Strawberry Cervix: Definition and Clinical Significance
A "strawberry cervix" (colpitis macularis) is a distinctive clinical finding characterized by punctate hemorrhages on the cervical surface that create a red, stippled appearance resembling a strawberry, and is classically associated with Trichomonas vaginalis infection 1.
Clinical Appearance and Pathophysiology
The strawberry cervix represents colpitis macularis—punctate hemorrhagic spots on the cervical epithelium caused by inflammatory changes from trichomoniasis. This finding creates a characteristic red, granular appearance on speculum examination that resembles the surface of a strawberry.
Diagnostic Significance
This finding is highly specific but poorly sensitive for trichomoniasis:
- When present, colpitis macularis has an extremely strong association with T. vaginalis infection (odds ratio = 241) after adjusting for other confounding variables 1
- However, the sensitivity is relatively low—meaning most women with trichomoniasis will NOT have a strawberry cervix visible on examination 1
- The finding is best visualized with colposcopy, though it may occasionally be seen on routine speculum examination
Associated Clinical Features
When evaluating a patient with suspected trichomoniasis, look for these accompanying signs that cluster together 1:
- Purulent vaginal discharge (yellow-green, frothy)
- Vaginal and vulvar erythema
- Abnormal vaginal odor
- Vulvar itching
Clinical Management Implications
When you identify a strawberry cervix, you should:
Test for T. vaginalis using the most sensitive method available—culture or nucleic acid amplification tests (NAAT), as wet mount microscopy has only ~50% sensitivity 2, 3
Evaluate for co-infections, particularly C. trachomatis and N. gonorrhoeae, as cervicitis can accompany trichomoniasis 2
Treat presumptively while awaiting confirmatory testing, given the high specificity of this finding
Screen for HIV and other STIs, as trichomoniasis increases HIV acquisition risk 3
Common Pitfall
Do not rule out trichomoniasis based on the absence of a strawberry cervix—this finding has low sensitivity, so most cases of trichomoniasis will not display this classic sign 1. The diagnosis requires laboratory confirmation through culture, NAAT, or point-of-care testing 3.