What are the causes of chronic cervicitis?

Causes of Chronic Cervicitis

Chronic cervicitis is most commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae, though the majority of cases have no identifiable infectious organism, particularly in women over 30 years old. 1, 2

Primary Infectious Causes

Sexually Transmitted Infections

• Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequently identified pathogens when an organism is isolated in cervicitis cases 1, 2
• Trichomonas vaginalis causes cervicitis, especially in women with concurrent trichomoniasis 1, 2
• Herpes simplex virus type 2 (HSV-2) can cause cervicitis, particularly during primary infection 1, 2
• Mycoplasma genitalium has emerged as a candidate etiologic agent, though standardized diagnostic tests are not commercially available 1, 3

Key Clinical Context

• In the majority of cervicitis cases, no organism is isolated, especially in women at relatively low risk for recent STD acquisition (women aged >30 years, stable relationships) 1, 2
• High-risk populations (age <25 years, new or multiple sex partners, unprotected sex) are more likely to have identifiable chlamydia or gonorrhea 2

Non-Infectious Causes

Mechanical and Chemical Factors

• Frequent douching is associated with persistent cervicitis and should be discontinued 1, 2
• Chemical irritants from feminine hygiene products or spermicides can contribute to cervical inflammation 1, 4
• Persistent abnormality of vaginal flora may cause ongoing inflammation 1, 2

Idiopathic Inflammation

• Idiopathic inflammation in the zone of ectopy (where columnar epithelium is present on the ectocervix) can produce persistent cervicitis without an identifiable infectious cause 1, 2, 4
• This creates a visible red, granular appearance around the cervical os that can produce discharge and inflammation 4

Bacterial Vaginosis

• Bacterial vaginosis (BV) has been identified as a potential cause of cervicitis and should be evaluated and treated if present 1, 2, 3

Critical Clinical Pitfalls

Persistent Cervicitis Without Identified Pathogen

• For reasons that are unclear, cervicitis can persist despite repeated courses of antimicrobial therapy 1
• The majority of persistent cases are not caused by relapse or reinfection with C. trachomatis or N. gonorrhoeae 1
• Other determinants such as persistent abnormality of vaginal flora, douching, exposure to chemical irritants, or idiopathic inflammation in the zone of ectopy are likely involved 1, 4

Avoid Indefinite Antibiotic Therapy

• Do not continue empiric antibiotics indefinitely without an identified pathogen, as this has no proven benefit and risks adverse effects 4
• The value of repeated or prolonged administration of antibiotic therapy for persistent symptomatic cervicitis is unknown 1

When to Consider Non-Infectious Causes

• Persistent mucopurulent-appearing discharge despite negative testing for gonorrhea, chlamydia, trichomonas, and other pathogens should prompt consideration of non-infectious ectopy inflammation 4
• Recurrent symptoms that do not respond to repeated courses of antimicrobial therapy may indicate non-infectious causes 4