What is the recommended treatment for cervicitis?

Treatment of Cervicitis

For cervicitis, doxycycline 100 mg orally twice daily for 7 days is the first-line treatment, with azithromycin 1 g orally in a single dose as an alternative when adherence is a concern. 1

First-Line Treatment Options

Chlamydial Cervicitis

• Doxycycline: 100 mg orally twice daily for 7 days

  • Higher efficacy (95.5% for urogenital infections, 96.9% for rectal infections) 1
  • Preferred first-line treatment per CDC guidelines

• Alternative: Azithromycin 1 g orally in a single dose

  • Slightly lower efficacy (92% for urogenital infections) 1
  • Advantage: Single-dose improves adherence and allows for directly observed therapy
  • FDA-approved for urethritis and cervicitis due to Chlamydia trachomatis 2

Gonococcal Cervicitis

• If gonorrhea cannot be excluded or is confirmed:
  • Ceftriaxone 500 mg IM in a single dose 3
  • Plus treatment for chlamydia as above if not excluded

Special Considerations

Pregnancy

• Doxycycline is contraindicated during pregnancy 1
• For pregnant patients: Use azithromycin 1 g orally in a single dose
• Alternative regimens for pregnant patients:
  • Erythromycin base 500 mg orally four times daily for 7 days
  • Amoxicillin 500 mg orally three times daily for 7 days 1

Treatment Failure

• For patients who fail treatment with azithromycin:
  • Consider doxycycline 100 mg orally twice daily for 7 days
• For patients who fail treatment with doxycycline:
  • Consider azithromycin 1 g orally in a single dose

Partner Management

• All sexual partners from the preceding 60 days should be evaluated, tested, and treated 1
• The most recent partner should be treated even if the last sexual contact was more than 60 days before diagnosis
• Patients and partners should abstain from sexual intercourse until:
  • 7 days after single-dose therapy OR
  • Until completion of a 7-day regimen 1

Follow-Up Recommendations

• Test of cure generally not needed after completing treatment with doxycycline or azithromycin unless symptoms persist 1
• Consider test of cure 3 weeks after completion of treatment with erythromycin
• Retesting approximately 3 months after treatment is recommended due to high risk of reinfection 1

Clinical Pearls and Pitfalls

Important Considerations

• Untreated cervicitis can lead to serious complications:
  • Pelvic inflammatory disease (PID)
  • Ectopic pregnancy
  • Infertility
  • Chronic pelvic pain 1, 4

Common Pitfalls

1. Failing to test for co-infections: Patients with chlamydial cervicitis often have concurrent gonorrhea requiring dual therapy 1
2. Poor medication adherence: To maximize compliance:
   • Dispense medications on site when possible
   • Consider directly observed therapy with azithromycin when adherence is a concern 1, 5
3. Inadequate partner treatment: Failure to treat partners is a major cause of reinfection 1
4. Missing asymptomatic infections: Cervicitis may be asymptomatic but can still cause complications 4, 6

Antimicrobial Stewardship

• While dual therapy with azithromycin and ceftriaxone was previously recommended, current guidelines have moved away from this approach due to antimicrobial stewardship concerns and increasing azithromycin resistance 3

Remember that early and appropriate treatment of cervicitis is essential to prevent serious reproductive health complications and reduce transmission of infection.