What Causes Cervicitis (Inflammation of the Cervix)
The most common causes of cervicitis are sexually transmitted infections, particularly Chlamydia trachomatis and Neisseria gonorrhoeae, though in the majority of cases no organism is identified, especially in women over 30 years old. 1
Primary Infectious Causes
Most Common Pathogens
When an organism is isolated in cervicitis, it is typically one of the following: 1
- Chlamydia trachomatis - the most frequently identified pathogen 1, 2
- Neisseria gonorrhoeae - second most common bacterial cause 1, 2
- Trichomonas vaginalis - cervicitis can accompany trichomoniasis 1
- Herpes simplex virus type 2 (HSV-2) - especially during primary infection 1
Less Common Infectious Causes
Limited data indicate these organisms may also cause cervicitis: 1
- Mycoplasma genitalium - emerging pathogen with limited diagnostic availability 1, 3
- Bacterial vaginosis-associated organisms - anaerobes and other BV-related bacteria 1, 3
- Group B Streptococcus - rarely responsible but documented in chronic cases when typical pathogens are excluded 4
Non-Infectious Causes
Mechanical and Chemical Irritants
Several non-infectious factors can contribute to cervical inflammation: 1
- Frequent douching - associated with persistent cervicitis 1
- Chemical irritants - exposure to various substances 1
- Persistent abnormality of vaginal flora - may perpetuate inflammation 1
- Idiopathic inflammation in the zone of ectopy - inflammation without identifiable cause 1
Critical Clinical Context
The Majority Are Culture-Negative
An important caveat: in most cases of cervicitis, no organism is isolated, particularly in women at relatively low risk for recent STD acquisition (such as women aged >30 years). 1 This reality underscores that cervicitis often persists despite repeated antimicrobial courses, suggesting non-infectious or unidentified etiologies play a significant role. 1
Risk Stratification Matters
The likelihood of identifying a specific pathogen varies by patient demographics: 1
- High-risk populations (age <25 years, new or multiple sex partners, unprotected sex) - more likely to have chlamydia or gonorrhea 1
- Low-risk populations (older age, stable relationships) - less likely to have identifiable STD pathogens 1
Persistent Cervicitis
When cervicitis persists despite treatment, the causes are typically NOT relapse or reinfection with chlamydia or gonorrhea, but rather other determinants including persistent vaginal flora abnormalities, chemical irritants, or idiopathic inflammation. 1
Diagnostic Implications
Because cervicitis might signal upper genital tract infection (endometritis), all women with new cervicitis should be assessed for pelvic inflammatory disease and tested for both chlamydia and gonorrhea using nucleic acid amplification tests (NAATs). 1 Additionally, evaluation for bacterial vaginosis and trichomoniasis is warranted, as these conditions should be treated if present. 1