Etiology
Cervicitis may be infectious or noninfectious (nonspecific).
If an organism is isolated by culture, it is most often Neisseria gonorrhoeae or Chlamydia trachomatis. These must be isolated from the cervix or urine. Vaginal swabs may reveal Trichomonas vaginalis, herpes simplex virus (HSV) type 2, Mycoplasma genitalium, Gardnerella vaginalis, or one of various streptococcal species. Organisms typically identified in cases of infectious cervicitis predispose to ascending genitourinary infections. Organisms such as T vaginalis and HSV type 2, which characteristically affect the squamous epithelium of the vagina, may also be associated with cervicitis, but do not result in ascending infections as sole organisms. Mycoplasma genitalium is an emerging cause of sexually transmitted infections in men and women worldwide, and there is a significant association between M genitalium and cervicitis.[6][7][8]
Noninfectious causes include vaginal bacterial overgrowth, local trauma, malignancy, radiation, chemical irritation, vaginal douches, systemic inflammatory diseases, or idiopathic inflammation.[9]
Pathophysiology
Cervicitis is inflammation of the columnar epithelial cells of the endocervix with possible extension to the ectocervix (particularly with a genital herpes infection or Trichomonas infection). Infiltration of endocervical tissue with large numbers of polymorphonuclear leukocytes with possible focal epithelial necrosis may be seen. Lymphoid germinal centers in the cervical stroma can be seen with chlamydial infection.[2] Intracellular inclusion-forming units in patients with C trachomatis infections may correlate with transmissibility and pelvic inflammatory disease.[10]
Reactive changes, such as epithelial disorganization and nuclear atypia, or hyperkeratosis can also be seen.[2] These changes can occur from a variety of causes, including human papillomavirus.
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