Cervicitis: A STD Complication which Can Lead to PID

The repercussions of sexually-transmitted diseases (STDs) can go beyond the original symptoms. Previously, we discussed how untreated gonorrhea and chlamydia can lead to pelvic inflammatory disease (PID). However, not limited to PID, gonorrhea and chlamydia can also cause an inflammation of the cervix called cervicitis. An infection upsetting the end of the uterus, cervicitis can present extreme symptoms that appear abruptly (this condition is referred to as acute cervicitis) or symptoms that go on for months or longer (chronic cervicitis).

In some cases, women can have cervicitis without knowing it since symptoms do not always show up. Although most cervicitis cases are due to bacterial and viral infections spread through sexual contact, this condition can also occur because of allergies, injuries and bacterial imbalance in the vagina.

Causes and risk factors of cervicitis

The factors mentioned below are what can cause cervicitis:

  • STDs. Infections that result from sexual contact is the main reason why cervicitis happens in the first place. Several bacterial and viral STDs are known to be the culprit behind this infection:
    • Gonorrhea. Gonorrhea is an STI caused by Neisseria gonorrhoeae. This bacterium irritates the reproductive tract (cervix, uterus and fallopian tubes). There is a link between PID and cervicitis. Cervicitis beginning from gonorrhea can affect the uterine lining and fallopian tubes, leading to PID.
    • Chlamydia. Caused by Chlamydia trachomatis, both men and women can get chlamydia. In women, chlamydia infects the cervix, rectum or throat. 40% of cervicitis are said to originate from chlamydia. Gonorrhea and chlamydia cervicitis tend to affect the endocervix (inner part of the cervix connecting the vagina to the uterus). Compared to gonococcal cervicitis, chlamydia cervicitis is 4 to 5 times more common. Besides cervicitis, chlamydia is one reason behind infertility, ectopic pregnancy and PID.
    • Herpes. Genital herpes (HSV-2) can trigger acute cervicitis. Sometimes, minor ulcerations will happen and infections take place in the vulva or introital epithelium. In other cases, cervicitis resulting from HSV-2 can be asymptomatic but accompanied with vaginal discharge.
    • Trichomoniasis. Unlike gonorrhea and chlamydia which attack the inner part of the cervix, genital herpes and trichomoniasis affect the squamous epithelium of the ectocervix (outer part of the cervix that projects into the vagina).
  • Allergies. Allergies leading to cervicitis are reactions developed because of chemical and mechanical agents. These agents, unlike STDs mentioned above, are non-infectious.
  • Chemical agents: soaps, spermicides, laundry products, latex condoms, and feminine products (vaginal douches or deodorants).
  • Mechanical agents: contraceptives, cervical caps, tampons, diaphragms, and a number of other foreign objects.
  • Bacterial imbalance. Some types of bacteria that overgrow can cause cervicitis.
  • Systemic inflammatory diseases. Other diseases such as Behcet syndrome and lichen planus are sometimes associated with cervicitis.

Some people may have a greater risk to contract cervicitis:

  • Individuals who engage in risky sexual behaviours and preferences such as having multiple partners (and partners who also partake in high-risk sexual behaviours) and unprotected sex
  • Sexually active women at the age of 15 to 24. Not only is women’s anatomy making young females more susceptible to STDs, the Centers for Disease Control and Prevention (CDC) stated that this age group is the most prone to contracting STDs
  • Higher incidence rate is more common in HIV-positive women
  • Individuals with a history of STIs and STDs

The difference between cervicitis and vaginitis

One too many times, people often mistake cervicitis for vaginitis. While it is true that both diseases are related to female organs, they affect different parts. Cervicitis is an inflammation of the cervix and vaginitis is an inflammation of the vagina. They also differ in symptoms. Vaginitis is mostly indicated by itching and odor. Meanwhile, abnormal bleeding between periods of after sexual intercourse, pelvic pain and pain during intercourse are indicative of cervicitis. One shared symptom between vaginitis and cervicitis is vaginal discharge, but discharge caused by cervicitis is usually accompanied with pus (also known as ‘purulent discharge’). In several cases, bacterial vaginosis (BV), which is part of vaginitis, can progress into cervicitis.

Diagnosing cervicitis

Examining a person’s medical history along with performing pelvic exams are two ways of diagnosing cervicitis. During pelvic exams, doctors will inspect pelvic organs to detect swelling or tenderness. A speculum may also be used to get a view of the upper, lower and side walls of the cervix and vagina. These tests can determine whether or not abnormalities (redness, discharge, blood and inflammation) occur in the cervix. Along with pelvic exams, you may also undergo tests for gonorrhea, chlamydia, herpes and trichomoniasis.

Treatment for cervicitis

Antibiotics serve as the main treatment for cervicitis. However, treatment may also depend on factors such as age, medical history, current health, as well as the severity of the disease and symptoms. For example, cervicitis resulting from allergic reactions to chemicals may not require treatment, but if the cervicitis stems from an STI, treatment is necessary. Individuals under the age of 25 who practice high-risk sexual behaviours can be prescribed antibiotics even when bacteria are not present.

Antibiotics used to treat cervicitis revolve around azithromycin, doxycycline, or penicillin. Treatment for cervicitis by infectious agents (STDs) are as follows:

  • Gonorrhea: intramuscular ceftriaxone (250mg) AND azithromycin (a single oral dose of 1g)
  • Chlamydia: Azithromycin (a single oral dose of 1g) OR doxycycline (100mg, twice daily for 7 days)
  • Trichomoniasis: Metronidazole OR tinidazole (a single oral dose of 2g)
  • Genital herpes: Acyclovir (oral, 400mg, taken three times daily for 7 to 10 days)

Untreated cervicitis can progress into PID, causing infertility and peritonitis. Peritonitis is an inflammation of the membrane lining the abdominal walls and abdominal organs.

Regular STD screening to check for gonorrhea, chlamydia, trichomoniasis and herpes is the first step to better mitigate cervicitis. Shim Clinic is a male sexual health STD clinic providing STD testing, diagnosis and STD treatment. We also carry STD prevention methods such as HIV PEP, HIV PrEP and HPV vaccination (Gardasil-9).