What Is Cervicitis

The medical condition cervicitis refers to the inflammation of the cervix,¹ the lower end of the uterus also known as the neck of the womb. Cervicitis usually occurs as a result of sexually transmitted viral or bacterial infections which may initiate inflammation of the cervix if left untreated. Cervicitis may also occur as a result of a chemical or physical irritation to the cervix. The condition is common in women of all ages, particularly in sexually active women between the ages of 15 and 24.² The condition may be acute or chronic, however in any case there are complications that may develop if cervicitis is not diagnosed and treated accordingly.

Overview

Cervicitis affects at least half of all women at any point during their adult life. The condition is more common in women with a history of high risk sexual behaviour and a history of sexually transmitted infections (STIs).³ The cervix is an important barrier against infection of the uterus, therefore cervicitis increases the risk of infections spreading further into the uterus which may add complications to one’s health. The underlying cause of the inflammation or swelling of the cervix is usually the first step forward towards treating the condition.

Causes of cervicitis

The most common cause of cervicitis are STIs. There are several STIs that can cause infectious cervicitis. Some of the STIs frequently associated with cervicitis are:

• Gonorrhoea:⁴ this STI causes gonococcal cervicitis. There are further risks in pregnant women with gonorrhoea who may pass on the untreated infection to the baby
• Chlamydia:⁵ chlamydial cervicitis is caused by the bacteria Chlamydia trachomatis which is passed on through unprotected sexual intercourse. There are further risks of health complications if chlamydia is left untreated
• Trichomoniasis:⁶  A protozoan parasite called Trichomonas vaginalis causes this STI 
• Mycoplasma genitalium⁷: this is a bacteria that can be transmitted sexually in women to cause infectious cervicitis and other complications such as urethritis. Mycoplasma genitalium accounts for up to 30% of infectious cervicitis cases in women⁷

Bacterial infections are the most common cause of infectious cervicitis, and it has been reported in a recent study that chlamydia and gonorrhoea account for up to 50% of infectious cervicitis.⁸ It may be beneficial to take part in regular health screens,⁹ that are implemented as part of disease control in our communities.¹⁰

Infectious cervicitis may also be the result of viral infections. Genital infection with the Herpes Simplex Virus (HSV), a common virus, can cause cervicitis, oral and genital herpes.¹¹The Human Papillomavirus (HPV) is the most common STI according to the Centers for Disease Control and Prevention.¹² HPV can cause inflammation of the cervix and may be an early sign of cervical cancer in rare cases. The viral infection can be transmitted by skin contact with the genitals of an infected person. In many cases, however, HPV is asymptomatic and does not cause any health problems. Genital warts,¹³ which appear as soft, fleshy lumps on the genitals, are a common symptom of HPV infection in symptomatic cases.

Bacterial vaginosis (BV) is another condition that can cause inflammation of the cervix. BV results from an overgrowth of naturally occurring bacteria found in the vagina. Although it isn’t a sexually transmitted disease itself, quite often BV can increase susceptibility to STIs,¹⁴ if left untreated. Inflammation of the cervix that results from these infectious causes is known as acute cervicitis.

Alternatively, chronic cervicitis usually results from chemical or physical irritants that lead to inflammation of the cervix. Foreign objects, such as tampons and contraceptive diaphragms, may cause physical trauma on the cervix that can initiate inflammation. Chemical irritants from latex condoms, contraceptive creams and soaps, too, can initiate an allergic reaction and inflammation of the cervix, although rarely. 

Signs and symptoms of cervicitis

In many cases, cervicitis does not show any symptoms especially where the underlying cause is an asymptomatic infection. The following are symptoms frequently experienced where cervicitis shows up:

• Vaginal discharge: chlamydial cervicitis is often mucopurulent where a grey or yellowish discharge is seen
• An irregular menstrual cycle: bleeding may occur in between the menstrual cycle of after sexual intercourse
• Pelvic pain
• Frequent urination
• Painful sexual intercourse
• Vaginal irritation
• Difficulty conceiving a baby which is often seen with chronic cervicitis

There are risks of health complications if the underlying cause of cervicitis is not treated by a healthcare professional. Pelvic inflammatory disease¹⁵ (PID) results from the spread of infection through the uterus, affecting the ovaries and fallopian tubes. Chronic pelvic pain, abscess formation and infertility are all associated consequences of the disease.²

Management and treatment for cervicitis

Infectious cervicitis can be treated by first diagnosing and treating the primary cause of infection. If symptoms are experienced, it is advised to visit a healthcare provider and avoid taking part in any sexual activities until treated.¹⁰ Sometimes cervicitis may get picked up on a regular cervical screen¹⁶  (smear test) or a visit to a sexual health clinic, especially in asymptomatic infections. Healthcare providers may perform a pelvic examination and collect samples of vaginal discharge to determine the type of infection. If tests return negative for infection, further tests to determine non-infectious causes may follow. There are some interesting studies that are developing our understanding of the causes of chronic cervicitis.¹⁷

Bacterial and viral STIs that mostly cause acute cervicitis can be treated or managed with prescribed antibiotics and antiviral drugs according to the underlying infection. Usually a prescription for a course of medication is made by a healthcare professional, and as with most antibiotics, it is essential to complete the course. In chronic cervicitis that is untreatable with antibiotics, tests for contact dermatitis and other allergies may be performed in order to determine the cause of inflammation.² It is also advised to avoid physical and chemical irritants on the cervix which may trigger inflammation.

FAQs

How is cervicitis diagnosed

A healthcare professional may perform a pelvic examination to look for abnormalities inside the vagina. Samples of vaginal discharge are usually tested for bacterial and viral infections.

A routine cervical screen,¹⁶ or pap smear test can also diagnose cervicitis and the healthcare provider will  provide further appropriate care.

How can I prevent cervicitis

Preventative measures like safe sex and low-risk sexual behaviours can avoid acute cervicitis that is caused by STIs. Regular sexual health screens are vital in order to treat underlying asymptomatic STIs that lead to cervicitis. Avoiding chemical and physical irritants inside the vagina may be advised if this is thought to cause chronic cervicitis.

Is cervicitis contagious

If acquired through an untreated STI, the residual infection may be passed on through sexual intercourse.

Who are at risks of cervicitis

Cervicitis is more prevalent in communities with high STI infection rates and no access to sex education or preventative measures such as condoms and sexual health screening clinics. Engaging with multiple sexual partners also increases your risk  of infectious cervicitis. Not having regular cervical screens,⁹ can increase the risk and complications of cervicitis.

How common is cervicitis

Cervicitis can affect at least half of women at least once in their lifetime. The condition is common in women of all ages, particularly in sexually active women between the ages of 15 and 24.²

When should I see a doctor

If symptoms occur or if you have had unprotected sex with a new partner, it is best to seek medical advice as soon as possible in order to get tested and, if medically necessary, receive treatment. These actions avoid spreading a possible underlying STIs.

Summary

In summary, cervicitis is a common condition that occurs as a result of STIs or chemical and physical irritants on the cervix. Having regular sexual health and cervical screens can help to catch and treat the underlying causes of cervicitis, thereby reducing the risk of the condition.