What are the causes of cervicitis?

Cervix is a narrow passage that connects the vagina to the lower end of the uterus. Cervicitis is a disease that causes inflammation and irritation of the cervix. Most often, cervicitis is a sexually transmitted disease, that is, you get it from your partner who is already infected with cervicitis causing organisms. According to the World Health Organization, more than 1 million sexually transmitted infections are acquired every day worldwide, and there are about 357 million new infections with either chlamydia, gonorrhoea, syphilis, or trichomoniasis. [1] Symptoms of cervicitis include pus like discharge, vaginal bleeding or spotting between periods, or spotting after intercourse or after menopause, and painful intercourse. Other symptoms include frequent and painful urination, irritation of the genitalia, and sometimes, lower back pain. Although the most common cause of cervicitis is infection with the bacteria Chlamydia trachomatic and Neisseria gonorrhoeae, virus such as herpes simplex virus (HSV) that cause genital herpes and human papillomavirus (HPV), as well as a protozoan Trichomonas vaginalis can also cause the inflammation of cervix. Here’s a 101 on some of them. Chlamydia:

• Chlamydia trachomatis is a bacterium that causes the infection through sexual contact.
• The infection mainly occurs in women aged 25 years or less.
• Many people who have chlamydia do not develop any symptoms, but they can still infect their sex partners.
• It can also spread from mother to baby by pregnancy or when breastfeeding.
• Although infants infected with chlamydia may not show obvious symptoms, it may cause perinatal death. However, early diagnosis and appropriate treatment may reduce perinatal complications.[2]
• Sometimes, the bacteria can transfer to the eye causing acute conjunctivitis.
• Reactive arthritis is a rare complication of chlamydial infection.
• The infection resolves within days to few weeks.
• The infection is treatable with antibiotics.

Neisseria gonorrhoeae: This bacterium causes the infection called gonorrhoea, and generally, occurs along with chlamydia in young women aged 25 years or less. So much so, researchers have found that young age remains the most powerful predictor of chlamydia and N. gonorrhoeae in women with cervicitis. [3] The infection is treatable with medication. Untreated gonorrhoea can cause pelvic inflammatory disease (PID) which can lead to complications such as blocked fallopian tubes, ectopic pregnancy, infertility, and long term abdominal and pelvic pain. Mycoplasma genitalium: It is the smallest known bacterium species responsible for sexually transmitted infection (STI). It  is a long known cause of male urethritis, and now researchers have found that it causes cervicitis and pelvic inflammatory disease in women. [4] Risk factors include - Younger women aged 21 - 23 years, and younger age during first intercourse

• Higher number of partners; chances of M. genitalium increases by 10 percent for every additional sexual partner [5]
• Having a partner with M. genitalium infection
• Co-infection with other sexually transmitted pathogens like Chlamydia

Herpes simplex virus (HSV) or genital herpes:

• There are two types of genital herpes virus - herpes simplex virus 1 and herpes simplex virus 2.
• Herpes virus is risky in a woman of reproductive age because the baby can be infected from exposure to HSV in the genital tract during delivery.
• Typical symptom of HSV is the appearance of blisters and ulceration of the cervix. Blisters can break and cause painful sores. Healing can take weeks. However, in many women these symptoms do not occur, but they have copious creamy white discharge, which is more common in the above mentioned bacterial infections. [6]
• Other symptoms include headache, swollen lymph nodes, and painful urination.
• The virus is transmitted by having intercourse with someone who has the disease. Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. The virus can also be released through skin and spread the infection to the sex partner. This is called viral shedding.
• -There is no cure for herpes cervicitis. However, medicines taken daily can prevent or reduce the outbreak.
• The only to prevent HSV infection is to avoid sex. Being in a long term monogamous relationship who has been tested negative for HSV, and using latex condoms the right way can lower chances of HSV infection.
• Herpes infection during pregnancy can cause a miscarriage or premature delivery. The virus can pass on to the baby as well.

Human papillovirus (HPV): Also called genital warts, HPV infection is characterized by flesh coloured or grey growth in the genital area and anus in women.

• HPV infection is a very common sexually transmitted disease that can occur at any age but is more prevalent in young people of 17-33 years of age.
• It is one of the most contagious infections. Even a single sexual contact with a person with genital warts can cause the infection.
• In some cases, HPV cervicitis can lead to cervical cancer. HPV-6 and HPV-11 are low risk infections for cancer, but HPV-16 and higher are high risk for cervical cancer. Read more about How you can prevent cervical cancer

Trichomonas vaginalis:

• Trichomoniasis is a sexually transmitted disease caused by a single-celled parasite (protozoan) called Trichomonas vaginalis.
• Symptoms include frothy yellow-green or gray vaginal discharge, itching of genitals, painful urination, discomfort during intercourse, and a foul smell from the vagina.
• Symptoms may appear 5-28 days after exposure to the protozoan, according to the Centers for Disease Control and Prevention.
• Trichomonas infection can increase the risk of developing or passing on other sexually transmitted infections such as HIV.
• Pregnant women with T. vaginalis infection are more likely to have pre-term delivery and low birth weight babies.
• The infection is treated with medication, but all sex partners need to undergo treatment. Normally, the infection returns within 3 months of treatment and requires further treatment.

Cervicitis is not always caused by sexual transmission. Sometimes, other factors may contribute to the development of inflammation or irritation in cervix. These include -

• Allergic reactions to

a.latex condoms b.contraceptive spermicides c.chemicals that come into contact with the vagina

• Trauma to the cervix
• Intrauterine device
• Bacterial vaginosis, where there is overgrowth of harmful bacteria in the vagina
• Unknown factors; researchers have established that most infections are not caused by Neisseria gonorrhoeae and Chlamydia trachomatis as thought earlier, rather, for most cases of cervicitis the cause is not known. [7]

Cervicitis is a treatable condition that resolves in a week or so after starting medication. The only exception is genital herpes which cannot be cured but it can certainly be treated. Cervicitis does not lead to cancer. However, specific HPV infections may lead to cervical cancer in some cases. See an Ob/Gyn if you have new vaginal discharge or discharge that has changed colour, or you have recurrent pain during intercourse, or you have vaginal bleeding in between your period or after menopause. Reference

1. World Health Organization. Sexually transmitted infections. http://www.who.int/mediacentre/factsheets/fs110/en/

2. Numazaki K, Asanuma H, Niida Y. Chlamydia trachomatis infection in early neonatal period. BMC Infectious Diseases. 2003;3:2. doi:10.1186/1471-2334-3-2.

3. Marrazzo J, Martin D. Management of Women with Cervicitis. Clinical Infectious Diseases. 2007;44(Supplement 3):S102-S110. doi:10.1086/511423.

4. Sethi S, Singh G, Samanta P, Sharma M. Mycoplasma genitalium: An emerging sexually transmitted pathogen. The Indian Journal of Medical Research. 2012;136(6):942-955.

5. Manhart LE, Holmes KK, Hughes JP, Houston LS, Totten PA. Mycoplasma genitalium among young adults in the United States: an emerging sexually transmitted infection. Am J Public Health. 2007;97:1118–25.

6. Fowotade A, Okolo AC, Manga MM, Anaedobe CG, Salami AA, Akang EEU. Apparent Rarity of Asymptomatic Herpes Cervicitis in a Woman with Intra-Uterine Contraceptive Device. Journal of Public Health in Africa. 2013;4(2):e14. doi:10.4081/jphia.2013.e14.
7. Taylor S. Cervicitis of Unknown Etiology. Current Infectious Disease Reports. 2014;16(7). doi:10.1007/s11908-014-0409-x.

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