What is the term for an irritated cervix?

Mucopurulent Cervicitis: Term for an Irritated Cervix

The medical term for an irritated cervix is "cervicitis," specifically "mucopurulent cervicitis" when characterized by inflammation with purulent or mucopurulent discharge from the endocervical canal. 1

Diagnostic Characteristics

Cervicitis is defined by two major diagnostic signs:

1. Purulent or mucopurulent endocervical exudate visible in the endocervical canal or on an endocervical swab specimen
2. Sustained endocervical bleeding easily induced by gentle passage of a cotton swab through the cervical os 1

Either or both signs may be present. Additional findings may include:

• Abnormal vaginal discharge
• Intermenstrual vaginal bleeding (especially post-coital)
• Leukorrhea (>10 WBC per high power field on microscopic examination of vaginal fluid) 1

Etiology

Cervicitis is most commonly caused by:

• Infectious agents:

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Trichomonas vaginalis
  • Herpes simplex virus (especially primary HSV-2 infection) 1, 2

• Other potential causes:

  • Mycoplasma genitalium
  • Bacterial vaginosis
  • Frequent douching
  • Chemical irritants
  • Idiopathic inflammation in the zone of ectopy 1

In many cases (particularly in women over 30 years), no specific organism is isolated despite testing 1.

Diagnostic Approach

When cervicitis is suspected, the following tests are recommended:

• Nucleic Acid Amplification Tests (NAATs) for C. trachomatis and N. gonorrhoeae (most sensitive and specific tests) 1, 3
• Evaluation for bacterial vaginosis and trichomoniasis 1
• For symptomatic women with negative microscopy for trichomonads, further testing (culture or antigen-based detection) 1
• Visual examination for purulent/mucopurulent discharge and easily induced bleeding 3

Clinical Significance

Cervicitis requires proper diagnosis and treatment because:

• It may be a sign of upper genital tract infection (endometritis or PID)
• Untreated infections can lead to serious complications including:
  • Pelvic inflammatory disease
  • Ectopic pregnancy
  • Infertility 2, 4
• In pregnant women, infections are associated with premature rupture of membranes and increased fetal morbidity 4

Treatment Approach

Treatment depends on the identified cause:

• For confirmed or suspected chlamydial cervicitis:

  • First-line: Doxycycline 100 mg orally twice daily for 7 days (95.5% efficacy for urogenital infections) 3
  • Alternative: Azithromycin 1 g orally in a single dose (92% efficacy) 3

• For gonococcal cervicitis:

  • Follow current CDC guidelines for gonorrhea treatment

• For persistent cervicitis (after negative testing for common STIs):

  • Consider empiric treatment covering C. trachomatis and N. gonorrhoeae in high-risk women 5
  • In low-risk women, adjust antibiotic therapy based on microbiological results 5
  • For truly chronic cases, additional treatments may include hormonal treatments, silver nitrate, or surgical procedures 6

Follow-up Recommendations

• Patients should abstain from sexual activity for 7 days after treatment initiation and until all partners are treated 3
• Routine test-of-cure is not recommended if symptoms resolve 3
• Consider retesting 3-12 months after treatment due to high risk of reinfection 3
• All sexual partners from the past 60 days should be notified, evaluated, and treated 3

Important Caveats

• Cervicitis is frequently asymptomatic but can still cause upper genital tract complications 2, 5
• No single risk factor reliably predicts infection, making screening important in high-risk populations 4
• "Normal vaginal flora" are rarely responsible for cervicitis, but should be considered as potential pathogens when tests for routine pathogens are negative 7
• Chronic nongonococcal nonchlamydial cervicitis can be particularly challenging to treat and may require multiple treatment approaches 6