Cervicitis

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

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.

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.

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.

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.

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.

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

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.

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 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.

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.

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).

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

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.

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.

There are no ECG findings specific for cervicitis.

There are no x-ray findings associated with cervicitis.

There are no CT scan findings associated with cervicitis.

There are no MRI findings associated with cervicitis.

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

There are no other imaging findings of cervicitis.

There are no other diagnostic studies for cervicitis.

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.

Surgical intervention is unnecessary in the management of cervicitis.

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

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

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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]

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.^[1]

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.^[1]

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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]

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.

Cervicitis may be classified according to the etiology, anatomical location and disease duration as follows:

Some of the infectious causes are gonorrhea, C. trachomatis and herpes. Examples of the non-infectious causes are traumatic injury to the cervix, chemical exposure, douching, latex, contraceptive creams, systemic inflammatione(e.g. Behcet syndrome), as well as radiation exposure.

There is not an established timeline to define these classes, however, chronic cervicitis usually leads to complications. Chronic cervicitis is mostly a result of non-infectious causes.

Endocervical cervicitis is more common than ectocervical cervicitis. The ectocervix is made of squamous epithelium and is relatively resistant to infectious agents compared to the endocervix, which is composed of columnar epithelium.

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

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. 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.^[1] 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 inflammtory reactions in the affected areas, and is occasionally associated with follicular aggregation of lymphocytes.^[2][3] 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.^[4]

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.^[1] 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 inflammtory reactions in the affected areas, and is occasionally associated with follicular aggregation of lymphocytes.^[2][3] 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.^[4]

Inflammation and ulceration of the ectocervix is evident in herpetic 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.^[1] 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 inflammtory reactions in the affected areas, and is occasionally associated with follicular aggregation of lymphocytes.^[2][3] 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.^[4]

Inflammation and ulceration of the ectocervix is evident in herpetic cervicitis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hilda Mahmoudi M.D., M.P.H.^[2] Prince Tano Djan, BSc, MBChB [3]

Cervicitis is caused by infectious ^{[1][2][3][4][5][6][7][8][9][10]} 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.

Cervicitis may be caused by infectious and non-infectious causes.

The most common causes of infectious cervicitis are sexually transmitted infections (STIs) that include:^{[1][2][3][4][5][6][7][8][9][10]}

• Chlamydia trachomatis
• Gonorrhea
• Herpes simplex virus (genital herpes) mostly type 2
• Human papillomavirus (genital warts)
• Mycoplasma genitalium
• Trichomoniasis

Non-infectious causes of cervicitis include:

• Behcet’s syndrome

• Cervical cap

• Contraceptive creams

• Contraceptive diaphragm

• Foreign bodies

• Intrauterine device
• Local trauma to the cervix

• Latex condom

• Malignancy

• Radiation therapy

• Reactive arthritis

• Reiter’s disease

• Spermicides

• Surgical instruments

• Reinfection with C. trachomatis or N. gonorrhoeae is not the cause in majority of persistent cases.
• Factors responsible for persistent infection include:
  • Abnormality of vaginal flora,
  • M. genitalium
  • Douching
  • Exposure to other types of chemical irritants
  • Dysplasia
  • Idiopathic inflammation in the zone of ectopy

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Bacterial vaginosis, chlamydia trachomatis, fungi, herpes simplex virus, human papilloma virus, mycoplasma genitalium, neisseria gonorrhoeae, parasites, streptococci group A, trichomonas vaginalis, tuberculosis, viruses
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric / Gynecologic	Nabothian cyst
Oncologic	Malignancy
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Behcet’s syndrome, contraceptive creams, latex condom, reactive arthritis, Reiter’s Disease, spermicides, systemic inflammatory diseases
Sexual	No underlying causes
Trauma	Cervical cap, contraceptive diaphragm, intrauterine device, pessary, surgical instruments, tampon
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Foreign bodies, radiation therapy, vaginal douches

• Bacterial vaginosis

• Behcet’s syndrome

• Cervical cap

• Chlamydia trachomatis

• Contraceptive creams

• Contraceptive diaphragm

• Foreign bodies

• Fungi

• Herpes simplex virus

• Human papillomavirus

• Intrauterine device

• Latex condom

• Malignancy

• Mycoplasma genitalium

• Nabothian cyst

• Neisseria gonorrhoeae

• Parasites

• Pessary

• Radiation therapy

• Reactive arthritis

• Reiter’s disease

• Spermicides

• Streptococci group A

• Surgical instruments

• Systemic inflammatory diseases

• Tampon

• Trichomonas vaginalis

• Tuberculosis

• Vaginal douches

• Viruses

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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]

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

Cervicitis must be differentiated from other diseases that cause vaginal discharge and/or pelvic pain, such as

• Endometritis
• Salpingitis
• Vaginitis
• Vulvovaginitis

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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]

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.^[1] Cervicitis is relatively more prevalent in HIV-positive women than non-HIV positive women.^[2] Among this population, the prevalence of cervicitis is estimated to be 7,400 per 100,000 women diagnosed with HIV infection.^[3] The overall prevalence of nongonococcal cervicitis is higher than gonococcal cervicitis.^[4] Chlamydia cervicitis is four to five times more prevalent than gonococcal cervicitis.^[5][4] However, co-infection of gonococcal and chlamydia cervicitis is higher in PID than in cervicitis.^[5] Cervicitis commonly follows the pattern of age prevalence of sexually transmitted infections with the highest incidence among women aged 15-24.^[6][7][8] There is no racial predilection to developing cervicitis. The prevalence of cervicitis is higher in under-served communities and developing countries.^[9][10]

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.^[1] 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.^[11][12]

Cervicitis is relatively more prevalent in HIV-positive women than non-HIV positive women.^[2] Among this population, the prevalence of cervicitis is estimated to be 7,400 per 100,000 women diagnosed with HIV infection.^[3] Screening and treatment of M. genitalium among HIV-infected individuals may be needed to improve cervical health and reduce morbidity.^[3] The overall prevalence of nongonococcal cervicitis is higher than gonococcal cervicitis.^[4] Chlamydia cervicitis is four to five times more prevalent than gonococcal cervicitis.^[5][4] However, co-infection of gonococcal and chlamydia cervicitis is higher in PID than in cervicitis.^[5]

Cervicitis commonly follows the pattern of age prevalence of sexually transmitted infections with the highest incidence among women aged 15-24.^[6][7][8]

There is no racial predilection to developing cervicitis.

The prevalence of cervicitis is higher in under-served communities and developing countries.^[9][10]

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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]

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 sexual partners, and bacterial vaginosis.^[1][2][3][4]

The risk factors of cervicitis include:^[1][2][3][4]

• High-risk sexual behavior
• History of STDs
• Multiple sexual partners
• 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

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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]

Screening for the infectious causes of cervicitis is recommended according to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC.^[1][2][3][4]

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.

Screening for the infectious causes of cervicitis is recommended according to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC as follows:^[1][2][3][4]

• Sexually active women under 25 years of age
• Sexually active women aged 25 years and older if at increased risk
• Retest approximately 3 months after treatment.

In pregnant women as follows:

• All pregnant women under 25 years of age
• Pregnant women, aged 25 and older if at increased risk
• Retest during the 3rd trimester for women under 25 years of age or at risk

Individuals with HIV as follows:

• For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter
• More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology

Screening is recommended in high risk individuals as follows:

• Sexually active women under 25 years of age

• All pregnant women under 25 years of age and older women if at increased risk

Sexually active women age 25 years and older if at increased risk as follows:

• Prior history of sexually transmitted infections
• A new sexual partner
• More than one sexual partner

A sexual partner with concurrent partners

• A sexual partner who has a sexually transmitted infection

HIV infected women as follows:

• For sexually active individuals, screen at first HIV evaluation, and at least annually
• More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology

Screening is recommended in pregnant women. Cesarean delivery is recommended in pregnant women with an active lesion.

There is no specific screening modality for trichomonas vaginalis,^[5] Mycoplasma genitalium and bacterial vaginosis.

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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]

If left untreated, cervicitis may progress to PID with associated infectility especially in chronic cervicitis.^[1][2] 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:^{[3][1][4][5][6][7]} pelvic inflammatory disease, infertility, chronic pelvic pain, ectopic pregnancy, spontaneous abortion, premature rupture of membranes and preterm delivery

If left untreated, cervicitis may progress to PID with associated infectility especially in chronic cervicitis.^[1][2] 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 are:^{[3][1][4][5][6][7]}

• pelvic inflammatory disease
• infertility,
• chronic pelvic pain,
• ectopic pregnancy.
• spontaneous abortion,
• premature rupture of membranes,
• preterm delivery

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