What is the management of cervicitis?

From the Guidelines

Management of cervicitis involves prompt antibiotic treatment targeting the most common causative organisms, Chlamydia trachomatis and Neisseria gonorrhoeae, with first-line treatment including doxycycline 100 mg orally twice daily for 7 days for chlamydial infection, and ceftriaxone 500 mg intramuscularly as a single dose for gonorrhea, as recommended by the most recent guidelines 1.

Key Considerations

• The treatment regimen for HIV-infected women with cervicitis is the same as for HIV-negative women, with the added benefit of reducing cervical HIV shedding and potentially decreasing HIV transmission to sex partners 1.
• For patients with persistent symptoms despite treatment, metronidazole 500 mg orally twice daily for 7 days may be added to target bacterial vaginosis or Trichomonas vaginalis 1.
• Sexual partners should be treated simultaneously to prevent reinfection, and patients should abstain from sexual activity until both they and their partners complete treatment 1.
• Follow-up testing is recommended 3 months after treatment to ensure cure, and empiric treatment is often initiated before test results are available due to the high prevalence of asymptomatic infections and the risk of complications like pelvic inflammatory disease 1.

Special Considerations

• For pregnant patients, azithromycin is preferred over doxycycline due to safety concerns.
• Ablative therapy may be considered by a gynecologic specialist for women with persistent symptoms that are clearly attributable to cervicitis 1.

Treatment Approach

• The majority of cases of cervicitis are caused by C. trachomatis or N. gonorrhoeae, but other organisms such as Trichomonas vaginalis and Mycoplasma genitalium may also be involved 1.
• Treatment should be tailored to the suspected or confirmed etiologic organism, and patients should be instructed to return for reevaluation if symptoms persist despite treatment 1.

From the FDA Drug Label

Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed The management of cervicitis includes antimicrobial therapy for infections caused by susceptible bacteria such as Chlamydia trachomatis or Neisseria gonorrhoeae. Key steps in management include:

• Performing serologic tests for syphilis
• Obtaining cultures for gonorrhea
• Initiating appropriate antimicrobial therapy based on the results of these tests 2

From the Research

Management of Cervicitis

• The management of cervicitis typically involves the use of antibiotics to treat the underlying infection 3, 4, 5, 6, 7.
• Azithromycin and doxycycline are commonly used antibiotics for the treatment of cervicitis, particularly for chlamydial cervicitis 3, 4, 5.
• A single dose of azithromycin (1g) has been shown to be equivalent to a 7-day course of doxycycline (100mg twice daily) in treating uncomplicated chlamydial cervicitis 3, 5.
• Empiric treatment with azithromycin has been shown to reduce cervicitis at follow-up in populations with high prevalence of Chlamydia trachomatis and/or Mycoplasma genitalium 4.
• However, empiric azithromycin treatment may not be effective in reducing cervicitis at follow-up in cases of non-specific cervicitis 4.
• Other antibiotics such as moxifloxacin, levofloxacin, and sitafloxacin have also been shown to be effective in treating Mycoplasma genitalium-positive uterine cervicitis 7.
• The choice of antibiotic and treatment duration may depend on the specific cause of the cervicitis and the patient's individual needs 6, 7.
• It is essential to perform a pelvic exam and diagnostic testing to confirm the diagnosis and rule out upper tract infections 6.
• Treatment of sexually transmitted illnesses, such as trichomoniasis, chlamydia, and gonorrhea, requires partner therapy to prevent reinfection 6.