Mucopurulent Cervicitis

Mucopurulent cervicitis is cervical inflammation with yellow or green mucopus visible in the endocervical canal or on a white swab, with a friable cervix.

• Chlamydia trachomatis and Neisseria gonorrhoeae cause most cases; in many women no cause is found.
• It is a marker of upper genital tract infection risk.
• Treatment is given on the clinical finding when testing is not possible.

Yellow or green vaginal discharge, intermenstrual or post-coital bleeding, dyspareunia and dysuria.

• Cervix red, oedematous, easily bleeding, with mucopus on the endocervical swab.
• Differential diagnosis: bacterial vaginosis, trichomoniasis, cervical ectropion, herpes cervicitis, pelvic inflammatory disease, cervical cancer, retained foreign body.
• Complications: pelvic inflammatory disease, tubal infertility, ectopic pregnancy, preterm birth and neonatal conjunctivitis or pneumonia.

Diagnosis is by speculum examination with the white swab test and testing for chlamydia and gonorrhoea.

• Speculum examination and white swab test of the endocervical canal.
• NAAT for chlamydia and gonorrhoea; Gram stain with more than 10 white blood cells per high-power field.
• Wet mount and vaginal pH.
• HIV, syphilis and hepatitis B tests; pregnancy test.
• Cervical screening if due.

Treat on the clinical finding when testing is not possible, covering chlamydia and gonorrhoea, and treat partners.

• Supportive: abstain from intercourse for 7 days after both partners complete treatment; partner notification and treatment; condoms.
• Pharmacological: ceftriaxone 500 mg IM single dose plus doxycycline 100 mg oral 12-hourly for 7 days (or azithromycin 1 g oral single dose), plus metronidazole 400 mg oral 12-hourly for 7 days. Paracetamol 1 g oral 6-hourly (maximum 4 g in 24 hours) for pain.
• Procedures: none.
• Special groups: in pregnancy give ceftriaxone 500 mg IM single dose and azithromycin 1 g oral single dose, with retesting 4 weeks later; avoid doxycycline. In ceftriaxone allergy give gentamicin 240 mg IM single dose plus azithromycin 2 g oral single dose.
• Red flags: lower abdominal pain, fever, cervical motion tenderness, adnexal tenderness, arthritis or skin pustules.
• Follow-up: review at 1 week if symptoms persist; retest at 3 months.