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Cervicitis
Background: Cervicitis is an inflammation of the uterine cervix. Infectious cervicitis might be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus (HSV), or human papillomavirus (HPV). Noninfectious cervicitis might be caused by local trauma, radiation, or malignancy. The infectious etiologies are significantly more common than the noninfectious causes, and all possible infectious causes of cervicitis are sexually transmitted diseases (STDs). This article focuses on the infectious etiologies of cervicitis.
Pathophysiology: Because the female genital tract is contiguous from the vulva to the fallopian tubes, there is some overlap between vulvovaginitis and cervicitis. Vulvovaginitis and cervicitis are commonly categorized as lower genital tract infections. Infections involving the endometrium and fallopian tubes are commonly categorized as upper genital tract infections and are not discussed in this article.
Internationally: Worldwide, more than 400 million adults become infected with an STD every year. Four STDs that are spread primarily through sexual contact are completely curable—trichomoniasis, chlamydia, syphilis, and gonorrhea. These infections account for 333 million STD infections, or about 80% of the worldwide total. Approximately 9% of all persons aged 15-44 years in North America contract 1 of these STDs annually, but the rate rises to 25% in sub-Saharan Africa.
Worldwide, over 170 million cases of trichomoniasis are reported each year. Infection rates have been reported as high as 67% in Mongolia in 1988, 40-60% in Africa, and 40% in indigenous Australians older than age 40.
Chlamydia is the next most common STD with approximately 92 million cases a year. Prevalence of chlamydia varies enormously across the world. In the 1990s, rates amongst pregnant women in Europe ranged from 2.7% in Italy to 8.0% in Iceland, while studies in South America found rates of 1.9% amongst teenagers in Chile and 2.1% amongst pregnant women in Brazil. In Asia, rates among pregnant women tend to be much higher: up to 17% in India and 26% in rural Papua New Guinea. In Africa, studies amongst pregnant women have revealed rates from 6% in Tanzania to 13% in Cape Verde.
HPV, HSV, and gonorrhea each account for roughly 20-60 million cases of STDs per year.
The prevalence of HPV, a cause of cervical cancer, varies roughly 20-fold internationally. Among the countries evaluated, Spain had the lowest prevalence of HPV; only 1.4% of women in Spain tested positive for HPV. The highest prevalence of HPV was seen in sub-Saharan Africa; 26% of the women in Nigeria tested positive for HPV. South America tended to have rates that were in between those of Europe and sub-Saharan Africa, while rates in Asia varied widely (with the lowest rates in Hanoi, Vietnam, and the highest in India and Korea).
In a variety of studies, the seroprevalence of HSV-2 is higher in the United States (13-40%) than in Europe (7-16%), and the highest is in Africa (30-40%).
Mortality/Morbidity: Complications from untreated infectious cervicitis depend on the pathogen. Morbidity includes pelvic inflammatory disease (PID), infertility, ectopic pregnancy, spontaneous abortion, cervical cancer, premature rupture of membranes, and preterm delivery. Perinatal and neonatal infections can cause mental retardation, blindness, low birth weight, stillbirth, meningitis, and death. The social stigma is strong and might expose women to verbal, emotional, or physical abuse from others, particularly male partners.
Race: No racial predilection exists. Known risk factors include urban residence and low socioeconomic status.
Sex: Male urethritis is more often symptomatic; therefore, diagnosis is usually made earlier in males than in females. Females with cervicitis are most often asymptomatic, so they do not seek evaluation or treatment as readily. Age: Individuals younger than age 25 and single marital status are both risk factors for cervicitis. Both biological (eg, postulated immaturity of the female reproductive tract) and behavioral factors (eg, greater number of partners, low awareness of acquired immunodeficiency syndrome (AIDS) and other STDs, and limited use of protection against STDs) are thought to contribute to this risk. Routine screening of sexually active adolescents and young adults is therefore recommended.
Background: Cervicitis is an inflammation of the uterine cervix. Infectious cervicitis might be caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus (HSV), or human papillomavirus (HPV). Noninfectious cervicitis might be caused by local trauma, radiation, or malignancy. The infectious etiologies are significantly more common than the noninfectious causes, and all possible infectious causes of cervicitis are sexually transmitted diseases (STDs). This article focuses on the infectious etiologies of cervicitis.
Pathophysiology: Because the female genital tract is contiguous from the vulva to the fallopian tubes, there is some overlap between vulvovaginitis and cervicitis. Vulvovaginitis and cervicitis are commonly categorized as lower genital tract infections. Infections involving the endometrium and fallopian tubes are commonly categorized as upper genital tract infections and are not discussed in this article.
Internationally: Worldwide, more than 400 million adults become infected with an STD every year. Four STDs that are spread primarily through sexual contact are completely curable—trichomoniasis, chlamydia, syphilis, and gonorrhea. These infections account for 333 million STD infections, or about 80% of the worldwide total. Approximately 9% of all persons aged 15-44 years in North America contract 1 of these STDs annually, but the rate rises to 25% in sub-Saharan Africa.
Worldwide, over 170 million cases of trichomoniasis are reported each year. Infection rates have been reported as high as 67% in Mongolia in 1988, 40-60% in Africa, and 40% in indigenous Australians older than age 40.
Chlamydia is the next most common STD with approximately 92 million cases a year. Prevalence of chlamydia varies enormously across the world. In the 1990s, rates amongst pregnant women in Europe ranged from 2.7% in Italy to 8.0% in Iceland, while studies in South America found rates of 1.9% amongst teenagers in Chile and 2.1% amongst pregnant women in Brazil. In Asia, rates among pregnant women tend to be much higher: up to 17% in India and 26% in rural Papua New Guinea. In Africa, studies amongst pregnant women have revealed rates from 6% in Tanzania to 13% in Cape Verde.
HPV, HSV, and gonorrhea each account for roughly 20-60 million cases of STDs per year.
The prevalence of HPV, a cause of cervical cancer, varies roughly 20-fold internationally. Among the countries evaluated, Spain had the lowest prevalence of HPV; only 1.4% of women in Spain tested positive for HPV. The highest prevalence of HPV was seen in sub-Saharan Africa; 26% of the women in Nigeria tested positive for HPV. South America tended to have rates that were in between those of Europe and sub-Saharan Africa, while rates in Asia varied widely (with the lowest rates in Hanoi, Vietnam, and the highest in India and Korea).
In a variety of studies, the seroprevalence of HSV-2 is higher in the United States (13-40%) than in Europe (7-16%), and the highest is in Africa (30-40%).
Mortality/Morbidity: Complications from untreated infectious cervicitis depend on the pathogen. Morbidity includes pelvic inflammatory disease (PID), infertility, ectopic pregnancy, spontaneous abortion, cervical cancer, premature rupture of membranes, and preterm delivery. Perinatal and neonatal infections can cause mental retardation, blindness, low birth weight, stillbirth, meningitis, and death. The social stigma is strong and might expose women to verbal, emotional, or physical abuse from others, particularly male partners.
Race: No racial predilection exists. Known risk factors include urban residence and low socioeconomic status.
Sex: Male urethritis is more often symptomatic; therefore, diagnosis is usually made earlier in males than in females. Females with cervicitis are most often asymptomatic, so they do not seek evaluation or treatment as readily. Age: Individuals younger than age 25 and single marital status are both risk factors for cervicitis. Both biological (eg, postulated immaturity of the female reproductive tract) and behavioral factors (eg, greater number of partners, low awareness of acquired immunodeficiency syndrome (AIDS) and other STDs, and limited use of protection against STDs) are thought to contribute to this risk. Routine screening of sexually active adolescents and young adults is therefore recommended.
