this lecture involves full, simple and easy description of cervicitis
including acute and chronic cervicitis and the major causes for it as Neisseria gonorrhea and chlamydia trachomatous
also chronic infection and ectopy
2. Definition
An inflammatory process in the cervical epithelium and stroma can be associated with
trauma, inflammatory systemic disease, neoplasia and infection
There are 2 types:
Ectocervicitis
HSV or result from severe vaginitis by T vaginalis or candida albicans
Endocervicitis (mucopurulent cervicitis)
Nonspecific organism as staph, strept, E-coli …..
Specific infection C. trachomatis, N. gonorrhea, mycoplasma genitalie
4. Definition
• Clinically
Gross visualization of yellow purulent material on a white cotton
swab
• Histologically
Presence of 10 or more PMN leukocytes per HPF on gram-
stained smears obtained from ectocervix
5. Clinical
presentation
• Asymptomatic in about 60%
• Postcoital bleeding
• Purulent or mucopurulent vaginal discharge
• Hypertrophied edematous cervix
• Dyspareunia, dysuria, deep pelvic pain,
backache
• Perinatal infections of membranes, AF and
neonatal infections
• The physical sign of cervical infection grossly
appearance of yellow mucopurulent
material on a white cotton swab
7. Investigations
WET MOUNT
GRAM STAIN PRESENCE OF
10 OR MORE PMN
LEUKOCYTES PER HPF ON
GRAM-STAINED SMEARS
OBTAINED FROM
ENDOCERVIX
CULTURE & SENSITIVITY
NAAT TEST DIRECT PROBE ANALYSIS
9. Microbiology
• Gram negative coccobacilli
• Invade columnar & transitional epithelial cells to be intracellular so squamous vaginal
epithelium didn’t be affected
10. Transmission
Sexual contact
Nonsexual from mother to neonate during childbirth (ophthalmia neonatorum)
Infection of:
1ry sites urethra, skene's gland, Bartholin gland, endocervix, rectum, pharynx, conjunctiva
Spread PID, perihepatitis (Fitz-Hugh-Curtis syndrome)
Systemic spread arthritis, endocarditis, meningitis, septicemia
11. Clinical presentation
• Asymptomatic
• Postcoital bleeding
• Purulent or mucopurulent vaginal discharge
• Dysuria, dyspareunia
• Bartholin abscess
• During pregnancy
Perinatal transmission, PPROM, PTL, chorioamnionitis,
Newborn ophthalmia neonatorum, pneumonia, otitis media
Male urethritis, epididymitis, prostatitis, proctitis
12. Detection
• Endocervical smear
• Gram stain
Gram negative coccobacilli
• Culture
On chocolate agar or Thayer
martin agar
• NAAT
Gold standard for diagnosis
13.
14. Treatment
• Abstinence until therapy is completed
• Investigate for other STDs
• Treat patient & sexual partner
• Drugs used for treatment
Ceftriaxone 250 mg IM + Azithromycin 500 mg
1gm single dose
Or
Cefixime (Suprax) 400 mg orally once +
Azithromycin 500 mg 1gm single dose
16. Microbiology
Immotile
Didn’t stain with gram (resist gram staining)
replicate only within a host cell
Present in 2 forms
Elementary bodies (spore like & infectious)
Reticulate bodies (replicative stage % only within
host cells)
17. Classification
Types A,B,C causes trachoma
Types from D to K infect genital
tract, non gonococcal urethritis,
cervicitis, salpingitis, PID
Types L1,L2,L3 infection of lymph
nodes near genitals (LGV)
lymphogranuloma venereum
18. Transmission
• Sexual contact
• Nonsexual from mother to neonate
during childbirth (ophthalmia
neonatorum, pneumonia
It is the most common sexually
transmitted bacteria
The most common infectious cause
of blindness
19. Clinical
presentation
• Asymptomatic
• Postcoital bleeding
• Purulent or mucopurulent vaginal discharge
• Dysuria, dyspareunia
• Bartholin abscess
• During pregnancy
Perinatal transmission, PPROM, PTL, chorioamnionitis,
Newborn ophthalmia neonatorum, pneumonia, otitis
media
Male urethritis, epididymitis, prostatitis, proctitis
20. Investigations
• Microscopic inspection
Reveals 20 or more leukocytes per
HPF
• Gram stain
Resist stain with gram stain
• Culture
Not cultured except on tissue culture
• Molecular testing NAAT
• Enzyme linked immunosorbent
assay (ELISA)
21. Treatment
• Abstinence until therapy is completed
• Investigate for other STDs
• Treat patient & sexual partner
• Drugs used for treatment
Doxycycline 100 mg orally 2 times per day for
7 days
Or
Azithromycin 500 mg 1gm single dose
23. Definition
Chronic condition in which cervical glands act as a
reservoir for pyogenic organisms and associated with
macroscopic changes in cervical architecture, shape
or secretions
32. Treatment
• Prophylaxis
Early proper treatment of acute cervicitis
• Medical
Antiseptics
Hygiene
Antibiotics are not effective (as no pathogen)
• Drainage of pus
Electrocautery
Cryotherapy
Laser
33. Cervical ectopy
Presence of endocervical epithelium in the ectocervix
Etiology
Chronic cervicitis
Congenital
Hormonal effect (COC users, pregnancy, lactation)
Presentation
Asymptomatic
Mucopurulent discharge
Contact bleeding
Examination
Simple (red flat), papillary (velvet like), follicular
Investigations
Pap smear, culture and sensitivity
Treatment
Follow up and no treatment is required or treat as chronic cervicitis if present as chronic cervicitis