From the Guidelines
Treatment of chronic cervicitis should focus on reevaluating for possible reexposure to an STD, reassessing vaginal flora, and considering ablative therapy by a gynecologic specialist if symptoms persist and other causes are excluded. According to the 2006 guidelines for sexually transmitted diseases treatment 1, the management options for persistent cervicitis are undefined if relapse and/or reinfection with a specific STD has been excluded, bacterial vaginosis (BV) is not present, and sex partners have been evaluated and treated. Key considerations in the treatment of chronic cervicitis include:
- Reevaluating the patient for possible reexposure to an STD
- Reassessing the patient's vaginal flora
- Evaluating and treating sex partners to prevent reinfection
- Considering ablative therapy, such as cryotherapy, electrocautery, or laser therapy, for persistent symptomatic cervicitis, as recommended by a gynecologic specialist 1. It is essential to note that the value of repeated or prolonged administration of antibiotic therapy for persistent symptomatic cervicitis is unknown, and patients who receive such treatment should return after completion for follow-up evaluation to determine if cervicitis has resolved 1.
From the FDA Drug Label
Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. The treatment of chronic cervicitis with azithromycin (PO) is not explicitly mentioned in the drug label. However, the label does indicate that azithromycin is used to treat cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae.
- The label does not differentiate between acute and chronic cervicitis.
- Key points to consider when treating cervicitis with azithromycin include:
- Performing appropriate culture and susceptibility tests before treatment
- Initiating therapy before results of these tests are known, and adjusting antimicrobial therapy accordingly once results become available
- Using azithromycin only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2
From the Research
Treatment Options for Chronic Cervicitis
- Antibiotic treatments, such as azithromycin, have been shown to be effective in reducing cervicitis at follow-up in populations with high prevalence of Chlamydia trachomatis and/or Mycoplasma genitalium 3
- A single 1-g dose of azithromycin has been found to be as effective as a standard seven-day course of doxycycline for the treatment of uncomplicated genital chlamydial infections 4
- Azithromycin offers the potential of effective single-dose treatment for chlamydial cervicitis, which can help prevent serious gynecologic complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy 5
- Single dose oral azithromycin has been compared to seven-day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis, with no statistically significant difference in efficacy between the two treatments 6
Response to Therapy
- The cure rate after initial antibiotic treatment for chronic nongonococcal nonchlamydial cervicitis has been reported to be around 65.6% 7
- Additional treatments, such as secondary antibiotics, hormonal treatments, vaginal hydrocortisone, silver nitrate, cryotherapy, and loop excision electrosurgical procedure, may be necessary for patients who do not respond to initial antibiotic treatment 7
- The overall cure rate for chronic nongonococcal nonchlamydial cervicitis has been reported to be around 93.4% 7