Cervicitis: Symptoms, Causes, Diagnosis, and Treatment

Introduction

Cervicitis: A condition poorly understood, neglected, and carries more repercussion than we think

Cervicitis is a medical condition where the cervix is inflamed. This can result from an infection or even an irritant. It is defined when there is evidence of mucous-pus discharge from the cervix and possible spotting from the cervix due to a fragile, inflamed cervix. When cervicitis occurs acutely, one can have uncomfortable noticeable symptoms. However, when the cervicitis runs a more chronic journey, symptoms become more tolerable. One can potentially ignore the symptoms as they can be mild.

Cervicitis is not a new medical condition. Yet, it is not commonly discussed of, one may even ignore the condition in hope of spontaneous resolution of symptoms.

Good awareness, understanding, early screening and treatment of cervicitis are imperative in halting further irreversible pelvic scarring and obstetric complications

Symptoms of cervicitis

One with cervicitis can have non-specific mild vaginal symptoms to no symptoms at all, making it a difficult diagnosis to pick up without screening tests.

One who are experiencing symptoms of cervicitis can present with

• Abnormal vaginal discharge such as excessive volume, unusual color, odor, vaginal itch or discomfort
• Painful intercourse
• Unusual bleeding/spotting between period or after intercourse

If you have potential exposure to genital infection(s), abnormal lower genital symptoms above, you are encouraged to speak to your healthcare providers for further evaluation of your condition.

Can my pap smear screen for cervicitis?

Cervical smear such as pap smear is used to screen for early cervical cell changes or cervical cancer. Pap smear can be useful in guiding patients and physicians on whether a person may potentially have cervicitis. Pap smear showing inflammatory cells may be a clue of underlying cervicitis or lower genital infection that has not been taken care off.

Pap smear test alone is not conclusive of a cervicitis diagnosis, but the abnormal results can be a telltale sign of infection(s) around the lower genital area.

One should consider a follow-up high-vaginal swab to evaluate specific potential pathogen(s) that can cause vaginal and cervix infections. This is important in subsequent targeted treatment to eradicate the infection(s).

Infections that can cause cervicitis

Inflammation of the cervix is frequently due to underlying infection, such as STDs. Infective pathogens - bacteria and viruses can be contracted during sexual intercourse. Persistent infection of the lower reproductive area such as the vaginal canal can eventually lead to cervicitis or even ascending infection (pelvic inflammatory disease).

Untreated STDs that can result in cervicitis include

• Chlamydia trachomatis
• Neisseria Gonorrhea
• Human Papilloma Virus (HPV)
• Mycoplasma Genetalium
• Herpes Simplex Virus (HSV)
• Trichomonas vaginalis

Interestingly, non-STD related bacteria such as Gardnerella vaginalis (which is associated with bacterial vaginosis) can also result in inflammation of the cervix.

Understanding the pattern and types of infections responsible in cervicitis allows us to screen and treat cervicitis promptly

Observational studies over the years reveal interesting trend of infection types in women with cervicitis. Chlamydia and gonorrhea bacteria remain the top common causative pathogens that are responsible of cervicitis.

However emerging data shows

• Polymicrobial infection (more than 1 infection) can be found in women with cervicitis
• Mycoplasma genitalium is increasingly seen in women with cervicitis
• Bacterial vaginosis related female bacteria can be found in women with cervicitis
• Less commonly, virus such as HSV can also be a cause of cervicitis.

This shift in pattern of pathogens in cervicitis can be explained by human behavior, modern dating, earlier age of becoming sexually active, multiple sexual partner(s), engaging in various sexual orientations, use of oral contraception and not using barrier contraception, resulting in a predisposition of co-infections in the lower reproductive organs.

In addition, sexual health clinical services may not be widely available to everyone. In particular, screening tests may not be fully available in non-sexual health clinic. In return, this explains the rise of multiple lower reproductive organ infections, missing diagnosis, delay of right treatment, persistent cervicitis and complication such as pelvic irreversible inflammation and scarring.

While bacterial vaginosis is not considered a STD, it is more commonly seen in those who are sexually active or who have multiple sexual partner(s). Bacterial vaginosis is a common female lower reproductive organ infection due to disruption and disequilibrium of the healthy pH vaginal microflora, leading to depletion of healthy lactobacillus microflora and overgrowth of bacterial vaginosis related bad bacteria. At a glance, this may seem a benign condition with mild vaginal abnormal symptoms (or even no symptoms at all). However, there is increasing medical evidence showing the causative relationship between bacterial vaginosis, cervicitis and pelvic inflammatory disease. To make things worse, presence of bacterial vaginosis increases risk of contracting STDs including HIV, HPV, Herpes, chlamydia and many more.

With the knowledge above, blind treatment with broad-spectrum antibiotics or pessaries may be a hit-and-miss treatment for lower genital infection. There is a role to consider pro-active measures such as regular women checkup with appropriate vaginal test panels to capture these pathogens that can affect our cervical health.

Cervicitis can be non-infections

Douching/wash agents, contraceptive materials such as spermicides, diaphragms, tampons or even condom can lead to irritation of the cervix in some women, resulting in cervicitis.

What are the implications of not treating cervicitis?

Infective cervicitis, if not treated, will result in more serious health morbidities. The infection can spread upwards towards the rest of the reproductive organs, affecting the uterus, fallopian tubes, even the ovaries, leading to chronic inflammation and scarring. One can develop chronic pelvic pain, discomfort, infertility, and even risk of ectopic pregnancy.

To make things worse, untreated cervicitis is a risk factor of contracting HIV infection. One is also more susceptible of contracting other STDs if cervicitis left untreated. If the untreated cervicitis is due to STDs, one can also infect their loved ones through intercourse.

HPV and cervicitis: Will cervicitis lead to cancer?

Cervicitis itself is generally not life threatening though it can be associated with long term health complications such as infertility, and obstetrical complications. Cervicitis secondary to high-risk HPV infection can potentially lead to cancer.

As mentioned, cervicitis is commonly caused by STDs including viruses such as HPV. High-risk HPV strains infection can lead to inflammation of the cervix tissues. If a person's immune system is unable to clear off the HPV infection, over time, there can be chronic cervicitis changes, progressive cervix cells inflammation and changes, leading to abnormal cervical cells formation, precancerous changes and eventually lead to cancer cells over the cervix.

It is worth understanding these 3 facts:

• Cervical cancer takes months to years to develop from initial HPV infection.
• There iseffective HPV vaccination for women 45 years old and below to protect against cervical cancer.
• Those with precancerous cervical cells changes can be treated with procedural or surgical intervention.

HPV-related cervicitis and cancer risk can be mitigated. We should always encourage our female family members, friends, colleagues for regular cervical cancer screening to pick up early abnormal changes, get HPV immunization vaccine if age-eligible and without contraindication, and seek medical assistance early if any abnormal cell changes detected.

What can I expect when I see my doctor for suspected cervicitis?

If there is concern of cervicitis, one should consider arranging a medical checkup with your healthcare provider.

Your doctor will offer you a physical examination involving a pelvic and vaginal checkup. A sterile speculum will be introduced gently into the vagina to visualize the cervix. A cervix with mucous discharge, red dots, bleeding spots, ulcers may be suggestive of cervicitis. Having said that a normal physical review does not rule out cervicitis.

In those with risk factors or possible exposure to genital infection and cervicitis, your doctor may obtain vaginal, cervical swab samples, urine samples for further screening of infections.

Can cervicitis be treated?

• If infection is the cause of cervicitis, appropriate antibiotics and antiviral medication are usually effective in eradicating the STDs, thereafter leading to resolution of cervicitis.
• Sexual partner(s) for the last 3-6 months should also be screened and treated if need. Those with cervicitis should avoid sexual activities until infection has been cleared. (both the patient and partner)

What have I learnt today?

• Cervicitis symptoms can be mild, non-specific and the condition is commonly unaddressed.
• Cervicitis can carry long term health complications such as irreversible pelvic inflammatory disease, scarring of reproductive organs and can be associated with pregnancy complications.
• Untreated cervicitis increases the risk of contracting STDs, including HIV infection.
• While cervicitis can be due to non-infectious reasons, commonly cervicitis is due to underlying genital infections such as STDs.
• Pap smear test and vaginal swab tests are immensely useful in determining the underlying infection(s) that causes cervicitis, allowing targeted antimicrobial treatment to be delivered to manage cervicitis.

Contact DB Clinic

If you are experiencing symptoms of cervicitis or have concerns about your reproductive health, accurate diagnosis and prompt treatment are essential. Take control of your health with a confidential consultation and effective care from our experienced medical team. Schedule your appointment today.

References:

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