Cervicitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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.
Medical Therapy
- 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:[1]:*Women aged ≤25 years
- New or multiple sex partners
- Patients who engage in unprotected sex
- Concomitant therapy for N. gonorrhea (gonococcal cervicitis) is recommended among the following patients:[2]
- Patients in regions with high incidence of gonococcal infections
- Patients at high risk of gonococcal infections
Chlamydial Cervicitis
- Cervicitis, Chlamydial[1]
- Preferred regimen (1): Azithromycin 1 g PO in a single dose
- Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days
- Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
- Alternative regimen (2): Erythromycin ethysuccinate 800 mg PO qid for 7 days
- Alternative regimen (3): Ofloxacin 300 mg PO bid for 7 days
- Alternative regimen (4): Levofloxacin 500 mg PO qd for 7 days
Gonococcal Cervicitis
- Cervicitis, Gonococcal[2]
- 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)
- 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.
Recurrent and Persistent Cervicitis
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.
Follow-Up
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).
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).
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 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.