persistent symptomatic cervicitis remains unknown. Women who receive such therapy should return after treatment so that a determination can be made regarding whether cervicitis has resolved. Research is needed on the etiology of persistent cervicitis including the potential role ofM. genitalium (266). In women with persistent symptoms that are clearly attributable to cervicitis, referral to a gynecologic specialist can be considered.
*Sexual partners should also be treated for the pathogens as listed above.
*A test of cure is also recommended 1 week after the first dose of antimicrobial therapy.
*EPT and other effective partner referral strategies are alternative approaches for treating [[male]] partners of women who have [[chlamydial]] or [[gonococcal]] [[infection]].


===Follow-Up===
===Follow-Up===
*A test of cure is recommended 1 week after the first dose of [[antimicrobial therapy]].
*If symptoms persist, women should be instructed to return for re-evaluation because women with documented [[chlamydial]] or [[gonococcal infections]] have a high rate of reinfection within 6 months after treatment.
*For untreated women, a follow-up visit gives an opportunity to communicate test results obtained as part of the cervicitis evaluation.
*Women with a specific [[diagnosis]] of [[chlamydia]], [[gonorrhea]], or [[trichomoniasis]] should be offered partner services and instructed to return in 3 months after [[treatment]] for repeat testing because of high rates of [[reinfection]], regardless of whether their sex partners were treated.


Follow-up should be conducted as recommended for the infections for which a woman is treated. If symptoms persist, women should be instructed to return for re-evaluation because women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment. Therefore, repeat testing of all women with chlamydia or gonorrhea is recommended 3-6 months after treatment, regardless of whether their sex partners were treated (267).
===Mycoplasma genitalium cervicitis===
 
First line antibiotic used to be azithromycin however recent anitibiotic resistance strains has made moxifloxacin more preferred.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref>
===Management of Sex Partners===
 
Management of sex partners of women treated for cervicitis should be appropriate for the identified or suspected STD. Partners should be notified and examined if chlamydia, gonorrhea, or trichomoniasis was identified or suspected in the index patient; these partners should then be treated for the STDs for which the index patient received treatment. To avoid reinfection, patients and their sex partners should abstain from sexual intercourse until therapy is completed (i.e., 7 days after a single-dose regimen or after completion of a 7-day regimen). Expedited partner treatment and patient referral (see Partner Management) are alternative approaches to treating male partners of women that have chlamydia or gonococcal infections (68,69,71).
 
===Special Considerations===
 
'''HIV Infection'''


Patients who have cervicitis and also are infected with HIV should receive the same treatment regimen as those who are HIV negative. Treatment of cervicitis in HIV-infected women is vital because cervicitis increases cervical HIV shedding. Treatment of cervicitis in HIV-infected women reduces HIV shedding from the cervix and might reduce HIV transmission to susceptible sex partners (268–270).
===Trichomonas vaginalis cervicitis===
Trichomonas vaginalis cervicitis is treated with metronidazole.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 16:01, 5 October 2021

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

Overview

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.[1]

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.
  • The following patients are at increased risk of C. trachomatis:[2]
    • Age < 25 years
    • New or multiple sex partners
    • Patients who engage in unprotected sex
    • Sex partner with concurrent partners
    • Sex partner who has an STI
  • Concomitant therapy for N. gonorrhea (gonococcal cervicitis) is recommended among the following patients:[3]

Chlamydial Cervicitis

  • Cervicitis, Chlamydial[2]

Gonococcal Cervicitis

  • Cervicitis, Gonococcal[3]
  • Preferred regimen: Cephalosporin IM in a single dose AND (Azithromycin 1 g PO in a single dose OR Doxycycline mg PO bid for 7 days)
  • Alternative regimen, cephalosporin allergic: Azithromycin 2 g PO in a single dose
  • Note (1): A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
  • Note (2): Sexual activity should be withheld for 1 week until the antimicrobial regimen is complete.

Treatment of Sexual Partners

  • The partner's sexual activity should be withheld until the antimicrobial regimen is complete.
  • All sex partners during the previous 60 days should be referred for evaluation, testing, and presumptive treatment if chlamydia, gonorrhea, or trichomoniasis was identified.
  • Sexual partners should also be treated for the pathogens as listed above.
  • A test of cure is also recommended 1 week after the first dose of antimicrobial therapy.
  • EPT and other effective partner referral strategies are alternative approaches for treating male partners of women who have chlamydial or gonococcal infection.

Follow-Up

  • A test of cure is recommended 1 week after the first dose of antimicrobial therapy.
  • If symptoms persist, women should be instructed to return for re-evaluation because women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment.
  • For untreated women, a follow-up visit gives an opportunity to communicate test results obtained as part of the cervicitis evaluation.
  • Women with a specific diagnosis of chlamydia, gonorrhea, or trichomoniasis should be offered partner services and instructed to return in 3 months after treatment for repeat testing because of high rates of reinfection, regardless of whether their sex partners were treated.

Mycoplasma genitalium cervicitis

First line antibiotic used to be azithromycin however recent anitibiotic resistance strains has made moxifloxacin more preferred.[4]

Trichomonas vaginalis cervicitis

Trichomonas vaginalis cervicitis is treated with metronidazole.

References

  1. ↑ 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
  2. ↑ 2.0 2.1 Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
  3. ↑ 3.0 3.1 Centers for Disease Control and Prevention (CDC) (2012). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections". MMWR Morb Mortal Wkly Rep. 61 (31): 590–4. PMID 22874837.
  4. ↑ Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.


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