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Cervicitis
Prof. Aboubakr Elnashar
Benha University Hospital, Egyptnashar
Etiology
1.C. trachomatis (CT)
2.N. gonorrhoeae (NG)
3.Trichomoniasis (TV) and Bacterial vaginosis
(BV)
4. M. genitalium and HSV-2.
5. Majority of cases: no organism is isolated.
Frequent douching
Persistent abnormality of vaginal flora
Chemical irritants
idiopathic inflammation of ectopy
Aboubakr Elnashar
Gonococcal cervicitis
Mucopurulent cervicitis
Aboubakr Elnashar
Erosive cervicitis due to HSV infection
Aboubakr Elnashar
Symptoms
Frequently is asymptomatic
Abnormal vaginal discharge
Intermenstrual vaginal bleeding
Contact bleeding (after SI).
Aboubakr Elnashar
Signs
2 major
1) Mucopurulent discharge
in endocervical canal or
on an endocervical swab
2) Endocervical bleeding by passage of a
cotton swab.
Aboubakr Elnashar
Mucopurulent cervicitis due to
chlamydia: ectopy, edema, and
discharge
Chlamydial cervicitis: mucopurulent
cervical discharge, erythema, and
inflammation.
Chlamydial cervicitis: ectopy,
discharge, bleeding.
Aboubakr Elnashar
Mucopurulent discharge from cervix on a swab
(positive swab test)
Aboubakr Elnashar
Diagnosis
1.Assessment for signs of PID: {cervicitis might be a
sign of endometritis}
2.Direct microscopy:
>10 WBC in vaginal fluid (in the absence of T.V.):
sensitive indicator of cervical inflammation caused
by C.T. or N.G., with a high negative predictive
value.
3. Gram stain:
increased number of WBC
not available in the majority of clinics.
low PPV for infection with C.T and N.G
insensitive {observed in only 50%}.
Aboubakr Elnashar
3. Test for C.T and for N.G:
NAAT (nucleic acid amplification tests).
on either cervical or urine samples {the
most sensitive and specific test}
4. Test for BV and TV.
Aboubakr Elnashar
TV:
 Microscopy {sensitivity is low (50%)}
 Culture or antigen-based detection: if
microscopy is negative
Purulent Vaginal Discharge in TV
Aboubakr Elnashar
Strawberry" cervix due to T. V
Aboubakr Elnashar
Saline wet mount: 2 TV (arrows),
leukocytes and a normal vaginal epithelial
cell
McGraw-Hill
Pap smear: 70% sensitive
in showing TV.
Aboubakr Elnashar
BV:
3 of the following S or S:
1. Homogeneous, thin, white discharge that
smoothly coats the vaginal walls
2. Clue cells on microscopic examination
3. pH of vaginal fluid >4.5
4. Fishy odor of vaginal discharge before or
after addition of 10% KOH (Whiff test).
Aboubakr Elnashar
5.Testing for HSV-2 (culture or serologic
testing):
value is unclear.
6.Tests for M. genitalium:
not commercially available.
Aboubakr Elnashar
Treatment
1. C. T:
a. increased risk for STD (age <25 years, new
or multiple sex partners, and unprotected
sex)
b. follow-up cannot be ensured
c. insensitive diagnostic test (not a NAAT) is
used.
2. Concurrent therapy for N.G: if the
prevalence is high (>5%).
3. T.V. or BV: if detected.
Aboubakr Elnashar
Recommended Regimens for Presumptive
Treatment*
Azithromycin (Zithromax) 1 g orally in a single
dose
OR
Doxycycline 100 mg orally twice a day for 7
days
•Azithromycin (Zithromax) is safe and effective
during pregnancy
Aboubakr Elnashar
Recommended Regimens of Uncomplicated
Gonococcal Infections of the Cervix, Urethra, and
Rectum
Ceftriaxone 125 mg IM in a single dose
OR
Cefixime 400 mg orally in a single dose
OR
Ciprofloxacin 500 mg orally in a single dose*
OR
Ofloxacin 400 mg orally in a single dose*
OR
Levofloxacin 250 mg orally in a single dose*
PLUS
TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL
INFECTION IS NOT RULED OUTAboubakr Elnashar
BV:
Recommended Regimens
Metronidazole 500 mg orally twice a day for 7 d
OR
Metronidazole gel, 0.75%, one full applicator (5 g)
intravaginally, once a day for 5 days
OR
Clindamycin cream, 2%, one full applicator (5 g)
intravaginally at bedtime for 7 days
Alternative Regimens
Clindamycin 300 mg orally twice a day for 7 days
OR
Clindamycin ovules 100 g intravaginally once at
bedtime for 3 days
Routine tt of sex partners is not recommended.
Aboubakr Elnashar
TV:
Recommended Regimens
Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single dose
Alternative Regimen
Metronidazole 500 mg orally twice a day for 7
days
Sex partners: should be treated.
Aboubakr Elnashar
Recurrent and Persistent Cervicitis
1. Exclude relapse and/or reinfection with
a specific STD
2. Exclude BV
3. Sex partners: evaluated and treated
4. Repeated or prolonged administration
of antibiotic therapy.
5. Ablative or superficial excisional
therapy
Aboubakr Elnashar
Aboubakr Elnashar
Follow-Up
As recommended for each infections
If symptoms persist, women should be
instructed to return for reevaluation.
Aboubakr Elnashar
Management of Sex Partners
1. Examination.
2. Avoid SI {avoid re-infection}
until therapy is completed
(7 days after a single-dose regimen or
after completion of a 7-day regimen).
Aboubakr Elnashar
Thank You
Prof. Aboubakr Elnashar
Email: elnashar53@hotmail.comAboubakr Elnashar

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Cervicitis

  • 1. Cervicitis Prof. Aboubakr Elnashar Benha University Hospital, Egyptnashar
  • 2. Etiology 1.C. trachomatis (CT) 2.N. gonorrhoeae (NG) 3.Trichomoniasis (TV) and Bacterial vaginosis (BV) 4. M. genitalium and HSV-2. 5. Majority of cases: no organism is isolated. Frequent douching Persistent abnormality of vaginal flora Chemical irritants idiopathic inflammation of ectopy Aboubakr Elnashar
  • 4. Erosive cervicitis due to HSV infection Aboubakr Elnashar
  • 5. Symptoms Frequently is asymptomatic Abnormal vaginal discharge Intermenstrual vaginal bleeding Contact bleeding (after SI). Aboubakr Elnashar
  • 6. Signs 2 major 1) Mucopurulent discharge in endocervical canal or on an endocervical swab 2) Endocervical bleeding by passage of a cotton swab. Aboubakr Elnashar
  • 7. Mucopurulent cervicitis due to chlamydia: ectopy, edema, and discharge Chlamydial cervicitis: mucopurulent cervical discharge, erythema, and inflammation. Chlamydial cervicitis: ectopy, discharge, bleeding. Aboubakr Elnashar
  • 8. Mucopurulent discharge from cervix on a swab (positive swab test) Aboubakr Elnashar
  • 9. Diagnosis 1.Assessment for signs of PID: {cervicitis might be a sign of endometritis} 2.Direct microscopy: >10 WBC in vaginal fluid (in the absence of T.V.): sensitive indicator of cervical inflammation caused by C.T. or N.G., with a high negative predictive value. 3. Gram stain: increased number of WBC not available in the majority of clinics. low PPV for infection with C.T and N.G insensitive {observed in only 50%}. Aboubakr Elnashar
  • 10. 3. Test for C.T and for N.G: NAAT (nucleic acid amplification tests). on either cervical or urine samples {the most sensitive and specific test} 4. Test for BV and TV. Aboubakr Elnashar
  • 11. TV:  Microscopy {sensitivity is low (50%)}  Culture or antigen-based detection: if microscopy is negative Purulent Vaginal Discharge in TV Aboubakr Elnashar
  • 12. Strawberry" cervix due to T. V Aboubakr Elnashar
  • 13. Saline wet mount: 2 TV (arrows), leukocytes and a normal vaginal epithelial cell McGraw-Hill Pap smear: 70% sensitive in showing TV. Aboubakr Elnashar
  • 14. BV: 3 of the following S or S: 1. Homogeneous, thin, white discharge that smoothly coats the vaginal walls 2. Clue cells on microscopic examination 3. pH of vaginal fluid >4.5 4. Fishy odor of vaginal discharge before or after addition of 10% KOH (Whiff test). Aboubakr Elnashar
  • 15. 5.Testing for HSV-2 (culture or serologic testing): value is unclear. 6.Tests for M. genitalium: not commercially available. Aboubakr Elnashar
  • 16. Treatment 1. C. T: a. increased risk for STD (age <25 years, new or multiple sex partners, and unprotected sex) b. follow-up cannot be ensured c. insensitive diagnostic test (not a NAAT) is used. 2. Concurrent therapy for N.G: if the prevalence is high (>5%). 3. T.V. or BV: if detected. Aboubakr Elnashar
  • 17. Recommended Regimens for Presumptive Treatment* Azithromycin (Zithromax) 1 g orally in a single dose OR Doxycycline 100 mg orally twice a day for 7 days •Azithromycin (Zithromax) is safe and effective during pregnancy Aboubakr Elnashar
  • 18. Recommended Regimens of Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum Ceftriaxone 125 mg IM in a single dose OR Cefixime 400 mg orally in a single dose OR Ciprofloxacin 500 mg orally in a single dose* OR Ofloxacin 400 mg orally in a single dose* OR Levofloxacin 250 mg orally in a single dose* PLUS TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL INFECTION IS NOT RULED OUTAboubakr Elnashar
  • 19. BV: Recommended Regimens Metronidazole 500 mg orally twice a day for 7 d OR Metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days OR Clindamycin cream, 2%, one full applicator (5 g) intravaginally at bedtime for 7 days Alternative Regimens Clindamycin 300 mg orally twice a day for 7 days OR Clindamycin ovules 100 g intravaginally once at bedtime for 3 days Routine tt of sex partners is not recommended. Aboubakr Elnashar
  • 20. TV: Recommended Regimens Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose Alternative Regimen Metronidazole 500 mg orally twice a day for 7 days Sex partners: should be treated. Aboubakr Elnashar
  • 21. Recurrent and Persistent Cervicitis 1. Exclude relapse and/or reinfection with a specific STD 2. Exclude BV 3. Sex partners: evaluated and treated 4. Repeated or prolonged administration of antibiotic therapy. 5. Ablative or superficial excisional therapy Aboubakr Elnashar
  • 23. Follow-Up As recommended for each infections If symptoms persist, women should be instructed to return for reevaluation. Aboubakr Elnashar
  • 24. Management of Sex Partners 1. Examination. 2. Avoid SI {avoid re-infection} until therapy is completed (7 days after a single-dose regimen or after completion of a 7-day regimen). Aboubakr Elnashar
  • 25. Thank You Prof. Aboubakr Elnashar Email: elnashar53@hotmail.comAboubakr Elnashar