- Published on
nfectious Disease - CERVICITIS
FUNDAMENTAL DESCRIPTION
Sexually transmitted infection characterized by inflammation of the endocervix and/or ectocervix.
Epidemiology
Prevalence • Common among sexually active adolescent females under 20 years of age • Also observed in young adults aged 20 to 24 years
• A prospective cohort study in the United States with 14,322 young adults aged 18 to 26 years:
The overall prevalence of chlamydial infection was 4.2%.
Women (4.7%) exhibited a higher infection rate than men (3.7%). The incidence was greatest among Black women.
– The overall prevalence of gonorrhea was 0.4%.
The prevalence of coinfection with chlamydial and gonococcal infections was 0.03%.
RISK FACTORS • Recent sexual partner during the last 3 months • Multiple sexual partners within the past 6 months • Sexual partner with several other partners • Irregular use of barrier contraception
GENERAL PREVENTION • Implementation of safe sexual practices • Assessment and treatment of sexual partners
• In instances where medical evaluation, counseling, and partner treatment are unfeasible, patient-delivered therapy serves as an alternative.
• Initiate presumptive treatment when the prevalence of Chlamydia trachomatis or Neisseria gonorrhoeae is elevated, or when adherence to follow-up appointments is considered improbable.
Annual chlamydial screening is advised for all sexually active women aged 25 years or younger, as well as for older women with risk factors, such as having a new or many sex partners.
ETIOLOGY
• Chlamydia trachomatis • Neisseria gonorrhoeae • Mycoplasma hominis, Ureaplasma urealyticum
• Mycoplasma genitalium • Herpes simplex virus • In most instances, no organism is identified • Vaginal infections caused by Trichomonas vaginalis or Candida albicans may extend to the ectocervix • Cytomegalovirus is seldom a causative agent
DIAGNOSTIC HISTORY
• Often asymptomatic • Abnormal vaginal discharge or bleeding, especially post-coitus • Dysuria or increased urinary frequency • Dyspareunia
PHYSICAL EXAMINATION • Presence of yellow exudate in the endocervical canal or on an endocervical swab specimen • Cervical friability observed
DIAGNOSTIC EXAMINATIONS AND ANALYSIS
Laboratory Preliminary laboratory examinations • cultivation of cervical discharge, encompassing cultivation for N. gonorrhoeae utilizing modified Thayer–Martin media.
• Gram staining
Cytological analysis of endocervical mucus specimens:
– The identification of gram-negative, intracellular diplococci in endocervical mucus is strongly indicative of gonococcal infection. It exhibits just 50% sensitivity in mucopurulent cervicitis, but it demonstrates 95% sensitivity in gonococcal urethritis. Microscopic analysis of ectocervical fluid specimens utilizing standard wet-mount saline and potassium hydroxide. Leukorrhea (>10 WBC per high power field in microscopic analysis of vaginal fluid) is linked to chlamydial and gonococcal infections of the cervix.
Nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis. This can be conducted on an endocervical sample, vaginal swab specimen, or urine.
• In the presence of cervical ulcers or necrotic lesions, conduct testing for genital herpes using PCR, DFA, virus culture, or type-specific serology.
• Women diagnosed with cervicitis should undergo assessment for bacterial vaginosis, trichomoniasis, and pelvic inflammatory disease.
• Caution: Clean the ectocervix with a swab before to collecting the endocervical mucus samples.
Subsequent Actions & Unique
Considerations • The management of sexual partners should be tailored to the diagnosed or suspected infection.
Patients and their sexual partners must refrain from sexual intercourse until therapy is concluded, specifically 7 days following a single-dose regimen or upon completion of a 7-day regimen, to prevent re-infection.
• In HIV-positive women, the management of cervicitis diminishes viral shedding and the likelihood of HIV transmission.
Pediatric Considerations
In pre-adolescent children, sexual abuse should be regarded as a potential source of chlamydial or gonococcal infection.
THERAPEUTIC PHARMACEUTICAL
Presumptive therapy is warranted when there is a significant incidence of C. trachomatis and N. gonorrhoeae in the local community, coupled with a low probability of patient adherence to follow-up appointments. It is advisable to await test findings prior to commencing treatment if the prevalence of C. trachomatis and N. gonorrhoeae is low and adherence to follow-up visits is probable.
Initial Line
• Chlamydia infection:
– Azithromycin 1 g orally, single dosage, or – Doxycycline 100 mg orally twice day for 7 days
• Gonococcal infection: Administer 250 mg of Ceftriaxone intramuscularly as a single dosage.
• Targeted therapy for alternative etiologies of cervicitis is warranted.
Second Line •
Chlamydial infection: – Ofloxacin 300 mg orally twice day for 7 days Levofloxacin 500 mg orally once daily for seven days
Erythromycin base 500 mg orally four times daily for seven days
• Gonococcal infection: – Administer Cefixime 400 mg orally as a single dosage.
Cefpodoxime 400 mg orally, one administration
The bactericidal level of oral cephalosporins is neither as elevated nor as prolonged as that of ceftriaxone.
– Fluoroquinolones are contraindicated due to rising incidence of gonococcal resistance.
- Spectinomycin 2 g intramuscularly, single administration
Spectinomycin exhibits limited effectiveness in gonococcal pharyngitis.
– It is important to note that Spectinomycin is not currently produced in the United States.
– A solitary 2 g oral administration of azithromycin is efficacious for uncomplicated urogenital gonococcal infection. It is inadvisable due to gastrointestinal intolerance and expense. Moreover, prolonged low concentrations of the medicine may facilitate the development of resistance.
Considerations for Pregnancy:
Primary Line
• Chlamydial infection: – Azithromycin 1 g orally, single dosage ,or – Amoxicillin 500 mg orally three times daily for 7 days
• Theoretically, amoxicillin may lead to a chronic chlamydial infection instead of achieving a microbiological cure. The clinical evidence available are inadequate to substantiate this worry.
• Gonococcal infection: Administer 250 mg of Ceftriaxone intramuscularly as a single dosage. Second Line.
• Chlamydial infection: – Erythromycin base 500 mg orally four times daily for 7 days
Erythromycin base 250 mg orally four times daily for 14 days
Erythromycin ethylsuccinate 800 mg orally four times day for seven days.
Erythromycin ethylsuccinate 400 mg orally four times day for 14 days:
Administer a reduced dosage in cases of gastrointestinal intolerance; fluoroquinolones and tetracyclines are contraindicated.
Erythromycin estolate is contraindicated in pregnancy due to its potential hepatotoxic effects.
• Gonococcal infection: Alternative cephalosporin or spectinomycin
CONTINUING TREATMENT POST-CARE SUGGESTIONS
• A test-of-cure for chlamydial infection is advised solely in the following circumstances:
– If therapy adherence is uncertain – If symptoms continue – If re-infection is suspected – During pregnancy • Follow-up testing should not occur immediately after clinical remission. Non-culture testing for C. trachomatis conducted within three weeks post-successful therapy may yield false-positive results because to the persistent excretion of nonviable organisms.
Patients with simple gonorrhea who have received adequate treatment do not require a test of cure. Patients exhibiting chronic symptoms should undergo culture evaluation for N. gonorrhoeae, and any isolated gonococci must be assessed for antibiotic susceptibility.
• In cases of persistent cervicitis, consider the following: – Re-infection (treat partner) – Bacterial vaginosis • Repeat screening should be contemplated within the initial three to four months post-therapy completion is recommended due to the elevated risk of re-infection, particularly among sexually active teens.
Patient Education: Recommend safe sexual practices.
COMPLICATIONS • Pelvic inflammatory illness • Ectopic pregnancy • Infertility • Chorioamnionitis • Premature rupture of membranes • Puerperal infections
FUNDAMENTAL DESCRIPTION
Sexually transmitted infection characterized by inflammation of the endocervix and/or ectocervix.
Epidemiology
Prevalence • Common among sexually active adolescent females under 20 years of age • Also observed in young adults aged 20 to 24 years
• A prospective cohort study in the United States with 14,322 young adults aged 18 to 26 years:
The overall prevalence of chlamydial infection was 4.2%.
Women (4.7%) exhibited a higher infection rate than men (3.7%). The incidence was greatest among Black women.
– The overall prevalence of gonorrhea was 0.4%.
The prevalence of coinfection with chlamydial and gonococcal infections was 0.03%.
RISK FACTORS • Recent sexual partner during the last 3 months • Multiple sexual partners within the past 6 months • Sexual partner with several other partners • Irregular use of barrier contraception
GENERAL PREVENTION • Implementation of safe sexual practices • Assessment and treatment of sexual partners
• In instances where medical evaluation, counseling, and partner treatment are unfeasible, patient-delivered therapy serves as an alternative.
• Initiate presumptive treatment when the prevalence of Chlamydia trachomatis or Neisseria gonorrhoeae is elevated, or when adherence to follow-up appointments is considered improbable.
Annual chlamydial screening is advised for all sexually active women aged 25 years or younger, as well as for older women with risk factors, such as having a new or many sex partners.
ETIOLOGY
• Chlamydia trachomatis • Neisseria gonorrhoeae • Mycoplasma hominis, Ureaplasma urealyticum
• Mycoplasma genitalium • Herpes simplex virus • In most instances, no organism is identified • Vaginal infections caused by Trichomonas vaginalis or Candida albicans may extend to the ectocervix • Cytomegalovirus is seldom a causative agent
DIAGNOSTIC HISTORY
• Often asymptomatic • Abnormal vaginal discharge or bleeding, especially post-coitus • Dysuria or increased urinary frequency • Dyspareunia
PHYSICAL EXAMINATION • Presence of yellow exudate in the endocervical canal or on an endocervical swab specimen • Cervical friability observed
DIAGNOSTIC EXAMINATIONS AND ANALYSIS
Laboratory Preliminary laboratory examinations • cultivation of cervical discharge, encompassing cultivation for N. gonorrhoeae utilizing modified Thayer–Martin media.
• Gram staining
Cytological analysis of endocervical mucus specimens:
– The identification of gram-negative, intracellular diplococci in endocervical mucus is strongly indicative of gonococcal infection. It exhibits just 50% sensitivity in mucopurulent cervicitis, but it demonstrates 95% sensitivity in gonococcal urethritis. Microscopic analysis of ectocervical fluid specimens utilizing standard wet-mount saline and potassium hydroxide. Leukorrhea (>10 WBC per high power field in microscopic analysis of vaginal fluid) is linked to chlamydial and gonococcal infections of the cervix.
Nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis. This can be conducted on an endocervical sample, vaginal swab specimen, or urine.
• In the presence of cervical ulcers or necrotic lesions, conduct testing for genital herpes using PCR, DFA, virus culture, or type-specific serology.
• Women diagnosed with cervicitis should undergo assessment for bacterial vaginosis, trichomoniasis, and pelvic inflammatory disease.
• Caution: Clean the ectocervix with a swab before to collecting the endocervical mucus samples.
Subsequent Actions & Unique
Considerations • The management of sexual partners should be tailored to the diagnosed or suspected infection.
Patients and their sexual partners must refrain from sexual intercourse until therapy is concluded, specifically 7 days following a single-dose regimen or upon completion of a 7-day regimen, to prevent re-infection.
• In HIV-positive women, the management of cervicitis diminishes viral shedding and the likelihood of HIV transmission.
Pediatric Considerations
In pre-adolescent children, sexual abuse should be regarded as a potential source of chlamydial or gonococcal infection.
THERAPEUTIC PHARMACEUTICAL
Presumptive therapy is warranted when there is a significant incidence of C. trachomatis and N. gonorrhoeae in the local community, coupled with a low probability of patient adherence to follow-up appointments. It is advisable to await test findings prior to commencing treatment if the prevalence of C. trachomatis and N. gonorrhoeae is low and adherence to follow-up visits is probable.
Initial Line
• Chlamydia infection:
– Azithromycin 1 g orally, single dosage, or – Doxycycline 100 mg orally twice day for 7 days
• Gonococcal infection: Administer 250 mg of Ceftriaxone intramuscularly as a single dosage.
• Targeted therapy for alternative etiologies of cervicitis is warranted.
Second Line •
Chlamydial infection: – Ofloxacin 300 mg orally twice day for 7 days Levofloxacin 500 mg orally once daily for seven days
Erythromycin base 500 mg orally four times daily for seven days
• Gonococcal infection: – Administer Cefixime 400 mg orally as a single dosage.
Cefpodoxime 400 mg orally, one administration
The bactericidal level of oral cephalosporins is neither as elevated nor as prolonged as that of ceftriaxone.
– Fluoroquinolones are contraindicated due to rising incidence of gonococcal resistance.
- Spectinomycin 2 g intramuscularly, single administration
Spectinomycin exhibits limited effectiveness in gonococcal pharyngitis.
– It is important to note that Spectinomycin is not currently produced in the United States.
– A solitary 2 g oral administration of azithromycin is efficacious for uncomplicated urogenital gonococcal infection. It is inadvisable due to gastrointestinal intolerance and expense. Moreover, prolonged low concentrations of the medicine may facilitate the development of resistance.
Considerations for Pregnancy:
Primary Line
• Chlamydial infection: – Azithromycin 1 g orally, single dosage ,or – Amoxicillin 500 mg orally three times daily for 7 days
• Theoretically, amoxicillin may lead to a chronic chlamydial infection instead of achieving a microbiological cure. The clinical evidence available are inadequate to substantiate this worry.
• Gonococcal infection: Administer 250 mg of Ceftriaxone intramuscularly as a single dosage. Second Line.
• Chlamydial infection: – Erythromycin base 500 mg orally four times daily for 7 days
Erythromycin base 250 mg orally four times daily for 14 days
Erythromycin ethylsuccinate 800 mg orally four times day for seven days.
Erythromycin ethylsuccinate 400 mg orally four times day for 14 days:
Administer a reduced dosage in cases of gastrointestinal intolerance; fluoroquinolones and tetracyclines are contraindicated.
Erythromycin estolate is contraindicated in pregnancy due to its potential hepatotoxic effects.
• Gonococcal infection: Alternative cephalosporin or spectinomycin
CONTINUING TREATMENT POST-CARE SUGGESTIONS
• A test-of-cure for chlamydial infection is advised solely in the following circumstances:
– If therapy adherence is uncertain – If symptoms continue – If re-infection is suspected – During pregnancy • Follow-up testing should not occur immediately after clinical remission. Non-culture testing for C. trachomatis conducted within three weeks post-successful therapy may yield false-positive results because to the persistent excretion of nonviable organisms.
Patients with simple gonorrhea who have received adequate treatment do not require a test of cure. Patients exhibiting chronic symptoms should undergo culture evaluation for N. gonorrhoeae, and any isolated gonococci must be assessed for antibiotic susceptibility.
• In cases of persistent cervicitis, consider the following: – Re-infection (treat partner) – Bacterial vaginosis • Repeat screening should be contemplated within the initial three to four months post-therapy completion is recommended due to the elevated risk of re-infection, particularly among sexually active teens.
Patient Education: Recommend safe sexual practices.
COMPLICATIONS • Pelvic inflammatory illness • Ectopic pregnancy • Infertility • Chorioamnionitis • Premature rupture of membranes • Puerperal infections
0 Comments
