From the Guidelines
The initial approach to managing cervical motion tenderness involves empiric treatment for pelvic inflammatory disease (PID) with antibiotics, as it is a key clinical sign of PID that can lead to serious complications if not promptly treated. The recommended regimen includes ceftriaxone 500 mg intramuscularly as a single dose, plus doxycycline 100 mg orally twice daily for 14 days, with optional metronidazole 500 mg orally twice daily for 14 days 1. For patients with severe symptoms or who cannot tolerate oral medications, inpatient treatment with intravenous antibiotics may be necessary. Pain management with NSAIDs like ibuprofen 600-800 mg every 6-8 hours should be provided.
Key Considerations
- Sexual partners from the past 60 days should be evaluated and treated, and patients should abstain from sexual activity until treatment completion and symptom resolution.
- The antibiotic regimen targets common causative organisms including Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobic bacteria.
- Empiric treatment should be initiated in sexually active patients at risk for STDs if uterine, adnexal, or cervical motion tenderness is present and no other cause of illness can be identified 1.
Diagnostic Criteria
- Oral temperature higher than 38.3°C (101°F)
- Abnormal cervical or vaginal mucopurulent discharge
- Presence of white blood cells on saline microscopy of vaginal secretions
- Elevated erythrocyte sedimentation rate
- Elevated C-reactive protein
- Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis 1
From the Research
Cervical Motion Tenderness
- Cervical motion tenderness is a sign that can be found in patients with pelvic inflammatory disease (PID) 2, 3, 4
- The diagnosis of PID is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination 3
- The initial approach to managing cervical motion tenderness involves treating the underlying cause, which may include PID 2, 3
- Treatment for PID typically involves antibiotics, such as ceftriaxone, doxycycline, and metronidazole, and may require hospitalization in severe cases 2, 3
Diagnosis and Treatment
- Cervical motion tenderness can be diagnosed through physical examination, including bimanual examination of the cervix and uterus 2, 4
- Trans-vaginal bedside ultrasound can also be used to increase confidence in the diagnosis of cervical motion tenderness 4
- Treatment for PID does not change in patients with intrauterine devices or those with HIV, and sex partner treatment is recommended 3
- Prevention of PID includes screening for Chlamydia trachomatis and Neisseria gonorrhoeae in all women younger than 25 years and those who are at risk or pregnant, plus intensive behavioral counseling for all adolescents and adults at increased risk of sexually transmitted infections 3
Related Conditions
- Cervical radiculopathy is a condition that can cause cervical motion tenderness, and treatment may involve manual physical therapy, cervical traction, and strengthening exercises 5
- Posteroanterior movements in the cervical spine can be related to tenderness and symptom production, and measuring these movements can help characterize PA mobility 6