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Last reviewed: 16 Mar 2025
Last updated: 21 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • risk factors for sexually transmitted infection (STI)
  • purulent vaginal or cervical discharge
  • intermenstrual/postcoital bleeding
  • dysuria and urinary frequency
  • easily induced cervical bleeding

Other diagnostic factors

  • dyspareunia
  • vulval and/or vaginal inflammation
  • strawberry cervix

Risk factors

  • age 15 to 24 years
  • inconsistent condom use
  • multiple sexual relationships
  • previous STIs
  • bacterial vaginosis (BV)
  • sex worker
  • absence of hydrogen peroxide-producing lactobacilli
  • infertility
  • education <12 years

Diagnostic tests

1st tests to order

  • pregnancy test
  • wet mount examination of cervical discharge
  • nucleic acid amplification testing (NAAT)
  • rapid tests (OSOM Trichomonas, AFFIRM VPIII)
  • Thayer-Martin agar cervical culture
  • Gram stain of cervical discharge

Tests to consider

  • cervical cytology
  • herpes simplex virus (HSV) serology
  • HIV serology
  • hepatitis B and C serologies
  • rapid plasma reagin testing

Treatment algorithm

Contributors

Authors

M. Jonathon Solnik, MD, FACOG, FACS
M. Jonathon Solnik

Associate Professor of Obstetrics & Gynaecology

Head of Gynaecology & Minimally Invasive Surgery

University of Toronto Faculty of Medicine

Mount Sinai Hospital

Toronto

Canada

Disclosures

MJS serves as a consultant for Medtronic, Olympus, and Hologic, and on the advisory board for Abbvie. He holds stocks in Felix and Field Trip Inc.

Acknowledgements

Dr M. Jonathon Solnik would like to gratefully acknowledge Dr Sharon Jakus, a previous contributor to this topic.

Disclosures

SJ declares that she has no competing interests.

Peer reviewers

Sandra R. Valaitis, MD

Associate Professor and Chief

Gynecology and Reconstructive Pelvic Surgery

University of Chicago

Chicago

IL

Disclosures

SRV declares that she has no competing interests.

Justin C. Chura, MD

Associate Division Director

Gynecologic Oncology

Crozer Chester Medical Center

Upland

PA

Disclosures

JCC declares that he has no competing interests.

Eva Jungmann, FRCP, MSc

Consultant Physician

GUM/HIV Camden Primary Care Trust

Archway Sexual Health Clinic

London

UK

Disclosures

EJ declares that she has no competing interests.

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