Cervicitis medicines
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Cervicitis - Medicines & Treatment
Cervicitis is inflammation of the cervix, most commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Mycoplasma genitalium accounts for 10-30% of cases. In ~50% of cases no pathogen is identified. Treatment targets these organisms and all sexual partners must be treated simultaneously.
1. Gonococcal Cervicitis (N. gonorrhoeae)
First-line:
| Drug | Dose | Route |
|---|---|---|
| Ceftriaxone | 500 mg (US) or 1 g (Europe) single dose | IM |
| + Doxycycline | 100 mg twice daily x 7 days | Oral |
- Dual therapy is standard because co-infection with chlamydia is common.
- Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) are no longer recommended routinely due to widespread resistance in N. gonorrhoeae.
- Cefixime (800 mg oral single dose) is an alternative if ceftriaxone is unavailable, but it is no longer a preferred first-line option.
If cephalosporin-allergic or resistant organism:
- Gentamicin 240 mg IM single dose + Azithromycin 2 g oral single dose
2. Chlamydial Cervicitis (C. trachomatis)
First-line:
| Drug | Dose | Notes |
|---|---|---|
| Doxycycline | 100 mg orally twice daily x 7 days | Preferred |
| Azithromycin | 1 g orally as a single dose | Alternative; useful when adherence is a concern |
- Single-dose azithromycin 1 g is no longer the preferred chlamydia treatment (as of updated CDC guidelines) but remains a valid alternative, especially where adherence is uncertain.
3. Empiric Therapy (When Pathogen Unknown / Patient Unlikely to Return)
When awaiting NAAT results or if follow-up is uncertain, treat empirically for both gonorrhea and chlamydia:
- Ceftriaxone 500 mg IM (single dose) + Doxycycline 100 mg orally twice daily x 7 days
4. Mycoplasma genitalium
- Emerging pathogen in cervicitis; consider if persistent cervicitis after standard therapy.
- Treated with azithromycin (extended regimen) or moxifloxacin (if macrolide-resistant).
5. Concurrent BV (Bacterial Vaginosis)
- Cervicitis is commonly associated with BV; untreated BV leads to symptom persistence.
- Add metronidazole (oral or vaginal) or clindamycin to the regimen if BV is diagnosed.
6. Special Populations
Pregnancy
- Tetracyclines (doxycycline) are contraindicated in pregnancy.
- Use Azithromycin 1 g oral single dose for chlamydial cervicitis in pregnant women - safe in pregnancy.
- Ceftriaxone remains safe for gonococcal treatment in pregnancy; test of cure by repeat NAAT at 3-4 weeks post-treatment is recommended.
Summary Table
| Cause | First-line Drug(s) | Alternative |
|---|---|---|
| N. gonorrhoeae | Ceftriaxone 500 mg IM (single) + Doxycycline 100 mg BD x 7d | Cefixime 800 mg oral (if CTX unavailable); Gentamicin 240 mg IM + Azithromycin 2 g if allergic |
| C. trachomatis | Doxycycline 100 mg BD x 7 days | Azithromycin 1 g oral single dose |
| Empiric (both) | Ceftriaxone 500 mg IM + Doxycycline 100 mg BD x 7d | - |
| Pregnancy | Ceftriaxone + Azithromycin 1 g oral | - |
| BV co-infection | Add Metronidazole 500 mg BD x 7d | Clindamycin |
Key clinical points:
- Always test for HIV and syphilis when diagnosing cervicitis.
- NAAT is the preferred diagnostic test for gonorrhea and chlamydia.
- Treat ALL sexual partners within the past 60 days.
- Screen all treated patients again at 3 months to exclude re-infection.
- Persistent cervicitis after treatment warrants investigation for abnormal vaginal flora, M. genitalium, frequent douching, or idiopathic inflammation.
Sources: Berek & Novak's Gynecology; Goldman-Cecil Medicine; Katzung's Basic and Clinical Pharmacology, 16th Ed; Smith & Tanagho's General Urology, 19th Ed; Rosen's Emergency Medicine
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