Chronic Cervicitis: Presenting Features and Response to Therapy
Polk J, Mattson S, Nyirjesy P
Drexel University College of Medicine, Department of Obstetrics and Gynecology
Results
Introduction
Cervicitis is a state of cervical inflammation which
results in an abnormal mucopurulent discharge and
cervical friability. More than 50% of cervicitis is not
caused by gonorrhea or chlamydia. The cause of
non-gonoccocal non-chlamydial (NGNC) cervicitis is
unknown and therefore so is the treatment. Only
one RCT has been published and it was suspended
due to lack of enrollment. Possible etiologies
include Mycoplasma genitalium and Ureaplasma
spp. M. genitalium is sexually transmitted and a
cause of urethritis. Ureaplasma spp. are common;
but their pathogenic role is even less clear.
Commercial tests for genital mycoplasmas are yet
not validated.
61 cases identified with the following characteristics.
Age (mean, SD): 31 yo, 8.6 years
Partners in the
last year
Race
Martial Status
Caucasian
37 (60.7%)
Asian
6 (9.8%)
African American
5 (8.2%)
Hispanic
1 (1.6%)
Not
recorded/unknown
12 (19.7%)
• Mucopurulent discharge noted by (1) patient and/or (2)
practitioner
• Cervical bleeding upon gentle probing with a cotton
swab.
Results
34 (56%) of the patients were tested for
Mycoplasma spp. and Ureaplasma spp.
Tests used were PCR and nucleic acid amplication
test (NAAT). 8 patients tested positive for some
species of ureaplasma; 3 of these however were
a test that grouped together all mycoplasmas and
ureaplasmas. The only mycoplasma detected was
M. hominis, a component of normal vaginal flora.
Married
41
(67.2%)
20
(32.8%)
Abnormal discharge
3 (4.9%)
1
33 (54.1%)
>1
18 (29.5%)
Unknown
7 (11.5%)
55 (90.2%)
39 (63.9%)
Itching
35 (56.5%)
Odor
27 (44.3%)
5 (8.2%)
Burning
26 (42.6%)
HSV
4 (6.6%)
Dyspareunia
24 (39.3%)
HPV
21 (34%)
Inter-menstrual bleeding 21 (34.4%)
Trichomonas
5 (8.2%)
Bleeding with coitus
16 (26.2%)
Urinary symptoms
7 (11.5%)
History of STI N, % overall, % of
STI
GC
CT
1 (1.6%)
Symptom Duration
Average, SD
Patients received one of three initial antibiotic
treatments: azithromycin (n=36), doxycycline
(n=14), moxifloxacin (n=8).
The overall cure rate was 62% and the respective
cure rates for each treatment were:
• Azithromycin (n=23), 64%
• Doxycycline (n=10), 71%
• Moxifloxacin (n=3), 37.5%
91.3% were eventually cured, 1.7% were not, and
7% were lost to follow-up. 19 (33%) patients
required one or more additional treatments with a
total of 11 different regiments.
2nd line treatments included:
Additional antibiotics (n=9)
Irritation
Site: Drexel vaginitis center
Patients typically are referred to this tertiary care center
from outside institutions due to persistent or recurrent
symptoms. Annually there are approximately 500 new
patient visits and 4300 return patient visits.
Single/separated
0
Presenting Symptoms
Methods
This study was a retrospective review. All patient
encounters with the diagnostic code for cervicitis
between April 1, 2008 and March 1, 2014 were
reviewed for the following diagnostic criteria (two
of three necessary):
Results
Additional
Characteristics
• Clindamycin, doxycycline, azithromycin,
moxifloxacin, flagyl
Hormonal treatments (n=8)
•
•
•
•
•
Depo-medroxyprogesterone, estradiol cream
Vaginal hydrocortisone (n=6)
Silver nitrate (n=4)
Cryotherapy (n=1)
LEEP (n=2)
Cure rates for each of these approaches:
•
•
•
•
•
•
Antibiotics- 43% (6/14)
Hormone treatments 50% (3/6)
Hydrocortisone 0% (0/6)
Silver nitrate 100% (4/4)
Cryotherapy 0% (0/1)
LEEP 100% (2/2)
Conclusions
25.2 months,
30.2 months
Nulliparous
36 (60.7%)
</= 1 month
10 (16.4%)
Smoker
6 (9.8%)
>1-3 months
7 (11.5%)
LEEP/CKC
5 (8.2%)
>3-12 months
12 (19.7%)
Abnormal pap
6 (9.8%)
>12 months
32 (52.5%)
Recurrent yeast
12 (19.7%)
Recurrent BV
36 (59.0%)
NGNC cervicitis is an uncommon reason for
referral to a tertiary care vaginitis center.
Doxycycline or azithromycin as initial therapy
cured 62% of patients. The best second line
treatment is unclear, but 9.3 % of patients
eventually were cured. The role of genital
mycoplasmas remains unclear. No patients tested
positive for M. genitalium and only a small number
were positive for other species.